Question: I’m interested in eyelid surgery and wondering how you decide whether to make incision on the outside or inside of the eyelid.
Answer: The decision to make an incision on the inside or the outside of the eyelid pertains to lower lid blepharoplasty. In upper eyelid surgery, if there is excess skin, which is generally the case for upper eyelid surgery, then the incision is made to remove excess skin and therefor the incision is done on the outside of the eyelid.
In lower eyelid surgery, the decision to make an incision on the inside versus the outside depends upon a few different factors. The status of the skin, muscle, and to some extent the strength and tone of the lower eyelid will guide our decision to perform an external incision or not. The age of the patient and the status of the fat or bags of the lower eyelids will also be taken into consideration. Generally, in younger patients with very little excess skin, lower eyelid surgery can be performed without the removal of any lower eyelid skin and therefor the incision can be make on the inside of the eyelid. In older individuals, there is generally a combination of too much fat, excess skin and muscle, and laxity of the lower eyelid which will all need to be addressed to properly rejuvenate the lower eyelid and will require an external incision to be made.