The lower eyelid may require a wide variety of treatments depending on the pre operative diagnosis. When the problem in the lower lid is primarily the bulging of fat, without excess skin, the lower lid blepharoplasty is conveniently carried out through an incision made inside the lower eyelid, thus eliminating all visible scarring. This procedure, called a transconjunctival blepharoplasty, has gained popularity because it minimizes the risk of pulling on the lower lid, a complication discussed below.
The transconjunctival approach can be combined with a chemical peel or laser resurfacing of the lower eyelid to help remove some of the lines in the lower eyelid skin. If significant laxity exists in the lower eyelid skin and muscle a traditional lower eyelid blepharoplasty by means of excising excess tissue from an incision along the lash line is another option that may be indicated. In certain cases, where the lower eyelid is extremely lax, additional work may be required to tighten the lid to prevent postoperative drooping.