What is lower blepharoplasty?

Lower blepharoplasty is a surgical procedure performed to improve concerns in the lower eyelid and under-eye area, such as under-eye bags, excess skin, laxity, and in some patients, hollowness/tear trough prominence. The goal is to create a fresher, brighter, and more rested appearance around the eyes.

This procedure is not only about “removing fat bags.” In suitable patients, it may also include fat preservation/repositioning, support of the skin-muscle layer, and strengthening lower eyelid support.

 

Who is a good candidate?

You may be a suitable candidate if you have one or more of the following:

• Prominent under-eye bags

• Lower eyelid skin laxity and fine wrinkles

• Tired or hollow under-eye appearance

• A noticeable groove between the lower eyelid and cheek (tear trough)

• Genetic under-eye bags at a younger age

• Insufficient improvement with non-surgical treatments

Suitability is determined based on lower eyelid anatomy, skin quality, dry eye symptoms, eyelid laxity, brow-cheek relationship, and your expectations.

 

Does lower blepharoplasty correct every under-eye problem?

No. Different factors can affect the under-eye appearance, including:

• Fat protrusion (bags)

• Skin laxity

• Volume loss

• Pigmentation (dark circles/discoloration)

• Reduced cheek support

For this reason, lower blepharoplasty alone may be sufficient in some patients, while others may benefit from additional treatments such as fat grafting, midface support, laser/peeling, or skin treatments.

 

What techniques are used?

Different approaches may be planned depending on examination findings:

• Transconjunctival lower blepharoplasty: The incision is made on the inner surface of the eyelid. This is often preferred in patients with prominent fat bags but little or no excess skin.

• Transcutaneous lower blepharoplasty: The incision is placed just below the eyelashes. This is more suitable when excess skin and/or muscle laxity are present.

• Fat preservation / fat repositioning: Instead of fully removing the fat, it may be redistributed to smooth hollow areas and create a more natural contour.

• Eyelid support procedures (e.g., canthopexy/canthoplasty): May be added in suitable patients to improve lower lid support.

The most appropriate technique depends on the type of under-eye bags, excess skin, lid tone, and the goal of a natural result.

 

Where will the scar be?

• With the transconjunctival technique: The incision is inside the eyelid, so there is no visible external scar.

• With the transcutaneous technique: The incision is usually placed just below the lash line and, with good healing, becomes much less noticeable over time.

Scar quality depends on individual healing, skin type, and adherence to aftercare recommendations.

 

Anesthesia and surgery time

Lower blepharoplasty may be performed under local anesthesia with sedation or general anesthesia, depending on the patient and surgical plan. Surgery typically takes about 1–2 hours (varies by patient and technique). Combined procedures may increase the duration.

 

Pre-operative preparation

Common recommendations include:

• Adjusting blood thinners and certain supplements as advised

• Evaluation of dry eye symptoms, allergies, prior eye surgeries, and contact lens use

• If you smoke: reducing/stopping smoking to support healing

• Arriving without makeup and arranging transportation/support for the day of surgery

• Ophthalmology evaluation if needed (especially in patients with significant dryness, eyelid issues, or other eye conditions)

 

Recovery and return to daily activities

A general timeline (varies by patient):

• First 48–72 hours: Swelling, bruising, tearing, tightness, and sensitivity may occur; cold compresses are helpful.

• 3–7 days: Bruising and swelling often persist but usually begin to improve.

• 5–10 days: Sutures may be removed (in transcutaneous cases, depending on the technique used).

• 1–2 weeks: Most patients can return to social activities (depending on the visibility of bruising/swelling).

• 3–6 weeks: Most swelling improves and the result becomes clearer.

• 2–3 months: Tissue healing continues and the appearance becomes more natural with finer details settling.

Keeping the head elevated, using cold compresses, gradually increasing screen time, and avoiding strain around the eyes help support recovery.

 

Safety, risks, and important considerations

Lower blepharoplasty is generally safe, but like any surgical procedure, it carries risks. Commonly discussed risks include:

• Swelling, bruising, temporary asymmetry

• Bleeding, infection

• Increased dry eye symptoms, burning/stinging sensation

• Temporary blurry vision (may be related to ointments/eye drops)

• Healing problems or noticeable scarring at the skin incision (in transcutaneous cases)

• Temporary numbness or altered sensation

• Lower lid pulling/rounding tendency (risk may be higher in patients with weak lid tone)

• Corneal irritation (surface eye irritation)

• Rarely, the need for revision surgery

 

Rare but important warning signs requiring urgent evaluation:
Sudden vision changes, severe and worsening pain, rapidly increasing one-sided swelling/bleeding, or high fever should be evaluated promptly.

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Frequently Asked Questions (FAQ)

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1) Does lower blepharoplasty completely fix dark circles?

Not always. Dark circles/discoloration may be caused by pigmentation, visible blood vessels, thin skin, or shadowing. Lower blepharoplasty is most effective for under-eye bags and skin laxity; additional treatments may be needed for discoloration.

 

2) Are under-eye bags completely removed?

The goal is to reduce puffiness while preserving a natural appearance. In some patients, fat repositioning/preservationprovides a more natural result than complete fat removal.

 

3) Will there be scars?

With the transconjunctival technique, there is no visible external scar. With a skin incision, the scar is placed just below the lashes and usually becomes quite subtle over time.

 

4) Will my eye shape change?

The goal is to preserve the natural eye shape. Proper patient selection, lid support assessment, and support procedures when needed help reduce the risk of a “pulled” or rounded-eye appearance.

 

5) Is it very painful?

Severe pain is not usually expected. Patients more commonly experience tightness, sensitivity, and a stinging/burning sensation, which are generally manageable with medication.

 

6) When can I return to work?

For desk-based jobs, some patients return within 5–10 days. The visibility of bruising and swelling varies from person to person.

 

7) When can I wear makeup?

After sutures are removed and the incision is healing well (in transcutaneous cases), eye-area makeup may be resumed gradually. Timing varies by patient.

 

8) When can I wear contact lenses again?

A short break may be needed due to early sensitivity. The exact timing is determined during follow-up visits.

 

9) I have dry eyes. Can I still have surgery?

Yes, but surgical planning should be more cautious. Existing dry eye symptoms may temporarily worsen after surgery. Ophthalmology evaluation may be recommended when appropriate.

 

10) When will the result fully settle?

The appearance may change during the first weeks because of bruising and swelling. Noticeable improvement is usually seen within 3–6 weeks, and a more settled result is typically seen by 2–3 months.

 

11) Are results long-lasting?

Improvement in under-eye bags is often long-lasting, but the aging process continues. Skin quality and lifestyle factors may affect the appearance over time.

 

12) Will I need revision surgery?

Most patients do not. However, revision may occasionally be needed for asymmetry, persistent puffiness/hollowness, excess skin, or eyelid position concerns.

 

13) Should it be combined with fat grafting?

Not in every patient. If there is significant volume loss at the lid-cheek junction, fat grafting may improve balance and make the result look more natural. This is decided during consultation.

 

14) Who has a higher risk of lower lid pulling/retraction?

Risk may be higher in patients with weak lid tone, significant dry eye symptoms, prior eyelid surgery, and certain anatomical features. This is why pre-operative assessment is especially important.

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The content on this page is for general informational purposes only; it does not replace diagnosis and treatment. The appropriate surgical plan is determined through face-to-face examination.