Lower Blepharoplasty: The Transcutaneous Approach Is Best for Almost all Patients.

This article presents the transcutaneous lower blepharoplasty X3 technique, a comprehensive approach to lower eyelid rejuvenation that integrates orbital fat transposition, orbicularis retaining ligament release, and three-vector periosteal suspension. By addressing the lower eyelid as part of the lid-cheek continuum, the technique effectively corrects tear trough and tear valley deformities, midface descent, malar mounds, and lower eyelid laxity. Clinical outcomes from a large patient series demonstrate durable aesthetic improvement, high patient satisfaction, and a low rate of complications, supporting the transcutaneous approach as a safe and reliable option for complete anatomic correction.