I only make incisions in the lower eyelid skin if there is significant skin excess that can’t be contracted with CO2 laser. The fat pads of the lower eyelids are accessed from invisible incisions behind the eyelids. If I need to remove skin surgically I make my incisions in the inferior tarsal crease not directly under the lash line (subciliary). Subcilliary incisions carry the risk of lower eyelid rounding, ectropion and shape change