Lower Eyelid Surgery

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Lower eyelid blepharoplasty is used to remove the fat deposits and loose skin that may form on the lower eyelids with age. Many factors, including heredity and sun damage, accelerate these changes. Younger people also elect to have this procedure done to eliminate puffiness of the eyes from congenital excess fatty tissue.

This procedure is frequently done at the same time as other procedures, such as upper eyelid blepharoplasty, facelift or forehead lift, and can be combined with laser or chemical resurfacing to smooth skin wrinkles. When overhanging of the upper lids interferes with peripheral vision, and both upper and lower eyelids are done at the same time, the procedure may be covered by insurance.

If you're considering lower eyelid blepharoplasty, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a facial surgeon who is board certified or has completed a residency program that includes instruction in this procedure.


*The 2010 average cost for Eyelid Surgery (excess fat, wrinkled, dropping skin of upper eyelids; bags, puffiness under eyes) is $2,813.

* Eyelid Surgery is one of the top five cosmetic surgical procedures of 2010.

Lower Eyelid Surgery is a procedure with long-lasting results.









  1. What are some of the most common benefits of this surgery?
  2. How is lower eyelid blepharoplasty performed?
  3. For transconjunctival blepharoplasty:
  4. What can I expect after surgery?
  5. What is the recovery period like?
  6. What is the long-term outcome like for most people?
  7. Ideal candidate
  8. Alternatives
  9. Risks
  10. How much pain is there?
  11. How long does the surgery take?


What are some of the most common benefits of this surgery?

Lower eyelid blepharoplasty can make a remarkable difference in the appearance of the face, alleviating the appearance of tiredness and old age by eliminating the excess, wrinkly skin beneath the eyes. The eyes appear fresher and more youthful, and the results may last for many years. The degree of improvement varies from patient to patient.

Important note: Lower eyelid blepharoplasty will not eliminate dark circles, fine lines or wrinkles around the eyes, or alter sagging eyebrows. To enhance the results of your eyelid procedure, your doctor may also recommend: 1.) a brow lift to correct a drooping brow and smooth the forehead, 2.) a facelift for saggy jowls, and/or 3.) skin resurfacing to eliminate fine lines.

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How is lower eyelid blepharoplasty performed?

For traditional lower lid blepharoplasty:

  1. An incision is made along the lash line, smile creases
  2. Excess fat, muscle and skin are removed
  3. Fine sutures are used to close the incision
  4. Permanent stitches will be removed three to five days after the procedure

If you have a pocket of fat beneath your lower eyelids, but do not need to have any loose skin removed, your surgeon may recommend a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with fatty lower eyelids. Transconjunctival blepharoplasty does not tighten the skin, reduces the puffiness in the lower eyelid region.

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For transconjunctival blepharoplasty:

  1. Incision is made on the inside of the lower eyelid
  2. Excess fat and muscle are removed (no tightening or removing of skin)

Incision is closed with self-dissolving sutures or they will heal naturally without sutures.

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What can I expect 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. Ointment is used in both methods.

The first evening after surgery, you should rest quietly with your head elevated. It will help to apply cold compresses to your eyelids. (Avoid any compress heavier than one ounce. A Ziploc bag with a few frozen peas works well.) Your blood pressure should be monitored to avoid bleeding complications that can affect vision. And, although you can be up almost immediately, you should limit your activities.

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What is the recovery period like?

At first the incisions will probably be red and somewhat bumpy. Eventually, the resulting scar should become flat and inconspicuous. Your sutures (stitches) will be removed sometime within the first week. The swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel better each day. Swelling and bruising varies considerably from person to person. Bruising typically disappears within seven to 10 days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration.

Your vision may be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. You may receive eyedrops to help relieve any burning or itching.

For the first week, you'll need to avoid activities that dry the eyes, including reading, watching television, wearing contacts, and using a computer. Also avoid excessive blinking, which leads to increased swelling. You should also wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation. The eyes may tire easily for several weeks; frequent naps are helpful.

For the first three or four weeks, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and sports. Your surgeon will let you know when you are ready for exercise. Also avoid drinking alcohol, which can lead to fluid retention and delay recovery.

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What is the long-term outcome like for most people?

The more alert, youthful look that this surgery provides is usually long lasting. Thin scars may remain slightly pink for six months or so, but can easily be concealed with makeup. They eventually fade to a thin, nearly invisible white line. The removal of fat is permanent, but the looseness of the skin and fine wrinkling of the eyelid area may return in the future.

Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time. If continued loss of skin tone in the forehead later causes sagging of the eyebrows, a forehead lift or second eyelid procedure may be performed.

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Ideal candidate:

In general, the best candidates for lower eyelid blepharoplasty are people:

  • 18 years of age or older
  • In good physical health
  • Psychologically stable
  • Understanding the procedure's outcome
  • Desiring correction of droopy, baggy eyelids
  • With no known ophthalmic conditions such as glaucoma or detached retina
  • With no known medical conditions such as high blood pressure, circulatory problems, hypothyroidism or other thyroid related conditions.
  • Having realistic expectations for the outcome

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he / she considers you an ideal candidate for lower eyelid blepharoplasty.

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Lower eyelid blepharoplasty is frequently combined with upper eyelid blepharoplasty, or with a face lift or forehead lift as part of an overall facial rejuvenation procedure. It can also be combined with laser resurfacing or chemical peel to further enhance the results. Usually, a cosmetic surgeon will recommend the resurfacing as a separate procedure, although it can be combined in certain situations.

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Significant complications from aesthetic eyelid surgery are infrequent. As with any surgical procedure, however, there is always a possibility of infection, or reaction to the anesthesia.

Other potential complications include:

  • Retrobulbar hematoma - (bleeding behind the eye) - rare, but can be serious. Symptoms include loss of vision
  • temporary problems with excessive tearing
  • decreased sensation in the eyelid
  • dry eyes - dryness, burning, stinging, gritty sensation in your eye(s)
  • prominence or firmness of the scars
  • blurred vision
  • asymmetry in healing or scarring
  • milia or whiteheads where the sutures emanate from the skin.
  • difficulty closing eyes completely; in rare cases, this condition may be permanent.
  • ectropion, or a pulling down of the lower lids.

Further surgery is uncommon but often may be quite straightforward. You can help minimize certain risks by following the advice and instructions of your facial 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. Caution should be exercised if you have ophthalmic problems, or other serious medical condition(s). In this case, your surgeon may require a clearance from your general practitioner or other physician.

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How much pain is there?

Initially, you may feel a tight sensation around the eyes, with minor discomfort that lasts for a day or two. A mild pain reliever can be taken as needed. People who have had blepharoplasty are often surprised at how painless eyelid surgery can be. Many times, isolated eyelid surgery can be performed under local anesthesia with a total recovery time as short as seven to 10 days. (Recovery time varies from person to person.)

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How long does eyelid surgery take?

Eyelid surgery generally takes about one to three hours to complete, depending on the technique used and the extent of the repair.

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The information on this web site is intended only as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

*Disclaimer: Source: According to the American Society for Aesthetic Plastic Surgery (ASAPS), nationally in 2010. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may vary depending the extensiveness of the procedure, location, and other factors. Costs are provided solely for research purposes. We are not a plastic surgery company and do not represent any plastic surgeons. For specific estimates, please contact a qualified plastic surgeon.

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