Lower eyelid pouches are bloated and swollen tissues of the lower eyelid that hang in a pouch-like fashion. Primary lower eyelid pouches tend to have a family history and are most often seen in young people, where excess intraorbital fat is the main cause; secondary lower eyelid pouches are most often seen in middle-aged and older adults, and are secondary to changes caused by weakness and laxity of the lower eyelid support structures. The clinical manifestation is a sagging of the lower eyelid skin and the accumulation and prolapse of the orbital fat, revealing a pouch-like, bloated lower eyelid skin that makes the face lose its smooth, flat appearance and gives a sense of fatigue and old age. For secondary lower eyelid pouches, a transdermal lower eyelid pouch excision, also known as lower eyelid debridement, is usually used to correct the problem. The operation is briefly described as follows: the face is routinely disinfected and sheeted, local infiltration anesthesia is applied, and the incision line is drawn 1 to 2 mm below the lower eyelashes to the outer canthus and the incision is properly extended downward. The skin and orbicularis muscle were incised to the front of the orbital septum, the septum was opened, the inner, middle and outer fat globules were excised, attention was paid to ligature hemostasis, the patient was instructed to look upward, the lower lid orbicularis muscle flap was shu flattened and the excess skin muscle tissue was excised, while local relaxation of the orbital septal fascia was repositioned, the relaxed orbicularis muscle was lifted and fixed on the outer canthus periosteum, the orbital septal fascia was closed with 6-0 absorbable sutures, and 7-0 monofilament nylon sutures were interrupted skin incision. How can I achieve a personalized lower eyelid debridement? Based on the main manifestations of the lower eyelid pouch, I advocate the following methods of treatment (personal opinions only, corrections welcome): 1. In cases where the lower eyelid orbicularis muscle is simply too thick (commonly referred to as “big eyelid”): on the basis of normal lower eyelid debridement, communicate with the patient before surgery to seek his or her opinion on the size of the eyelid and how much to keep. The orbicularis oculi muscle is partially removed. 2. For those with significant sagging of the orbicularis muscle of the lower eyelid: reorganize the orbicularis muscle (shorten the folded orbicularis muscle). This is also the most suitable method for patients aged 45-60 years. This is because almost all patients between the ages of 45 and 60 have significant drooping of the orbicularis oculi. 3. For patients with deep orbital-zygomatic sulcus (commonly known as “tear trough”): For those with little orbital fat in the lower lid, release the orbital fat without removing it, move it down to fill the orbital-zygomatic sulcus, and then remove some of the excess skin. Other steps are the same as for lower eyelid debridement. Figure 1: Lower eyelid incision line design Figure 2: Drooping orbicularis muscle Figure 3: Removal of septal fat Figure 4: Treatment of the orbitozygomatic sulcus (tear trough)