Lower Blepharoplasty
Under-eye bags, puffiness, and dark shadows can make the face look tired even when it is not. Lower blepharoplasty addresses the bulging fat, loose skin, and hollowing that develop under the eyes with age.
The under-eye area changes in three ways with age: fat bags in the lower eyelids become more prominent as we age, the cheek tissue loses volume and pulls away from the lid, and the skin itself becomes thinner and shows more shadowing. The combined effect is the classic tired, hollow, or puffy under-eye that no amount of sleep seems to fix.
Dr. Boxrud most often performs lower blepharoplasty transconjunctivally, through the inside of the lower eyelid, so there is no visible external scar. The bulging fat is either removed or, more often, repositioned over the orbital rim to smooth the transition between lid and cheek. When excess skin is also a concern, a small skin-only excision is added at the lash line. As an oculofacial plastic surgeon, she operates with a focus on preserving the natural shape and support of the lower lid, avoiding the rounded or pulled-down appearance that can follow under-eye surgery in less specialized hands.
Patients travel to her Los Angeles practice from across the city and beyond for under-eye surgery specifically because of this conservative, anatomic approach. The goal is a rested, natural look, not an obviously operated one.
- Procedure
- Outpatient, typically 60 to 90 minutes.
- Anesthesia
- Mild anesthesia with in most cases.
- Recovery
- Most patients return to non-public activities within 5 to 7 days. Bruising along the lower lid typically fades by two to three weeks.
- Approach
- Transconjunctival (no external incision) in most cases; skin-only excision added when needed.
What does lower blepharoplasty fix?
Lower blepharoplasty addresses under-eye bags, puffiness, dark shadows, hollows along the orbital rim, and loose lower-lid skin. It is one of the most technique-dependent eyelid procedures because the lower lid is delicate and unforgiving of error.
Will I have visible scars from lower eyelid surgery?
When the procedure is done from inside the lid (transconjunctival approach), there is no visible scar at all. When a small external incision is needed, it is placed just under the lash line and is designed to be virtually invisible once healed.
What is the difference between transconjunctival and external lower blepharoplasty?
A transconjunctival lower blepharoplasty is performed entirely through the inside of the lower lid, with no visible incision. It is ideal for patients whose main concern is fat pseudoherniation (bags). When excess skin also needs to be addressed, a small external incision under the lash line is added.
How long is recovery from lower blepharoplasty?
Most patients are comfortable in public around one week. Bruising and swelling resolve over two to three weeks. Final settling of the lower-lid contour takes three to six months.
Does lower blepharoplasty get rid of dark circles?
It depends on the cause. Dark circles from shadowing under bags improve dramatically once the bag is corrected. Pigmentary dark circles (where the skin itself is darker) are not addressed by surgery and may need laser or topical treatment.
Will lower eyelid surgery change the shape of my eye?
A pulled-down or rounded lower lid, the most-cited concern after lower blepharoplasty, comes from compromising the support of the lid. Dr. Boxrud’s technique is anatomic and conservative: addressing the fat and skin without disrupting that support.
Can lower blepharoplasty be combined with other procedures?
Yes, often. It is frequently planned together with upper blepharoplasty, midface lift, or non-surgical under-eye filler, depending on the anatomy.