Lower eyelid blepharoplasty may be perfomed either by going through the skin or by going inside the eyelid (internal or transconjunctival incision). Under most circumstances we prefer to make the incision inside the eyelid. We do that not so much to hide the incision, as a blepharoplasty skin incision if done correcty can be hidden completely, but because we do not believe that excision of skin in most cases is necessary to produce a great result. Also, skin excision in blepharoplasty carries with it a higher risk of eyelid malposition ie. the eyelid is pulled down showing too much of the white part of the eye and changing its shape. When we perform blepharoplasty we believe that the groove under the eyelid at the junction of the cheek is more important that the eyelid fat contouring. A youthful eyelid must be short in length from the lashes to the junction with the cheek. In order to produce a youthful eyelid the groove under the eyelid must be filled in essentially elevating the cheek and shortening the appearance of the eyelid. This filling can be done during blepharoplasty by repositioning the fatty tissue of the eyelid to a lower position to fill in the groove and elevate the cheek or by using an autologous fat transfer. It can also be done non-surgically in the office by using Restylane or other fillers. We often tighten the skin of the lower eyelid with a chemical peel to reduce the skin wrinkles and add to the result of the blepharoplasty.
I hope this has been helpful. Please feel free to review our before and after photos and of course call us with any further questions or to schedule a consultation. We would love to meet you.