Background <p>Traditional transcutaneous lower blepharoplasty often compromises the orbicularis oculi muscle, raising risks of complications like ectropion.</p> Objective <p>To evaluate the clinical outcomes of a modified transcutaneous lower blepharoplasty technique that preserves the palpebral orbicularis oculi muscle.</p> Methods <p>A retrospective analysis was conducted on 65 patients who underwent this procedure between January and May 2024. Surgical outcomes, complications, and patient satisfaction were assessed.</p> Results <p>The technique effectively improved lower eyelid bag deformity with high patient satisfaction, while avoiding damage to the orbicularis oculi muscle and related complications commonly seen in traditional surgeries.</p> Conclusions <p>The transcutaneous lower blepharoplasty with preservation of the palpebral orbicularis oculi muscle is a safe and effective surgical method, offering excellent aesthetic results, particularly for patients with lower eyelid skin laxity and orbital fat herniation.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors&#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>