Functional blepharoplasty is indicated in childhood when the drooping eyelids or ptosis is congenital and prevents vision work properly. Aesthetic blepharoplasty can also be considered in children and adolescents, especially of Asian origin, with heavy seudoptosic eyelids. However, in general, it is best to wait until a person is old enough to collaborate when applied local anesthesia.

The transconjunctival incision is made in the area inside the lower eyelid and it allows removing fat bags. Unlike classical ccess below the lashline, the scar that occurs does not but scarcely pull the lower lid down and does not cut the orbicularis muscle so that there is less ectropion (drooping eyelid), and it is hidden within the eyelid, and is therefore not visible. There is increased risk of intraoperative bleeding and greater technical difficulty.

It does not allow to dry skin of the lower eyelid, so if there is too much skin it is necessary to perform an external scar under the eyelashes to dry it.

In little expert hands , if excessive skin removal occurs in a loose lower eyelid, a rounded eye can be originated, and the conjunctiva will be visible, and the patient will look sad and fatigued. Besides corneal exposure during sleep, as eyes cannot be properly closed, can cause eye ulcers or conjunctivitis.

By associating in patients who have lax lower eyelid a procedure of canthopexy, that achieves to suspend and tighten the outer part of the eyelids (outer edge), slightly making the eye almond like.

Most people who come to be subjected to upper eyelid surgery also present a brow ptosis (lowered position thereof to a greater or lesser extent) and compensate by contracting the frontalis (forehead) to raise them and have a greater visual field. In these people the brow position falls further after an upper blepharoplasty. Therefore, we must make a careful evaluation of each patient before surgery to decide whether to also perform a procedure that raises their position, as a brow lift or temporal lift.

Often some patients require direct resection of variable amounts of the lower eyelid skin, because they have real skin excess. It is important to limit the resection to avoid the drooping of the lower eyelid or the rounded shape of the eye. This problem will often occur if it is not associated to a procedure of canthopexy in the intervention.

All patients should be warned about the impossibility of completely eliminating wrinkles from the lower eyelid, especially when smiling. Often some kind of surface correction, either laser techniques or chemical peel, may be the preferred treatment for these fine wrinkles.

Only rarely is it necessary to remove more than a few millimeters of skin from the lower eyelid.