Summary
The lower eyelid commonly develops two age-related changes: bags caused by fat prolapsing forward, and a hollow tear trough at the junction of the eyelid and cheek. Lower blepharoplasty addresses both, often by repositioning fat rather than simply removing it.
Who is this for?
Patients I commonly see:
- visible lower-eyelid bags worsening on smiling or in the evening,
- a hollow, shadowed tear trough,
- mild crepey skin (often best addressed with a small skin pinch),
- post-surgical or post-traumatic asymmetry.
Patients with significant lower-lid laxity may need a tightening procedure (a canthopexy or canthoplasty) at the same time.
What the procedure involves
The operation is performed under local anaesthetic with sedation or, by preference, a short general anaesthetic. The most common approach is transconjunctival: the incision is on the inside of the eyelid and leaves no external scar. Fat is repositioned over the tear-trough rim rather than excised, helping to restore a smooth contour.
A small skin pinch can be added for fine wrinkling. Where additional tightening is needed, a discreet lateral canthopexy is performed through a tiny incision at the outer corner.
Recovery and what to expect
- Day 0 to 4: bruising and swelling.
- Week 1 to 2: most patients return to work, often with light camouflage make-up.
- Month 2 to 3: the result settles. Subtle continued improvement up to 6 months.
Risks and alternatives
Risks include bleeding (rarely a retrobulbar haematoma, a recognised but very uncommon emergency), bruising, asymmetry, lower-lid retraction, dry eye, and revision surgery. Careful pre-operative planning and a conservative approach minimise these.
Non-surgical alternatives (tear-trough fillers, skin treatments) have a useful role in selected patients, particularly those who are not yet candidates for surgery.