Cosmetic lower eyelid blepharoplasty to remove bulging fat or excess skin is similar in Asian and non-Asian patients as long as several important precautions are observed. Any surgery that may round the contour of the lower lid is undesirable in either group, but such outcomes in patients of Asian descent can seem even more deforming because of the natural Asian almond eye shape and the common slight upward tilt of the lids where they join at their outer corners (lateral canthus).

Fat bags can be thinned by approaching the inside of the lid from either of two routes, via an incision on the skin or via an incision made along the inside surface of the eyelid (conjunctiva). While the skin approach is highly disruptive to normal eyelid anatomy and associated with a higher incidence of lower lid malposition and retraction, surgery from the inside "transconjunctival" route is not only less invasive but leaves behind no visible external scar, an unfair price to pay to relieve only slight lower fullness.

With transconjunctival lower blepharoplasty surgery in younger patients, canthopexy, or reinforcement at the lateral canthus, is of minimal benefit and seldom indicated. Even in older patients in whom some skin removal may be desired, a minimally-invasive pinch blepharoplasty technique is usually sufficient, thus allowing for avoidance of the more aggressive but outdated skin-approach (transcutaneous ) blepharoplasty still used in older Occidental patients.

Because of its thicker dermis, the thin lower eyelid skin is more resistant to wrinkling. When needed, however, skin resurfacing with traditional laser and chemical peels used commonly in non-Asian patients are best avoided in favor of less ablative techniques.

Some young patients object to a small roll that may develop just beneath the lashes upon smiling or squinting, while others will undego special surgery to create it. While this roll of muscle can be thinned surgically, doing so is not a good idea in the long run. If objectionable, a better solution for an "orbicularis roll" as well as for crowsfeet just beyond the eye's outer corners is injection with BOTOX ® Cosmetic.