Transconjunctival lower blepharoplasty better than transcutaneous method
I favor transconjunctival lower blepharoplasty and do not recommend transcutaneous approach for many reasons. Latter has chance of ectropion and altering the eye shape in addition to longer healing time. While it is okay to remove skin (through skin pinch), the problem with transcutaneous approach to address the fat/bags is that it can damage the orbicularis oculi muscle, which is responsible for eye closure, blinking, etc. Another point to make is it is best NOT to remove the fat/bags but rather reposition the fat to fill the hollow area around it. If you remove the fat/bags altogether, then that can create hollow sunken eye look. See video and link below for details. See an oculoplastic surgeon.
There are many nuances to blepharoplasty surgery. It is important to find a skilled, experienced surgeon whom you trust. If you are questioning your surgeon's recommendation from the outset, perhaps it would be best to get some additional opinions from highly skilled, well-trained, experienced surgeons. Best of luck.
Lower blepharoplasty procedure
When patients have herniated fat pads in the lower lids, a trans--conjunctival is performed to remove them. This is an incision on the inside of the eyelids. If patients have extra skin at rest, not upon animation, a small pinch of excess skin is removed at the lash line. In our practice, we do not violate the lower lid muscle to prevent ectropion and scleral show.
Lower lid bleph
An incision near the lashes on the outside is called a subcillary incision. An incision on the inside of the lid is transconjunctival. Your surgeon I think is describing a subcillary. This the incision I would probably use since I can then add support to your lid with a lateral canthopexy of some sort. At 48 you are probably getting some laxity to your lid, though I cannot know without an in person exam. Your surgeon is describing just about exactly what I would recommend. However, surgeons approach things differently and you will get varying opinions. Does your surgeon get good results and do you trust him? Get other opinions if you are not comfortable. Good luck.