This procedure is recommended when a patient has excess lower eyelid skin, muscle,wrinkles, fat herniation or all of the above. There are two techniques to this procedure depending on the underlying problem. Most patients suffer from protruding fat pads and some degree of wrinkles. In these patients the preferred method is tran-conjunctival, meaning that the procedure is performed through the conjunctiva. An incision is made through the conjunctiva (the pink portion under the eyelid) and the fat pads are found. A portion of the fat pads are removed, and the edges of the conjunctiva are put back together. There are no sutures; the conjunctiva heals by itself in one week. In some patients where there are wrinkles, a milf chemical peel is performed, where a chemical (TCA) is applied to the lower lids and the top layer of the skin burns and exfoliates. When the skin heals itself, there is more collagen, therefore the skin becomes smoother with fewer wrinkles and fewer brown spots. This procedure is performed under sedation or general anesthesia in a surgery center. The procedure is one hour long. Short term recovery is one week. Patients are usually advised not to be exposed to the sun, so that there is proper healing of the lower lid skin from the chemical peel. Some patients have excess skin, and role of muscle, with or without fat protrusion. In those instances, the method of choice is a transcutaneous technique. An incision is made on the skin right beneath the edge of the lower eyelid and then skin and muscle are pulled away from the underlying fat. The excess fat is removed, if any, and the excess skin and muscle are removed and the skin is sewn up. This procedure is performed under sedation or general anesthesia in a surgery center. There are stitches which are removed after five to seven days. The short term recovery is one week as well. Risks and complications include bleeding and infection which are etremely rare, and increased pigmentation of the peeled skin if exposed to the sun. There is one in a million chance of blindness if there is uncontrollable bleeding.