Lower Blepharoplasty Overview: 

Heredity, time, and environmental factors can cause the fat and skin of the lower eyelid to become baggy and wrinkled, often resulting in a tired and aged facial appearance. Lower blepharoplasty, also known as lower eyelid surgery, can help reverse the signs of ageing and help patients look and feel their best.

Lower blepharoplasty is a very popular cosmetic surgical procedure to reshape the excess fat and drooping skin of the upper eyelid. Additionally, the procedure will minimise bags under the eyes and tighten the lower eyelid skin. While lower eyelid surgery doesn’t stop the aging process, the benefits are long-lasting, resulting in a refreshed, rejuvenated and younger-looking appearance.

While most people decide to have eyelid surgery to minimize the signs of ageing, even some people in their late 20s and early 30s can benefit from lower blepharoplasty.

Operation Techniques:

Lower blepharoplasty can be performed by using either an external (transcutaneous) or internal (transconjunctival) approach.

 Transcutaneous blepharoplasty

Transcutaneous blepharoplasty is performed via an incision through the eyelids from the outside, with the incision usually placed below the lashes of the lower eyelids, which minimizes any visible scarring. A well-placed incision can be virtually invisible when fully healed.

This approach often includes making incisions and flaps of the orbicularis oculi muscle. The fragile orbicularis oculi muscle is crucial as it supports the lower eyelid. If the integrity of the muscle is compromised, the shape of the eye can be changed.

When drooping and sagging is notable, the incisions may stretch out towards the temples where they would be concealed by crow’s feet. The surgeon will then separate the skin from muscle and fatty tissue, removing excess fat and trimming loose skin and muscle.

Unlike transconjunctival blepharoplasty, the transcutaneous approach requires sutures to cover the incision. Transcutaneous eyelid surgery is most suitable for patients who have notable bulges and wrinkles under the eyes.

Patients considering a transcutaneous blepharoplasty should be aware that darker skin may result in darker pigmentation (hyperpigmentation) along the incision line.

Transconjunctival blepharoplasty

The transconjunctival approach is frequently performed to remove fatty tissue that produces puffy “bags” under the eyes. No skin is removed in this method.

During the procedure, the surgeon pulls away the lower eyelid from the eyeball and makes an incision from inside the eyelid, either with a scalpel or laser. The fat will then be removed or rearranged accordingly. Finally, the incision will be closed with sutures.

Ideal candidates for transconjunctival blepharoplasty are men and women with good elasticity and muscle tone in the lower eyelid. Transconjunctival blepharoplasty has become increasingly popular, since it is less invasive and heals quicker than the transcutaneous method. Furthermore, it also gives the surgeon the ability to examine the result of the operation by reversing the eyelids to the natural position and make corrections accordingly.

One of the biggest advantages of transconjunctival blepharoplasty is the almost invisible incision line. The operation can also be performed with a laser or an electric cautery device. However, the procedure does not remove excess skin and is more suitable for patients who only have puffy or bulging skin under the eyes.

Preparation Prior to Surgery: 

  • Medical history assessment  (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation. 

  • Avoid smoking  for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process. 

  • Stop drinking alcohol, a week before the surgery and throughout your recovery period.

  • Taking any medications should be avoided such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery, and also avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

Operation Time: 

Lower eyelid blepharoplasty generally takes about one to three hours to complete, depending on the technique used and the extent of repair. 

Types of anesthesia use: 

General or local anesthesia  

Hospital admission: 

It depends on your preferences as well as your surgeon’s. Lower eyelid blepharoplasty can be performed on an outpatient basis, in the hospital, or in an ambulatory surgical suite.

Care After Surgery: 

After surgery, the physician will lubricate your eyes with ointment to reduce dryness in this area. Your vision may be blurred temporarily from the ointment. The first evening after surgery, you should rest quietly with your head elevated. It will help to apply cold compresses to your eyelids.

 Your blood pressure should be monitored to avoid bleeding complications that can affect vision and limit activities from mild to moderate gradually. You should wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.

Recovery Period: 

Stitches will be removed within the first week. Bruising, swelling and discoloration around your eyes will gradually subside for several weeks. Within the fist week you will be permitted to use make up to conceal any discoloration if desired.

For the first week you need to avoid activities like watching TV, wearing contacts and using computer. For the first 3 or 4 weeks, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and sports.


Lower eyelid blepharoplasty eliminates the appearance of tiredness and wrinkles beneath the eyes cause by old age. It gives you a more youthful appearance and the results will last for many years.

Risks and complications: 

Complications are rare; however there are risks associated with any medical procedure. Possible complications include: infection,bleeding (rare) but can cause loss of vision, prominence of the scars, asymmetry in healing or scarring, dryness, decreased sensation in the eyelid, difficulty closing the eyes,or any reaction to anesthesia and in rare instances blindness.

You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery. Pre existing conditions can also put you at risk. They include thyroid problems such as hypothyroidism, insufficient tear production or dryness of the eye, elevated blood pressure or other circulatory disorders, cardiovascular disease, and diabetes.