Lower Blepharoplasty
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney and Brisbane with over a decade of experience specialising in facial aesthetic surgery. At his clinic, Dr Turner offers lower blepharoplasty surgery for patients seeking correction of under-eye concerns, including puffiness, prominent fat pads, loose skin, and contour irregularities that contribute to a tired or aged appearance.
Lower blepharoplasty—commonly referred to as lower eyelid surgery—addresses the excess fat, skin, and tissue changes that develop in the under-eye region over time. These changes can create visible bags, shadowing, and an uneven transition between the eyelid and cheek. Through carefully positioned incisions—either hidden inside the eyelid or placed just below the lash line—Dr Turner removes or repositions tissue to restore a smoother, more rested appearance to the lower eye area.
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Understanding Lower Blepharoplasty Surgery
The lower eyelid region represents one of the first areas where visible ageing becomes apparent. Even subtle changes beneath the eyes significantly influence how rested, alert, and vibrant a person appears. Understanding the anatomical factors contributing to lower eyelid concerns helps patients appreciate how surgical correction addresses their specific situation.
Anatomy of the Lower Eyelid
The lower eyelid comprises multiple distinct tissue layers, each contributing to its appearance and structural integrity:
Skin Layer: The lower eyelid has fragile, delicate skin that progressively loses elasticity with age. This tissue becomes crepey and develops fine lines, particularly with sun exposure and repeated facial expressions.
Orbicularis Oculi Muscle: This circular muscle surrounds the eye and controls eyelid closure. Over time, this muscle can become lax, contributing to tissue descent and creating a tired appearance.
Orbital Septum: A fibrous membrane separating the eyelid structures from deeper orbital contents. Progressive weakening of this barrier allows underlying fat to protrude forward, creating visible bulging.
Orbital Fat Pads: Three distinct fat compartments (medial, central, and lateral) cushion the eye within the orbit. As supporting structures weaken with age, these pads may herniate forward, creating the characteristic “bags” beneath the eyes.
Tear Trough: The natural groove extending from the inner corner of the eye toward the cheek. Volume loss in this region creates shadowing and a hollow appearance, accentuating under-eye bags.
Lower Eyelid Retractors: Structures that help maintain proper eyelid position and movement. Laxity in these tissues can contribute to eyelid malposition.
How Ageing Affects the Lower Eyelid
Multiple factors contribute to lower eyelid changes over time:
Fat Prolapse: Weakening of the orbital septum permits underlying fat pads to bulge forward, creating puffiness and bags that may be present upon waking and persist throughout the day.
Volume Depletion: Loss of fat and bone support in the midface and tear trough region creates hollowing that accentuates the appearance of protruding lower eyelid fat.
Skin Laxity: Collagen and elastin degradation cause the lower eyelid skin to lose its ability to retract, resulting in progressive looseness, fine lines, and crepiness.
Muscle Changes: The orbicularis muscle may weaken or become redundant, contributing to tissue descent and altered eyelid contour.
Midface Descent: As cheek tissues descend with age, the transition between lower eyelid and cheek becomes more pronounced, creating a “double convexity” appearance.
Aesthetic Versus Functional Considerations
Lower blepharoplasty primarily addresses aesthetic concerns rather than functional impairment:
Aesthetic Enhancement: Most patients seek lower blepharoplasty to address the tired, aged, or puffy appearance created by under-eye bags, hollowing, and skin changes. Improving the lower eyelid contour creates a more alert, refreshed appearance that reflects how patients feel internally.
Combined Concerns: Many patients present with both upper and lower eyelid changes. Addressing both regions simultaneously creates harmonious periorbital correction and requires only a single recovery period.
Unlike upper blepharoplasty, lower eyelid surgery rarely qualifies for Medicare rebates because it typically does not affect visual function.
Am I a Suitable Candidate for Lower Blepharoplasty?
Lower blepharoplasty is suitable for individuals with visible concerns in the under-eye area who seek to improve their appearance. Appropriate candidate selection ensures satisfying outcomes whilst maintaining realistic expectations about what surgery can achieve.
Physical and Health Requirements
Suitable lower blepharoplasty candidates demonstrate:
- Good general health without conditions affecting surgical safety or healing capacity
- No active eye infections, inflammatory conditions, or uncontrolled glaucoma
- Adequate tear production (dry eye syndrome requires careful assessment, as lower blepharoplasty can temporarily worsen symptoms)
- Stable refracted vision without recent significant changes
- Non-smoking status or willingness to cease all tobacco and nicotine products for a minimum of six weeks before and after surgery
- Realistic understanding of achievable outcomes
- Psychological readiness for surgical intervention (mandatory psychological assessment required per Australian regulations effective July 1, 2023)
Anatomical and Aesthetic Indicators
Lower blepharoplasty proves particularly effective for patients presenting with:
- Visible puffiness or bagging beneath the eyes from protruding orbital fat
- Loose or crepey lower eyelid skin contributing to fine lines
- Dark shadowing caused by fat pad prominence creates contour irregularities
- Tear trough hollowing that accentuates under-eye bags
- Uneven transition between the lower eyelid and upper cheek
- Festoons or malar mounds (though these may require additional techniques)
- Asymmetry between the lower eyelids
- Desire for a more rested, alert appearance around the eyes
Age Considerations
Whilst lower eyelid concerns most commonly present in patients aged 35 and above, younger individuals may be suitable candidates when:
- Genetic predisposition causes early fat prolapse or under-eye bags
- Significant asymmetry requires correction
- Lifestyle factors have accelerated visible changes in the under-eye region
Chronological age alone does not determine candidacy; tissue characteristics and the specific concerns present prove more relevant to surgical planning.
How is Lower Blepharoplasty Performed?
Lower blepharoplasty is performed under general anaesthesia in an accredited private hospital setting. The procedure typically requires 60 to 90 minutes when performed in isolation for bilateral lower eyelid surgery. Most patients return home on the same day following appropriate recovery monitoring.
Surgical Technique: Transconjunctival Approach
The transconjunctival approach places the incision inside the lower eyelid, leaving no visible external scar. This technique is ideally suited for patients whose primary concern involves fat prominence without significant skin excess.
Incision Placement: A small incision is created in the conjunctiva (the inner lining of the lower eyelid), providing direct access to the orbital fat compartments.
Fat Management: Dr Turner carefully opens the orbital septum to access the three fat compartments. Depending on individual anatomy and aesthetic goals, fat may be:
- Conservatively excised to reduce prominent bulging
- Repositioned into the tear trough to smooth the eyelid-cheek junction
- A combination of reduction in some compartments and repositioning in others
Wound Closure: The conjunctival incision is closed with fine absorbable sutures or may be left to heal without sutures, depending on the specific approach used.
Adjunctive Treatments: When fine skin texture concerns exist, the transconjunctival approach can be combined with laser resurfacing or chemical peeling to address surface irregularities without external incisions.
Surgical Technique: Subciliary Approach
The subciliary approach positions the incision immediately below the lower lash line, providing access to both fat compartments and excess skin. This technique is preferred when significant skin laxity is present alongside concerns about fat.
Incision Placement: A fine incision is created 1-2mm below the lash line, extending from just lateral to the punctum (tear drainage point) to approximately 1cm beyond the outer corner of the eye.
Tissue Access: The skin is elevated, and the orbicularis muscle may be addressed depending on individual requirements. The orbital septum is opened to access the fat compartments.
Fat Management: Similar to the transconjunctival approach, fat is conservatively reduced or repositioned based on individual anatomy.
Skin Excision: Excess skin is carefully measured using a pinch technique to determine safe removal limits. Conservative excision avoids the risk of lower eyelid malposition from excessive tissue removal.
Muscle Management: When indicated, the orbicularis muscle may be tightened to provide additional support and improve lower eyelid contour.
Wound Closure: Fine sutures are used to close the incision in layers, positioning the scar to heal as an essentially invisible line just below the lash margin.
Fat Repositioning Versus Fat Removal
Modern lower blepharoplasty increasingly favours fat repositioning over aggressive fat removal:
Fat Repositioning: Prolapsing fat is released from its compartments and repositioned into the tear trough depression, effectively using the “excess” tissue to fill the “deficit.” This creates a smooth transition between the lower eyelid and cheek whilst avoiding the hollow, aged appearance that can result from excessive fat removal.
Conservative Fat Reduction: When fat repositioning alone is insufficient, conservative reduction of specific compartments addresses prominent bulging whilst preserving adequate volume for a natural appearance.
Avoiding Over-Resection: Excessive fat removal creates a hollow, cadaveric appearance that can be difficult to correct. Dr Turner’s conservative approach prioritises natural-looking results that age gracefully.
Combining Lower Blepharoplasty with Complementary Procedures
Lower blepharoplasty frequently forms part of a comprehensive periorbital enhancement plan:
Upper Blepharoplasty: Simultaneously addressing the upper and lower eyelids creates harmonious correction across the entire eye area and requires only a single recovery period.
Brow Lift: For patients with descended brows contributing to upper facial heaviness, combining a brow lift with eyelid surgery addresses multiple concerns comprehensively.
Midface Lift: When significant midface descent contributes to the appearance of the eyelid-cheek junction, midface elevation may enhance lower blepharoplasty results.
Facelift Procedures: Lower blepharoplasty complements face and neck lift surgery for comprehensive facial enhancement.
Fat Grafting: Strategic volume restoration to the tear trough, cheeks, or temples can complement surgical correction and enhance overall facial harmony.
Skin Resurfacing: Laser treatments or chemical peels can address fine wrinkles, pigmentation, and skin texture concerns that blepharoplasty alone does not correct.
During the consultation, Dr Turner discusses whether an isolated lower blepharoplasty or a combined procedure will best achieve your aesthetic objectives.
Recovery and Aftercare
Lower blepharoplasty recovery proceeds relatively smoothly compared to more extensive facial procedures. Swelling and bruising typically peak at 48-72 hours before gradually improving, with most patients appearing socially presentable within 10-14 days. During the first week, cold compresses, head elevation, and prescribed eye drops or ointment help manage symptoms and support healing. Sutures (if placed externally) are removed at approximately 5-7 days. Most patients describe mild discomfort rather than significant pain, which is easily managed with simple pain-relief medication. Temporary blurred vision, light sensitivity, dryness, and altered tear production are common initially but resolve as healing progresses.
Most patients return to office-based work within 7-14 days, though those in public-facing roles may prefer slightly longer before resuming professional activities. Light walking is encouraged from early recovery, whilst more strenuous exercise should be avoided for 3-4 weeks. Final results become fully apparent at 3-6 months, as residual swelling resolves and any incision lines mature into barely visible traces. Dr Turner schedules follow-up appointments at one week, one month, and three to six months to monitor healing progress and ensure optimal outcomes.
For detailed information about each recovery milestone, including specific care instructions and strategies to optimise your healing experience, please visit our comprehensive resource:
Recovery After Eyelid Surgery
Risks and Complications
All surgical procedures carry inherent risks that must be understood before proceeding with treatment. Most patients experience expected temporary effects, including swelling, bruising, mild discomfort, temporary vision changes from ointment or swelling, dryness or excessive tearing, and altered sensation around the eyelids—all of which typically resolve within the first few weeks. Less common but possible complications include haematoma (blood collection requiring drainage), infection, asymmetry, visible scarring (with subciliary approach), and under-correction requiring revision surgery.
More significant complications, though rare, include chemosis (conjunctival swelling), ectropion (outward turning of the lower eyelid margin), lower eyelid retraction, worsening or development of dry eye syndrome, and corneal irritation. Dr Turner minimises these risks through comprehensive pre-operative assessment, including lower eyelid laxity testing; conservative surgical technique; avoidance of excessive tissue removal; meticulous attention to haemostasis; and detailed post-operative care instructions. All procedures are performed in accredited facilities with appropriate emergency protocols. These potential risks will be discussed thoroughly during your consultation to ensure you can make a fully informed decision.
For comprehensive information about potential risks and how to minimise them, please read:
Risks and Complications of Blepharoplasty Surgery
Frequently Asked Questions
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by Dr Turner, Specialist Plastic Surgeon
