Puffy eyes are a normal physiological change that people of all ages usually have. However, some people appear prematurely, which makes people appear “old” and affects their appearance. In addition, some serious cases also produce some complications, such as lower eyelid ectropion, lower eyelid edge inversion, causing tearing, eye stinging and other discomfort. Therefore, for those whose eye bags are an obstacle to beauty as well as accompanied by complications, they can be removed through cosmetic surgery. Eye bag removal surgery is also called eye bag debulking. The surgical incision is made 1~2mm along the lower eyelid margin, the skin is cut from the inner canthus to the outer canthus, the orbital septum is opened to allow the natural overflow of the orbital fat, the excess fat is removed, and the appropriate amount of skin is removed depending on the case. Most patients worry about the scarring of the incision after surgery, but this is an unnecessary worry, because the skin at the lid margin is the thinnest and the scar formed is very small. However, the surgery is a kind of surgical trauma after all, and the key to success or failure of the surgery also lies in careful examination and design before surgery to decide how much fat and skin to remove, and repeated measurement during surgery, so as to achieve satisfactory results. The internal approach is also known as the “lower lid conjunctival incision approach” and is mainly used for young people who have a simple orbital fat displacement or excess without skin laxity. Patients with mild skin laxity, but good skin elasticity, subjective request not to leave incisional scar or recent social activities, and unwilling to perform external approach for mild bags, can also consider this method after full preoperative understanding. The internal approach has the advantages of light reaction, rapid swelling reduction, and scarless skin appearance, but for patients with combined lower lid skin and orbital septum laxity, the results are not ideal because of the inability to lift the lower orbital septum and remove excess loose skin, and this approach is generally not considered for patients over 35 years of age. What are the indications, advantages and disadvantages of the external approach The external approach is the most widely used surgical procedure to eliminate under-eye bags in clinical practice. In principle, it can be applied to the correction of lower eyebags without contraindications, and is more suitable for the following types: middle-aged and elderly people with lower eyebags, especially for moderate to severe bags. Mild lower eyelid bags with skin laxity and mild bulging of orbital fat. Those with pure skin laxity or pure orbicularis oculi hypertrophy may be considered for surgery if they urgently request it. The incision line of the external approach is 1.5mm from the lower eyelid margin, starting from below the tear dots, parallel to the next row of eyelashes from the inside out to the outer canthus, and then extending about 5~8mm in the direction of the fishtail line to the lower outer canthus. However, it also requires a high technical requirement such as accurate preoperative design, moderate amount of skin removal, and no trace of the incision for 3~6 months.