There are several differences between these two incisions. Through the inside incision, only fat can be removed. Through the outside incision, skin and muscle may also be removed. In many patients, particularly younger patients, removal of fat alone is adequate and can produce a tremendous cosmetic improvement. However, in older patients with a large among of extra skin, it may be desirable to remove a small skin strip from the edge.
Some patients prefer the scar-less incision no matter what the result.
The wrinkles of the lower lid can be treated with skin peeling to enhance the result. It occurs from bleeding behind the eyeball causing pressure on the nerve that carries vision. If it is drained early, usually permanent loss of vision can be avoided. The incisions in the eyelids may interfere with the drainage of the tear glands. If you wear contact lenses, this may be a problem.