As we age, the appearance of our eyes often changes from youthful and vibrant to aged and fatigued. This aged look commonly appears as under eye hollows (dark circles) or puffy bags. Lower blepharoplasty is a surgery that improves the appearance of the under eye area by reducing the prominence of eyelid bags, while simultaneously filling depressions around the eyes (ie. dark circles). Rather than removing precious eyelid fat, Dr. Massry instead transposes the excess fat to the hollows to reduce elevations (fat prominence) and fill the depressions (eyelid hollows). This technique smoothes the contour irregularities and re-creates the natural contours of youth.

Why does the appearance of your eyelids change?

The lower eyelid skin is very thin and delicate. Just below the eyelid skin is a layer of muscle, which is separated from the fat by a thin tissue membrane called the orbital septum. The muscle layers and orbital septum weaken and sag as you age and fat deposits shift in response to this weakness. This shift in fat causes puffiness and bags under the eyes. Additionally, the skin itself loses elasticity and collagen, causing the skin to become lax and saggy.

How is lower blepharoplasty performed?

There are two surgical techniques that can be used for removing or repositioning fat deposits in the lower eyelid. For patients with excess lower eyelid skin, the outside lower eyelift, which is technically referred to as transcutaneous lower blepharoplasty, is appropriate. This procedure removes excess skin and sometimes muscle tissue in addition to fat deposits. Alternatively, an inside lower blepharoplasty, referred to as a transconjunctival blepharoplasty, involves a single incision inside the lower eyelid in the thin membrane that lines the inside of the eyelid (the conjunctiva). This technique is used when the patient has fatty deposits and little or no excess skin that needs to be removed.

Lower blepharoplasty is most commonly performed under general anesthesia, but can also be performed under local anesthesia with sedation, in which the eyelids and surrounding areas are numb and you are relaxed but you may not be asleep. Protective shields, similar to contact lenses, may be applied to your eyes.

Outside lower blepharoplasty

An incision is made just beneath the lower eyelash line so that any resulting scars will be as inconspicuous as possible. Another small incision will be made in the muscle layer so that Dr. Massry can separate the skin and muscles from the underlying orbital septum. Dr. Massry will then carefully open the orbital septum to expose the three orbital fat deposits of the lower eyelid. The fat deposits will be removed or repositioned to reduce puffiness under the eyes. Finally, any excess skin is removed from the outer eyelid to get rid of the patient’s under eye bags, and the incisions are closed with sutures.

Inside lower blepharoplasty

When performing an inside lower blepharoplasty, Dr. Massry will make an incision inside the lining of the lower eyelid. He will then gently pull the lower eyelid away from the eye and make a small incision in the conjunctiva, exposing the orbital fat deposits. Fat deposits will be removed or repositioned to reduce the appearance of puffiness under the eyes. The incision will then be closed.

What to expect after lower blepharoplasty?

There will be pain, bruising and swelling after your lower blepharoplasty. Dr. Massry recommends you apply cold compresses and take some pain medication to make you as comfortable as possible during your recovery. You should avoid strenuous activity, such as exercise or heavy lifting, to allow your body sufficient time to heal. Swelling and bruising should subside within 7 – 10 days.

The results of your lower blepharoplasty will leave you looking well rested and rejuvenated! The results will be long lasting, however keep in mind that the aging process will continue.

To learn more about lower blepharoplasty, call 310.657.4302 to schedule a consultation with Beverly Hills eyelid expert Dr. Massry.

Watch Dr. Massry talk about his customized approach to lower blepharoplasty on!