There is not much practical difference between internal and external lower blepharoplasty approaches; to begin with it must be stated these are not at all kinds of blepharoplasties but ways to access to inner structures of the lower orbit, providing different grades of visualization and technical feasibility of surgical gestures; actually both internal and external open approach allow performing exactly the same maneuvers on the fat bags, however not on the skin and muscle, being surgeons skills, training and manual precision which determines the best suited option.
Internal approach in lower blepharoplasty is made by means of incisions inside lower eyelid, located at the conjunctiva between the eyeball and the tarsal cartilage. Transconjunctival blepharoplasty is best suited for lower eyelid fat bags removal by experienced and skilled surgeons in those cases without major muscle and skin excess or when the patient does not accept external visible scars.