01/03/2026
Patients commonly ask if I perform lower eyelid blepharoplasty surgery using an internal (transconjunctival) or external (transcutaneous) incision. My reply is both. If a patient younger and has lower eyelid puffiness and good tissue quality/elasticity, an internal incision is often best. However, if the orbicularis oculi muscle has lost its elasticity and bunches up when the patient smiles, it is important to tighten the lower eyelid orbicularis oculi muscle. This approach is performed through an external incision. Not only does it effectively correct the excess loose muscle and skin but it also supports the lower eyelid and avoids a change in lower eyelid shape following surgery. This extremely kind patient of mine who is in her early 70s, underwent previous lower blepharoplasty surgery which did not include a tightening of the lower eyelid orbicularis oculi muscle. Unfortunately, she developed a retraction of the lower eyelid following surgery and lower eyelid ectropion. I shushed allow me to perform lower eyelid revision surgery. I inclined a canthoplasty and lower orbicularis oculi tightening to restore her eyelid shape and function. I I this procedure has reminded me how helpful our profession can be in improving the quality of life of our patients. I t a privilege to have the trust of our patients.