A blepharoplasty is generally considered a cosmetic surgical procedure aimed at improving the appearance of the eyes. An upper blepharoplasty removes the fold of skin above the eyelid as well as fat pads which may be causing a puffy appearance. In addition to correction of upper eyelid hooding, an upper blepharoplasty restores or creates an "eye shadow" space in women and a sharper, more alert appearance in men.A lower blepharoplasty removes loose skin and fat pads which cause dark circles or puffiness underneath the eyelids causing a tired appearance. The goals of blepharoplasty are to improve the appearance of the eyes while maintaining the natural shape of the eyelids.

Different types of lower blepharoplasty.
There are a number of variations in technique for lower blepharoplasty with several different distinctions.

Transconjunctival Blepharoplasty - this technique hides the scar inside the lower eyelid and is designed primarily to remove the fat from the three fat pads underneath the lower eyelid. The main advantages are that the scars are hidden and the risk of changing the shape of the eyelids is reduced but not entirely eliminated. The main disadvantages are that excess skin and muscle underneath the eyelids cannot be tightened.

Transconjunctival Blepharoplasty with Laser - this technique combines the transconjunctival removal of fat with laser resurfacing with CO2, Erbium, or other lasers to tighten the skin under the eyes. The advantage is additional improvement of the lines underneath the eyelids and the crow's feet. The main disadvantages may be prolonged redness, change in the color of the color, or scarring from the laser as well as a change in the shape of the eyelids.

Transconjunctival Blepharoplasty with Chemical Peel - this technique combines transconjunctival blepharoplasty with use of a chemical peel around the eyes, most commonly TCA (trichloroacetic acid). The risks are similar to laser resurfacing.

 Lower Blepharoplasty - this technique hides the scar just under the eyelashes and in a smile line near the corner of the eye. The lower blepharoplasty is designed to remove fat from underneath the eyelids and tighten loose skin and muscle. The main advantage is a more longer lasting result allowing sculpting of the fat which reduces the risk of developing a hollow appearance long after surgery. The main disadvantage is that the shape of the eyelid can be changed ranging from a more round to serious complications such as scleral show and ectropion.

Lower Blepharoplasty with Lateral Canthopexy- similar to standard blepharoplasty with tightening of the corner of the eyelid to avoid changing the shape of the eye.