"Eyebags" (lower lid blepharoplasty)

The lower lids can age in a similar fashion to the upper eyelids (see Upper Eyelid Blepharoplasty), with changes in skin and muscle tone, lower eyelid laxity and prolapse of orbital fat. This can result in "puffy" lower eyelids or "eyebags" which can be ageing and give a tired appearance.

Patients with subtle eyebags or mild skin laxity may not be suitable for surgery and be better trying other less invasive procedures eg: improved skin care or a mild chemical peel using trichloracetic acid (TCA peel). Other people may have a tired look due to lower eyelid dark circles and be advised to try the relatively new treatment of using "tear trough" dermal fillers (see Restylane section) rather than undergoing a lower lid surgical procedure.

What does a Lower Eyelid Blepharoplasty involve?

A lower eyelid blepharoplasty can be performed under local anaesthetic with sedation, but is more commonly undertaken using a general anaesthetic, especially if combined with an upper eyelid blepharoplasty (known as a "four lid blepharoplasty").

There are two approaches for a lower eyelid blepharoplasty:

1. Transcutaneous (through the skin)
In an external transcutaneous lower eyelid blepharoplasty a fine incision is made just below the eyelashes extending out to laughter lines, or crows feet, at the outer corner of the eyelid. This approach allows excess skin to be removed and the orbicularis muscles tightened. At the same time any lower eyelid laxity can be addressed by shortening the lid or improving the lid support using appropriate sutures (canthopexy). Bulgy prolapsed fat can be debulked or repositioned (fat draping) in order to improve contour by smoothing out the hollow between the lower eyelid and the upper cheek. At the end of the procedure discreet sutures are used to close the incision and the wound usually heals well with no significant visible scar.

Tired looking eyes due to lower lid “eyebags” in a 41yr old lady

Tired looking eyes due to lower lid “eyebags” in a 41yr old lady

Same patient following a transcutaneous lower lid blepharoplasty

ame patient following a transcutaneous lower lid blepharoplasty

2. Transconjunctival (through the conjunctiva)
In situations where there is no excess skin to tighten or remove, usually younger patients, the surgery can be performed via an incision through the conjunctiva on the inside of the eyelid. This approach allows orbital fat to be effectively removed or more commonly repositioned. Post-operative swelling may be less using this technique which also has the advantage of not leaving any external scars.
It is important with any cosmetic eyelid surgery to have realistic goals and to have discussed fully concerns and expectations. Although most of the post-operative swelling and bruising resolves in the first 2 weeks after surgery, lower eyelids can take several more weeks to fully settle. Serious complications are rare in experienced hands, but potential risks, limitations and benefits will be fully communicated at an assessment.

Puffy "dark" lower lids in a 40yr old man

Puffy "dark" lower lids in a 40yr old man

Same patient 6 weeks after a transconjunctival lower lid blepharoplasty

Same patient 6 weeks after a transconjunctival lower lid blepharoplasty