Lower Blepharoplasty : Rejuvenate Tired, Puffy Eyes
A Comprehensive Guide to Lower Eyelid Surgery for Under-Eye Bags, Puffiness, and Tired Eyes
Lower blepharoplasty is a surgical procedure designed to improve the appearance of the lower eyelids by removing or repositioning fat, tightening skin and smoothing wrinkles or hollows.
It is one of the most effective ways to address signs of aging under the eyes, such as under-eye bags, puffiness, dark shadows and skin laxity, that can make you look older or constantly tired.
Whether performed alone or combined with other facial procedures, lower eyelid surgery can restore a refreshed, more youthful appearance.
What Is Lower Blepharoplasty?
Lower blepharoplasty is a type of ophthalmic plastic surgery that targets the delicate area beneath the eyes. This procedure is commonly sought to correct:
- Under-eye bags or puffiness
- Hollow tear troughs
- Loose or sagging skin
- Wrinkling or crepey texture
- Dark shadows and fatigued appearance
While some patients undergo the surgery for cosmetic reasons, others may benefit functionally, especially when excess fat or laxity causes irritation or visual disruption.
Causes of Lower Eyelid Aging
With age, the following changes can occur in the lower eyelids:
- Fat herniation (bulging fat pads beneath the eyes)
- Skin laxity due to collagen loss
- Weakened lower eyelid muscles
- Volume loss in the midface and tear troughs
These issues often occur together, contributing to a hollowed, puffy, or sagging look.
Refreshed Eyes, Natural Results
Surgical Techniques for Lower Blepharoplasty
Lower blepharoplasty can be performed using one of two primary techniques, depending on the patient’s anatomy, skin quality, and cosmetic goals. Both approaches aim to reduce puffiness, smooth contours, and rejuvenate the under-eye area.
1. Transconjunctival Approach (Hidden Incision)
This technique involves making an incision on the inside of the lower eyelid, leaving no visible scar. It is ideal for:
- Patients with good skin elasticity
- Individuals with fat prolapse or under-eye puffiness but minimal excess skin
Fat pads may be conservatively removed or repositioned into the tear trough area to smooth hollowing and avoid an overcorrected or hollowed appearance.
2. Transcutaneous (Subciliary) Approach
This method uses an external incision just beneath the lower lash line, which typically heals to be virtually undetectable. It is best suited for:
- Patients with loose or sagging skin
- Individuals requiring muscle tightening or skin removal
This technique allows for more extensive correction, including excision of excess skin, conservative fat repositioning or removal, and tightening of the orbicularis oculi muscle for better eyelid support and smoother contours.
Combination Approaches
In many cases, the most natural results are achieved by combining fat repositioning with skin tightening. Your surgeon may recommend combining lower blepharoplasty with:
- Laser skin resurfacing to improve fine lines and skin texture
- Facial fat transfer for volume restoration
- Brow lift or midface lift to address deeper facial aging
This comprehensive approach allows for smoother, more balanced rejuvenation of the lower eyelids and surrounding areas, enhancing overall facial harmony.
Recovery After Lower Blepharoplasty
Lower eyelid surgery typically involves minimal discomfort and a manageable recovery timeline:
- Swelling and bruising are most noticeable in the first 7–10 days
- Cold compresses and head elevation help reduce swelling
- Most patients resume social activities in 7–10 days
- Makeup can typically be worn after 1 week
- Final results settle over 4–6 weeks, though subtle refinement continues for several months
With proper care and guidance, most patients find lower eyelid surgery recovery to be smooth and well worth the refreshed, youthful appearance it provides.
Enhancing Recovery with Advanced Techniques
Some specialized practices, like Balikian Plastic Surgery, use photobiomodulation therapy (light-based treatments) after surgery to:
- Minimize bruising
- Reduce swelling
- Accelerate tissue healing
This advanced therapy uses specific wavelengths of light to stimulate cellular repair and improve circulation in the treated area.
When integrated into a post-operative protocol, photobiomodulation can enhance comfort, speed recovery, and support more refined surgical outcomes.
In addition, gentle lymphatic massage may be recommended to improve fluid drainage and further reduce post-surgical swelling.
Are You a Candidate?
You may be a good candidate for lower blepharoplasty if you:
- Have puffiness, under-eye bags, or sagging lower lids
- Appear tired despite feeling rested
- Are in good overall health and a non-smoker
- Have realistic expectations about results and healing
If these concerns resonate with you, a personalized lower blepharoplasty consultation can help determine whether this procedure is the right approach to refresh your appearance and restore a more rested, youthful look.
Consult with a Specialist
Dr. Richard Balikian is a double board-certified facial plastic surgeon with advanced expertise in lower eyelid surgery.
With over 20 years of experience he offers a personalized approach to help you look refreshed, never overdone.
Considering Lower Eyelid Surgery?
Schedule a consultation with Dr. Balikian to find out whether lower blepharoplasty is right for you.
Discover how expert surgical technique and thoughtful aftercare can help you achieve smoother, brighter, and more youthful-looking eyes.
Start Your Journey
Lower Blepharoplasty FAQs
What does lower blepharoplasty treat?
It addresses under-eye bags, puffiness, hollow tear troughs, and lax skin to create a smoother lid-cheek transition. Contemporary reviews describe shifting from “fat removal” toward contour restoration.
Will there be a visible scar?
Transconjunctival incisions are internal and not visible. Transcutaneous scars sit just beneath the lash line and typically blend well when tension is minimized and closure is meticulous.
Do you remove or preserve fat?
Dr. Balikian favors fat preservation and repositioning to avoid a hollow, aged look, using conservative reduction only for true bulges. Foundational and modern papers support volume-preserving strategies.
When is skin excision appropriate?
When there is lax, crepey, or redundant skin. If lines are due more to texture than excess, laser resurfacing can be paired with surgery to tighten and refine the skin envelope.
What is fat “repositioning,” and why do it?
Instead of discarding fat, it is moved across the orbital rim to fill the tear-trough hollow, creating a smoother lid-cheek contour and reducing shadows. Studies show sustained improvement in contour and satisfaction with repositioning or with conservative fat removal plus micro-grafting in select cases.
Is canthal support always required?
No. It is used selectively to maintain lid position and reduce malposition risk in patients with laxity. Literature supports routine assessment of lid tone and adding canthopexy or canthoplasty when indicated.
What are typical complication rates?
Pooled analyses show low rates for significant issues like ectropion and scleral show when cases are planned carefully and lids are supported. Example pooled rates: ectropion ~0.24 percent, scleral show ~0.37 percent, reoperation ~0.77 percent.
How does Dr. Balikian aim to reduce risks like lid retraction?
By preserving volume, avoiding over-resection of skin or muscle, assessing lid tone, and adding canthal support when needed. This preservation-first philosophy aligns with contemporary guidance.
What is the role of lasers or energy devices?
Fractional CO₂ or erbium lasers can be used to tighten skin and improve fine lines around the lower lids, often enhancing surgical results and recovery when used judiciously.
What is the recovery timeline like?
Swelling and bruising peak during days 2 to 4, then improve. Many patients are presentable around 7 to 14 days, with refinement over several weeks and continued maturation for months. These timelines are consistent with published series and reviews.
Does lower blepharoplasty help with dark circles?
If shadows are caused by contour (a hollow tear trough or a bag casting a shadow), fat repositioning can make circles look better. If circles are mostly pigment or skin texture, resurfacing and skin care are added.
Is transconjunctival surgery safer than transcutaneous?
Both are safe when well planned. Transconjunctival avoids an external scar and reduces anterior lamella disruption; transcutaneous allows precise skin and muscle work. Complication rates are low in large series for both, with selection based on anatomy and goals.
Are there situations where fat removal is better than repositioning?
Yes. True herniation that persists after repositioning or bulky medial fat pads may benefit from conservative removal. Balanced approaches that blend repositioning with limited reduction are reported to perform well.
Trust Your Face to a Facial Plastic Surgeon
Dr. Richard Balikian is a renowned facial plastic surgeon known for his dedication to patients throughout Southern California.
With more than two decades of experience and double board certification in Facial Plastic and Reconstructive Surgery and Otolaryngology – Head and Neck Surgery, he brings together surgical precision and an artist’s eye.
Dr. Balikian is among a select group of specialists whose advanced training is devoted entirely to procedures of the face and neck.
Learn More About Plastic Surgery
Richard V. Balikian, MD, FACS
Double Board-Certified Facial Plastic Surgeon
Balikian Facial Plastic Surgery: Richard V. Balikian, MD, FACS
Tyler Frew, MD
Board-Certified Plastic Surgeon
