Eyelid Surgery Techniques

External (Upper Eyelid Crease) Incision

When performing upper eyelid surgery, the most common approach involves making a fine incision along the natural crease of the upper eyelid. This incision placement is carefully planned to follow the eyelid’s existing fold, which helps ensure the scar remains discreet after healing.

Suitability: Patients with significant upper eyelid skin excess that may cause cosmetic concerns or affect peripheral vision. This method is appropriate for both cosmetic and functional upper eyelid surgery.

Benefits of This Technique:

• The scar is usually concealed within the natural crease, making it less visible when the eyes are open.
• Allows comprehensive correction of excess skin, fat, and muscle in one procedure.
• Suitable for both cosmetic improvements and functional cases where excess skin interferes with vision.

Transcutaneous Approach (Lower Eyelid Skin Incision)

The transcutaneous approach involves creating a fine incision just below the lower lash line. This placement allows direct access to the underlying tissues of the lower eyelid for precise adjustment. The incision provides access to the fat pads, which can be repositioned or partially removed to reduce puffiness. It also allows for skin tightening in cases of mild to moderate laxity. When necessary, Dr Murray may address the orbicularis muscle to improve eyelid support and contour.

Suitability: Patients with visible under-eye fat pads combined with loose skin. This method is often chosen when skin tightening is needed in addition to fat adjustment.

Benefits of This Technique:

• Enables comprehensive correction of excess skin and fat.
• Particularly effective for patients with significant skin laxity or wrinkling in the lower eyelid.
• Scar is typically well-concealed along the lash line and usually fades over time.

Transconjunctival Approach (Internal Lower Eyelid Incision)

The transconjunctival approach involves making the incision inside the lower eyelid, along the inner conjunctival surface. This method avoids any external scar while providing access to the lower eyelid fat pads. This technique allows removal or repositioning of fat deposits to reduce visible under-eye fat pads and is typically performed without removing skin.

Suitability: Patients with visible under-eye fat pads but good skin tone, who do not require skin removal. This technique is commonly selected for those concerned primarily with fat rather than skin laxity.

Benefits of This Technique:

• No visible external scar, as the incision is inside the eyelid.
• Minimal disruption to eyelid support structures compared to external techniques.
• Lower risk of postoperative eyelid malposition (e.g., ectropion) when performed appropriately.

Fat Repositioning and Fat Transfer

Fat repositioning involves adjusting the natural fat pads around the lower eyelid to achieve a smoother contour between the eyelid and the cheek. In some cases, fat transfer (using the patient’s own fat harvested from another area) can be performed to increase lost volume and reduce hollowing in the tear trough region. This technique may be performed during lower eyelid surgery to move existing fat into areas of hollowing or to add additional fat where volume loss is noticeable. This helps address both concerns in one procedure without relying on dermal treatments.

Suitability: Patients with tear trough hollowing combined with visible under-eye fat pads or fat prolapse. It is most appropriate for those where restoring volume is required for a balanced eyelid–cheek transition.

Benefits of This Technique:

• Addresses Multiple Concerns in One Procedure: This approach allows treatment of both excess fat and hollowing.
• Volume Restoration: Uses the patient’s own fat to increase volume, which integrates naturally with surrounding tissues.
• Improves Eyelid–Cheek Transition: By redistributing or adding fat where needed, the lower eyelid blends smoothly with the mid-face area.