How is lower lid blepharoplasty performed?

Depending on the degree of necessary dissection, and patient comfort with local anesthetic only, the procedure may be done under local or regional block with or without sedation, or under general anesthesia or some variation of it. Marks are made with the patient upright; the transcutaneous approach may be taken through a number of incisions, but most commonly just under the lower lash line. The appropriate anesthesia is then administered, and the superficial eyelid tissues infiltrated with local. The dissection is carried to the septum, which is opened, the fat in question removed or repositioned symmetrically, the lid tightened horizontally, a small triangle of outside skin excised, if at all, and the skin closed.