Lower Blepharoplasty

Lower Blepharoplasty

Lower blepharoplasty, also known as eyelid surgery, is a surgical procedure designed to address sagging, puffiness, or excess skin and fat under the lower eyelids. As we age, the skin around the eyes loses elasticity, and fat can accumulate, leading to the appearance of under-eye bags and/or dark circles. Lower blepharoplasty targets these concerns by removing or repositioning excess fat, tightening loose skin, and smoothing out the under-eye area, creating a more youthful and refreshed appearance. This procedure is ideal for individuals looking to enhance the contour of their lower eyelids and reduce the tired, aged look that can develop over time.

The three fat pads in the lower eyelid—the medial, central, and lateral fat pads—are crucial for maintaining the youthful and smooth appearance of the under-eye area.

As we age, these fat pads may shift, bulge, or lose volume, leading to common aesthetic concerns such as under-eye bags, puffiness, or hollowness.

Goals of Lower Blepharoplasty

For some patients, the goal may be to simply remove the herniated fat bags under the eyes

For other patients, the goal may involve ancillary procedures which may include:

• removing excess lower eyelid skin
• tightening the lower eyelid skin and/or muscle
• tightening the lower lid (tarsoligamentous laxity)
• volumizing/blending the eyelid-cheek junction 

Lower eyelid-Cheek Junction

Adapted from: 

Blending the Lower Lid Cheek Junction
Warren, Richard J.
Clinics in Plastic Surgery, Volume 52, Issue 1, 55 – 71

Lower Blepharoplasty Techniques

1. Transconjunctival Lower Blepharoplasty: This technique involves making an incision inside the lower eyelid (conjunctiva), which eliminates visible scarring. It is primarily used to address excess fat in the lower eyelid area, as it allows the surgeon to remove or reposition fat without needing to make an external incision. This method is ideal for patients with excess fat but minimal skin laxity.
2. Fat Repositioning Lower Blepharoplasty: This advanced technique involves repositioning the fat in the lower eyelid area rather than removing it. The fat is moved from areas of puffiness and redistributed to areas that have lost volume, such as the tear trough area. This creates a smoother, more natural transition between the lower eyelid and the cheek, providing a youthful and rejuvenated look without removing too much fat.
3. Lower Blepharoplasty with Skin Tightening: For patients with significant skin laxity, a lower blepharoplasty combined with skin tightening techniques can offer the best results. After removing or repositioning fat, the surgeon tightens the skin to smooth out wrinkles and reduce sagging. Skin tightening may be performed surgically (pinch excision) or non-surgically (resurfacing laser or chemical peel). This combination helps restore the taut, youthful appearance of the lower eyelid and surrounding areas.
4. Lower Blepharoplasty with Lid Tightening: Lid tightening (i.e.- canthopexy, canthoplasty) can be performed during a lower blepharoplasty to address patients who also have issues with eyelid laxity (sagging or drooping) or lateral canthal issues (the outer corner of the eye).                                                                            
5. Lower Blepharoplasty with Fat Grafting: In some cases, fat grafting may be added to lower blepharoplasty to restore volume to the under-eye area or to the cheeks. Fat is harvested from another part of the body (such as the abdomen or thighs), purified, and then injected into areas where volume loss has occurred. This technique enhances the natural contours of the face and improves the overall balance of facial features.