Background: Lower eyelid blepharoplasty has been addressed with such popular choices as skin flap transcutaneous blepharoplasty, skin-muscle flap transcutaneous blepharoplasty, transconjunctival blepharoplasty, fat-conserving or fat-replacing methods, wedge excision, and laser resurfacing techniques.However, each procedure has its own indication and obvious limit.Inadequate or too much correction, unsatisfactory reserved deformities are not rare if the surgeon prefer one procedure for all patients.Bleeding is another problem.Bleeding during operation, postoperative haematoma and ecchymoma is not seldom seen.Hemostasis with bipolar electrocautery takes the surgeon a rather long time.Edema is quite often.Methods: With transcutaneous approach, skin flap,orbicularis oculi flap and orbital septa flap were formed,fastened and shaped in three-dimensional way.A comprehensive way including operation techniques, drugs,electro scalpel and nursing techniques were addressed to avoid (not control but pre-control) bleeding.Results: From August 2005 to January 2011, two hundred and three patients underwent this technique.All patients have been satisfied with their appearance after their initial surgery except three patients with minimal associated morbidity.No haematoma nor ecchymoma occurred.Average operation time was 40 minutes.Edema disappeared quickly.Conclusions: Sandwich three-D blepharoplasty is effective way to remove lower eyelid bags.This technique applies to those candidates for both skin and skin-muscle flap transcutaneous blepharoplasty.Complications connected with bleeding are reduced effectively with pre-control bleeding techniques.