Classical lower eyelid blepharoplasty consists in making an incision under the eyelashes, then detaching a little bit of skin and finding and removing the fatty pockets through the orbicularis muscle.
However, this technique holds many disadvantages. The skin adheres greatly to the muscle and it is extremely difficult to detach it, whereas the muscle itself adheres only slightly to the underlying structures. It is really an anatomical detachment that is required.
Cutting the skin and detaching a little bit is not a satisfactory way to treat eyelid wrinkles. Classical blepharoplasty comes with a maximum risk of round eye and of modification of the regard and this is why I never do it.
Why do I prefer sub-palpebral lifting and what are its advantages?
To treat lower eyelid wrinkles, I prefer to use laser resurfacing which treats the quality and not the quantity of skin and, as such, comprises no risk whatsoever that the regard will be modified.
Classical blepharoplasty implies finding pockets of fat through the muscle in a random manner and comprises post-operative risks (e.g. Hollow eye) whereas with submuscular lifting you can discover the pockets of fat directly as they are more visible and, as such, remove them with greater precision.