Lower eyelid surgery (lower blepharoplasty)
Lower eyelid surgery (lower blepharoplasty) reshapes under-eye fat that has moved forward and, where needed, removes excess skin and supports the lid. Fat is either removed or repositioned into the hollow below it; the choice depends on lid tone, skin and the shape of the lid–cheek junction.
What problem does it treat?
The fat surrounding the eyeball moves forward as the thin membrane holding it in place weakens with age. This shows as an under-eye bag, often together with:
- A hollow just below the bag at the lid–cheek junction (tear trough)
- Thinner, finely wrinkled lower lid skin
- Loss of lower lid tone
Not every under-eye change comes from a fat bag. Fluid and cheek bags need other treatments; see under-eye bags.
Inner and outer approach
- Transconjunctival (inner) approach: the incision is on the inside of the lid, leaving no external scar and disturbing the lid's support structures less. Often chosen for younger patients without much skin excess.
- Subciliary (outer) approach: the incision is just below the lashes, so excess skin and muscle can be removed as well as fat. Chosen when skin excess is marked.
If the lower lid is lax, its outer corner can be secured to bone (canthopexy) to keep the lid from being pulled down after surgery.
Should the fat be removed or preserved?
Lower blepharoplasty used to remove most of the fat. It is now known that removing too much fat can leave the area hollow and aged over the years. Two options are weighed:
- Removing fat: when the bag is prominent and the hollow beneath is small, the excess fat is removed in measured amounts.
- Repositioning fat: when a clear hollow lies under the bag, the fat is moved into the hollow and fixed there, correcting both in one step.
Many patients need a combination. The decision is based on the shape of the lid–cheek junction, examined with the patient upright.
Who is it not suitable for?
- If the swelling is fluid (allergy, thyroid, kidney or heart related), the underlying cause is treated first.
- Significant dry eye or lid malposition from earlier surgery needs further assessment.
- Surgery does not change dark circles caused by pigmentation.
Recovery
- First week: swelling and bruising are visible; cold compresses and sleeping with the head raised help.
- One to two weeks: most bruising settles. With the outer approach, sutures are removed within the first week.
- Several months: the tissues soften and the final shape settles.
Risks
- Bruising, swelling, temporary swelling of the white of the eye (chemosis)
- Downward pull or outward turning of the lower lid; the risk is reduced by assessing lid tone beforehand
- Asymmetry, under- or over-correction
- Temporary dry eye and redness
- Very rarely, loss of vision from bleeding behind the eye; sudden pain, swelling or reduced vision must be reported immediately.
Frequently asked questions
Lower eyelid surgery or filler?
If the under-eye appearance comes from fat bags, filler does not remove them and can make them look more prominent. If there is only a hollow without a bag, filler can be an option. The distinction is made at the examination.
Is there a visible scar?
With the inner (transconjunctival) approach there is no external scar. If skin is removed, a fine incision is made just below the lashes, which usually fades over time.
How long does bruising last?
Bruising and swelling usually settle largely within one to two weeks; the final shape can take a few months.
References
This page is for general information only and does not replace a medical consultation. Anatomy and treatment plans differ from patient to patient.