Baggy eyelids are a feature of the eyes that appear as people age, affecting their appearance and making them feel aged, so lower eyelid blepharoplasty is one of the common procedures performed in plastic surgery clinics. The classical eyebag revision surgery has two types of conjunctival approach and skin approach, which are usually referred to as internal and external incision, of which the external incision is divided into skin flap method and myocutaneous flap method. 1, clinical data The patients in this group are male and female, aged from 36 to 68 years old, one of them had an internal incision eye bag revision surgery. All patients had orbital fat herniation, lower lid skin laxity, wrinkles and other phenomena need to remove fat and remove a certain amount of skin. 2, surgical methods (1) incision design (2) anesthesia (3) external incision to remove skin (4) internal incision to remove orbital fat (5) postoperative treatment: suture tape fixation, incision aureomycin eye ointment application, gauze bandage for 24 hours, cold compresses, oral antibiotics, stitches removed 6 days after surgery. 3, Results All patients in this group underwent eye bag revision by combined internal and external approach, the amount of skin removed ranged from 2 to 6 mm, and three stacks of orbital septal fat masses were removed from the inner, middle and outer sockets. The surgical procedure was smooth, anesthesia was satisfactory, and there was no significant postoperative swelling, no bleeding bruises, lower lid ectropion, and other complications. The results were satisfactory at 1-6 months of follow-up. 4, Discussion The classical eyebag revision is widely used clinically and the procedure is mature, but there are certain shortcomings and various corresponding complications. Detailed surgical procedures can be found in the second edition of Plastic Surgery. Kakizaki (Kakizaki) on 11 cases of Asian lower eyelids for the Matson’s staining histological study found that the superficial structure of the lower eyelids of Asian and non-Asian people is very similar, and the bags of Asian people are the result of the presence of certain septal unions in the lower lids, the fat bulging out in front and above, and the compression of the orbicularis oculi muscle make. Iwanami also performed a histologic study that concluded that aging changes in the lower lid include changes in the three components of the orbicularis oculi muscle, relaxation of the suborbital fixation fascia, herniation of the septal fat leading to loss of the area of anterior septal adipose tissue, and weakening of the supporting structures of the skin ligaments. The conjunctival approach is only suitable for young patients or patients with only herniated septal fat, because although this procedure is less invasive, it can only remove the septal fat but not the skin, and it cannot perform orbicularis oculi muscle reshaping. The skin approach can remove both skin and septal fat, but because the anatomical structure of the orbicularis oculi muscle is destroyed, orbicularis oculi plastic surgery must be performed at the same time, which is relatively more traumatic and results in significant postoperative bruising around the eyes. The author’s combined internal and external approach eye bag revision surgery has the following features: (1) It combines the advantages of both conjunctival approach and skin approach, which can remove both skin and septal fat. (2) The amount of skin removal can be correctly estimated in advance. (3) The surgery is minimally invasive without damaging the orbicularis oculi muscle. (4) The orbicularis muscle can be lifted and folded at the same time, depending on the need. (5) The surgery is simple, quick and short. (6)The swelling after surgery is not obvious and the recovery is fast. (7) The scars are subtle and the appearance is ideal. In summary, the authors’ combined internal and external access eye bag revision surgery is easy to operate, simple in method and has good clinical application value.