Some patients have prolapses of their lower lid fat pads causing the appearance of ‘eye bags’ and skin laxity but not all such patients require a transcutaneous lower lid blepharoplasty. A transconjunctival lower lid blepharoplasty with fat repositioning can be combined with a very conservative skin excision without the risk of lower lid retraction or rounding of the outer aspect of the eyelids. This patient has undergone such surgery with a fine scar just beneath the eyelashes extending along a laughter line. Such surgery has to be undertaken with great caution however, in patients who have more prominent eyes (such patients have what is referred to as a ‘negative vector’). Skin laxity in the lower eyelids must never be overestimated.
