Lower Blepharoplasty

Lower blepharoplasty is an operation to reduce puffiness, bags, and excess skin below the eyes, giving a smoother, more rested appearance to the lower eyelid area. It can be performed through a small incision inside the eyelid (transconjunctival) or through a cut just below the lashes (subciliary/transcutaneous).

Your surgeon will assess you and advise whether this procedure is suitable for you, but the decision to proceed is always yours.

You may benefit from this procedure if you have:

• Persistent "bags" caused by fat bulging beneath the lower eyelids
• Loose, crepey excess skin on the lower eyelid
• Fine wrinkling of the lower lid skin (sometimes better addressed with resurfacing alongside surgery)

Your surgeon will check the position and tightness ("laxity") of your lower eyelid, as this significantly affects the technique used and your risk of certain complications.

Lower blepharoplasty can reduce under-eye puffiness and create a smoother, more youthful contour. As with all cosmetic surgery, results cannot be guaranteed and depend on healing and individual anatomy.

Fillers can sometimes camouflage hollows beneath the eye bags without surgery, though they do not remove excess fat or skin. Laser or chemical skin resurfacing can improve fine wrinkling without addressing bulging fat. Radiofrequency skin tightening has a more modest effect than surgery.

The operation is usually performed under local anaesthetic with sedation, or occasionally general anaesthetic, and takes around 45 minutes to 1.5 hours.

• Transconjunctival approach (incision inside the lower eyelid, no visible scar): typically used to remove or reposition fat without removing skin — best suited to younger patients with good skin quality
• Subciliary/transcutaneous approach (incision just below the lash line): allows removal of excess skin as well as fat, but carries higher risk of lower lid position changes
• Canthopexy or canthoplasty (tightening of the outer corner of the eyelid) is often performed at the same time to support the eyelid and reduce the risk of the lid pulling down afterwards

All surgery carries risk. The figures below come from a published case series of 200 patients undergoing blepharoplasty and other peer-reviewed sources.

General risks of any operation: minor infection, bleeding, allergic reaction, and (rarely) blood clots.

Specific risks of lower blepharoplasty:

• Chemosis (swelling of the surface of the eye): the most common complication, affecting around 6% of patients in one series, more common after procedures involving canthoplasty due to increased handling of the eye surface; usually resolves within 3–4 weeks with drops if needed
• Lower eyelid malposition (retraction or ectropion — the lid pulling down or turning outward): the second most common complication, occurring in around 3% of patients in the same series; risk is significantly reduced when the outer corner of the eyelid is supported (canthopexy/canthoplasty) at the time of surgery. Of those affected, about 2.5% experienced retraction and 0.5% ectropion, with all cases in that study occurring in patients who did not have lateral canthal support performed
• Haematoma (bleeding under the skin): around 0.5% in the same series; larger or rapidly enlarging haematomas can rarely threaten vision and require urgent treatment
• Dry eye / lagophthalmos: can occur, especially with aggressive skin removal; usually managed with lubricating drops and resolves over time
• Scleral show (white of the eye visible below the iris): related to lower lid retraction; can be treated with lid-tightening procedures if persistent
• Asymmetry or cosmetic irregularity: possible, and around 3% of patients in the same series sought revision surgery for this, with good results after correction
• Orbital haemorrhage with vision loss: rare but serious, estimated at 1 in 2,000 to 1 in 25,000 procedures — immediate medical attention is required if you notice worsening pain, swelling, or vision change after surgery
• Diplopia (double vision): rare, usually related to bruising or swelling near the small eye muscles; typically resolves without treatment

• Tell your surgical team about all medications, blood thinners, herbal remedies, and supplements
• Stop smoking well before surgery
• A full eye examination is usually performed to check lower lid laxity, tear production, and any pre-existing dry eye

• Cold compresses and head elevation help reduce swelling and bruising in the first few days
• Lubricating drops or ointment may be needed, especially if the eyes don't fully close initially
• Sutures (if used) are typically removed within a week; transconjunctival incisions do not require suture removal
• Most bruising and swelling settle within 2–3 weeks
• Avoid strenuous exercise for about 2–3 weeks

Will I have a visible scar? If the transconjunctival (inside the eyelid) technique is used, there is no visible external scar. If the subciliary technique is used, the scar is hidden just below the lash line and usually fades well.

What is the most common complication? Chemosis (surface swelling of the eye) is the most frequently reported issue, affecting around 6% of patients, and it generally resolves on its own within a few weeks .

Can the lower eyelid change position after surgery? Yes, this is the main risk specific to lower blepharoplasty. Having the outer corner of the eyelid supported (canthopexy) at the time of surgery substantially reduces this risk .

Is lower blepharoplasty painful? Most patients report mild discomfort or tightness, well controlled with simple pain relief.

Can this be combined with upper blepharoplasty or a facelift? Yes, these are frequently performed together for balanced facial rejuvenation.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.