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Lower Blepharoplasty

Lower eyelid bags are not unusual and often occur from advancing age, eyelid swelling, allergies, certain medical conditions, and hereditary influences. In addition, the lower eyelids frequently develop fine wrinkles and crepey skin over time, both of which further contribute to an aged appearance. For individuals bothered by these cosmetic concerns, lower eyelid surgery can often be an effective solution.

Also called lower blepharoplasty, lower eyelid surgery is an aesthetic treatment that removes excess skin and bags while tightening the lower lids for a rejuvenated, more refreshed appearance. Considered technically demanding from a surgical standpoint, the procedure typically requires the expertise of a highly qualified and experienced surgeon to yield excellent results.

Our extensively trained oculoplastic surgeon—Michael Connor, MD—is regarded as one of South Florida’s foremost experts in lower blepharoplasty, having helped numerous patients achieve the look and function they desire in the eye region. To learn more about lower eyelid surgery and Dr. Connor’s approach, please take a look at the informative sections below, or contact our practice today to book a consultation.

What factors affect the lower eyelids and aging?

There are numerous factors that give you the appearance of your lower eyelids. First, is your DNA. You can thank your mom or dad. There is no way to choose the appearance of your lower eyelid. Look at pictures of your relatives and you will spot similarities between your eyelid appearance and theirs. Birthdays are another factor. As we age, we lose volume in the midface and the surrounding cheek descends with gravity, which allows the normal lower eyelid fat to appear. This is also known as an ‘eyelid bag’. These develop due to laxity in the skin and a structure called the septum. The tendon at the outer corner of your eyelids can also loosen from blinking several times a day over several years. This can change the shape of your eyelids to a round, sad, tired appearance. There are several anatomical differences between all of us including- the eyelid position, the underlying boney structure around the eyes, the eyebrow position, and the eyeball position in the socket (prominent or deep set). Examining and understanding those differences is instrumental in creating a plan for your personalized lower eyelid blepharoplasty.

Are there any skin care options that can help with the dark circles?

Dark circles under the eyes are created by three things:

1. Shadowing can be caused by eyelid contour abnormalities as well as a shadow casted down from the eyebrow or superior orbital rim.

2. Skin pigment in the tear trough, which is the area between the lower eyelid and cheek.

3. Thin skin in the lower eyelid is the most common cause. This is the thinnest skin in the body and it does not have a thick middle layer. There is an eyelid muscle called the orbicularis that sits just below the skin. The muscle is purple and is often times visible through the thin eyelid skin.

Treatment of dark circles depends on the cause and relies on the proper diagnosis. A lower eyelid blepharoplasty or placement of filler in the tear trough may improve the appearance of dark circles caused by contour abnormalities (i.e. fat bags).

If I’m not quite ready for surgery, are there non-surgical options available?

Absolutely. There are several options for patients who aren’t ready for surgery or cannot afford the downtime that comes with surgery. Lower eyelid appearance can be improved by using fillers to improve contour abnormalities, Botox for some of the dynamic lines such as crow’s feet and chemical skin peels to restore the quality of skin. We can also recommend a daily skin care regimen to reverse and prevent some of the aging changes seen in the lower eyelid.

What are the different methods for lower eyelid surgery?

Transconjunctival Lower Eyelid Blepharoplasty:
A transconjunctival lower eyelid blepharoplasty is performed on the back side of the lower eyelid through the conjunctiva. This allows access to the bags of fat without making a skin incision. The fat can be removed or repositioned across the tear trough to create a smooth transition to the cheek. This approach is used for younger patients or patients who want to avoid a scar in the lower lid. It can be combined with a conservative skin pinch or a chemical peel to improve the lower eyelid skin appearance.

Transcutaneous Lower Eyelid Blepharoplasty:
A transcutaneous (through the skin) lower eyelid blepharoplasty is where an incision is made 2 millimeters beneath the lash line, typically in a natural crease or fold. This allows direct access to the fat. The fat can be removed or repositioned. Redundant skin in the lower lid can also be removed. The skin incision heals remarkably well.

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How long does the lower eyelid surgery take?

The operating time for a lower eyelid blepharoplasty can range from an 1 to 1.5 hours. It depends on the extent of the work necessary to achieve a natural look.

What type of anesthesia is used?

A skin only lower eyelid blepharoplasty can be safely performed in the office under straight local anesthesia. This can be combined with an upper eyelid blepharoplasty. Numbing medicine is slowly and gently administered to the lower eyelid skin using a very small needle. Medicine is then added to the numb area and slowly spread throughout the eyelid. For more extensive lower eyelid surgery, such as fat excision or reposition and eyelid tightening, Dr. Connor prefers intravenous sedation to ensure the patient is comfortable throughout the procedure. This is done at an outpatient surgery center with an anesthesiologist. Intravenous sedation is safe and does not require a breathing tube. The patient sleeps through the procedure and wakes up in the recovery room.

What is recovery like for lower eyelid surgery?

Recovery from lower eyelid surgery is variable and depends on the amount of work you have done. Most patients will experience worsening bruising and swelling for the first 2-3 days. There is minimal to no pain, however a pain pill may be prescribed, and in most cases, patients only use it on the day of surgery. Tylenol is usually sufficient to keep you comfortable following your procedure. Cool compresses are recommended for 20 minute intervals for the first 2 days. You may return to work after 5-7 days but expect to still have some bruising and swelling. Bruising can last up to 2 weeks and can be covered by makeup after 1 week. You should not perform anything strenuous for 2 weeks following your surgery.

I am interested! How should I proceed?

If you are interested in learning more about your personal options, schedule a consultation with Dr. Connor to discuss your goals and concerns. A consultation is a great way to learn more about the treatments available to you. A customized procedure will be outlined for you if you are a suitable candidate.

What Does Lower Eyelid Surgery Cost?

Like most cosmetic procedures, pricing for lower blepharoplasty is unique to each individual. Some of the most common elements that can influence total cost include the the quantity of fat and/or skin removal needed, the specific technique utilized, and whether or not the procedure is combined with complementary treatments.

When choosing a doctor for lower eyelid surgery, it is imperative to understand that the fee a surgeon charges is often a good indication of their training, skill, and overall experience. As a result, the decision to select a particular eyelid surgeon should not be made based on cost alone—particularly for such a technically challenging procedure.

Contact Our Practice

To learn more about lower blepharoplasty, or if you would like to book an appointment with Dr. Connor to find out if this treatment is right for you, please do not hesitate to call our office or reach out to us online today.