Lower eyelid blepharoplasty can be performed from both the outside (transcutaneous) or inside (trans conjunctival) of the eyelid.  99.9% of the 3000 cases I have performed as an Ocular Plastic Surgeon in Sterling Hieghts, Michigan have been transconjuctival.  The advantage of my technique is: NO stitches; NO skin incision, and NO Scalpel blade. I perform the procedure with the MIXTO laser. 

This carbon dioxide (CO2) laser allows me to gently remove the fullness ( fat)  from the inside of the eyelid.  The beauty of this laser is that it stops bleeding as it removes this tissue so  the surgery is faster and my patients have less swelling (than traditional methods) and get back to work faster.  Instead of removing skin which can leave a tell tale scar line underneath the lashes, I tighten the skin with the Mixto laser!  The Mixto is phemomenal to resurface (refresh) the skin.  Smoothing of the skin with the laser is a perfect accompaniment to lower eyelid surgery.