Skin laxity among other aspects would need to be examined to answer this question. If there is skin laxity, skin removal will be necessary.
Kenneth Hughes, MD
Los Angeles, CA
Without a consultation and evaluating the laxity of the eyelid and skin, it isn't possible to tell you which approach is best. Generally if the eyelid is not too lax, a transconjunctival approach is preferred. Often I recommend repositioning fat rather than just fat removal since repositioning can create a smoother contour in many patients. Some patients benefit from laser treatment at the time of the surgery rather than skin removal to tighten the skin and minimize the chance of an external scar. An oculoplastic surgeon usually has the most experience in treating this delicate area and providing the most natural appearing result. In many cases, I talk patients out of surgery if volume loss in the face is the issue and treat them with long lasting fillers instead so they don't have a "hollow" look after surgery.
In most patients some repositioning of the herniated fat is beneficial to fill in the tear trough zone. Also a tightening of the orbicularis muscle is beneficial to relieving some of the downward pull of the lower eyelid. It may be that you have some existing laxity of the lower lid and a cantholysis and canthopexy may be beneficial.
No photograph was submitted. If however you need a canthopexy it is very likely you would need a transcutaneous or external incision lower blepharoplasty. If the issue is mostly herniated fat and there is no need for a canthopexy then perhaps a trans-conjunctiva on (internal eyelid incision) laser treatment of the skin laxity would be sufficient.
A lower eyelid blepharoplasty can be performed through a transconj incision or an external incision. If one needs skin removal the external incision will be necessary as well.
Without photographs, it's impossible to give an opinion on what may or may not be needed. In our practice, the primary goal of upper eyelid surgery is to remove occluded skin and a little bit of fat. The primary goal of lower eyelid surgery is to remove the herniated 3 fat compartments in the lower lids and a small amount of skin excess and needed. We perform a conservative fat removal on the lower lids through a trans-conjunctival approach. Any excess skin that is present is removed through a pinched technique and closed with tissue glue. There are no sutures on the lower lids. Most people do not need a canthopexy, unless they have sad or down turned lower eyelids. For many examples and more information, please see the link below
External lower blepharoplasty is what you need.The reason is you probably have excess skin the needs to be remove as well as fat repositioning.
A physical examination is necessary to answer your question. Depending on the patient and surgeon, both techniques are acceptable and the standard of care. Hope this helps
Chloesasha, know when can give you a good opinion without adequate photos or an exam. I can tell you that most of my lower lids are done trans-conjunctival and I prefer a "SOOF lift blepharoplasty". You may want to find someone who is familiar with this procedure. I can also tell you that most patients I see who are in their 60s do not necessarily need there upper lids done rather they need surgery done on their brows. I hope this helps, good luck!
There are several ways to do a lower lid blepharoplasty. If you are going to have a fat repositioning this is usually done through transconjunctival incision. If you need skin taken off, this can be done by excising a pinch of skin under the lashes after the fat has been moved. And if you need tightening, a small incision is made at the outer corner of the eye to do this. Some surgeons still prefer an external approach for the surgery. The results with this can also be very good if done correctly. There is a slightly higher incidence of lower eyelid retraction after opening up the lid with this surgery. You have to find a surgeon that you are comfortable with, and look at some of their before and after pictures to see if you like the result they obtain.