Whether or not a person with puffy eyes looks beautiful after eyelid surgery is actually closely related to the procedure and the experience of the surgeon. Conventional incision blepharoplasty, which only treats the skin, orbicularis muscle and orbital fat and preserves most of the pre-lid tissues, gives satisfactory results for most candidates. However, for those with puffy eyes, the postoperative improvement is not ideal, and the upper eyelid remains bulky or the double eyelid crease is unnaturally shaped. Are puffy eyes not beautiful? Many surgeons have found that the skin of the upper eyelid in the case of puffy eyes is loose and relatively excess, the orbicularis oculi muscle is hypertrophied, the fat under the orbicularis oculi muscle is thickened and the fat in front of the eyelid is thickened, especially the fat under the orbicularis oculi muscle is abundant as the main characteristic, and some of them are also accompanied by the prolapse of the lacrimal glands. This anatomical finding theoretically explains why conventional incision is often ineffective for puffy-eyed patients – conventional total eyelid incision only routinely deals with skin, orbicularis oris muscle and orbital fat, but neglects to remove the hypertrophied fat pads under the supraorbital orbicularis oris muscle, which inevitably fails to improve the appearance of the upper eyelid bulge. Once the accompanying lacrimal gland prolapse is detected, it is even more important for the surgeon to provide the correct treatment in a timely manner. Specifically, the cause of the puffy eyes and the presence of ptosis and lacrimal gland prolapse should be carefully analyzed in order to develop a customized surgical plan. For candidates with simple upper eyelid hypertrophy and bloating, in addition to removing excess skin, hypertrophied orbicularis muscle and prolapsed orbital fat, the fat pads under the outer orbicularis muscle should also be removed according to the contour of the eye and the need for the thickness of the tissues, usually the outer 1/3, but depending on the bloating of the eye, the middle and inner part should be separated and removed, which can be accurately judged based on experience, which will result in a significant improvement of the bloating of the upper eyelid compared to the previous one. Care should be taken to avoid injury to the supraorbital vessels and nerves during this procedure because of the abundance of blood vessels and nerves at the upper edge of the lid. For patients with prolapsed lacrimal glands, they should be detected in time through examination, and special attention should be paid to preventing damage to the lacrimal glands. For inexperienced doctors, it is not easy to distinguish the appearance of the prolapsed lacrimal glands from that of the meibomian cushion. During the examination, the doctor should note that a sliding mass can be detected in the outer supraorbital rim, and the prolapsed lacrimal gland can be seen under the conjunctiva of the outer supraorbital vault when the upper eyelid is flipped to expose the upper vault. If the diagnosis of prolapse of the lacrimal gland is made, the prolapsed lacrimal gland should be reset and fixed, and a “U”-shaped or loop suture can be used, which can ensure the reset of the lacrimal gland without cutting the lacrimal gland, reduce the pressure on the orbital diaphragm, and prevent the re-prolapse of the lacrimal gland, while retaining the normal anatomical and physiological functions of the lacrimal gland. (Comparison photos before and after surgery) Finally, it should be noted that the postoperative edema is more obvious than the general blepharoplasty for bubble eye patients, but it mostly disappears in 2 weeks to 1 month, and some of them may have subconjunctival hemorrhage, which is mostly eliminated within 2 weeks.