44 year old who complained of heavy lower eyelids. She was constantly asked by friends is she was tired. Note the post operative photo showing full correction of the lower lid bulge. The procedure was done through a transconjunctival approach (from inside the lower eyelid) as opposed to making an incision over the lower eyelid as traditionally done. This approach preserves the lower eyelid orbicularis muscle and does not result in an external scar. External scars in this location have the potential for unfavorable scarring and can possibly distort the corner of the eye resulting in an unnatural appearance. Also, the fat was not removed as traditionally performed, but displaced lower into her cheek to fill this area. This results in a smooth transition from cheek to lower eyelid without lower lid hollowing.