Lower Blepharoplasty


Lower Eyelid Blepharoplasty

  • As we grow older, our bodies undergo a number of visible changes. One of {the} most noticeable changes is {the} ‘ageing eyes’ that is characterized by changes in {the} upper eyelids and lower eyelids.
  • The lower eyelids are plagued by three main aesthetic problems, namely festoons of {the} orbicularis oculi muscle, malar mounds and protruding intraorbital fat which are effectively managed by a lower eyelid blepharoplasty.

Defining Problems of {the} Lower Eyelid

  • Festoons of {the} eyelids are redundant folds of lax skin and orbicularis muscle of {the} upper or lower eyelids that hang, in hammock-like fashion, from canthus to canthus when {the} face is upright. Festoons might be in {the} upper eyelid, pretarsal or lower eyelid, orbital, malar or cutaneous dewlap with no muscle.
  • Malar mounds are discrete, pillow-like, soft tissue bulges that protrude from {the} lateral part of {the} malar eminence. They are inconspicuous during normal facial expressions but might be accentuated by smiling.
  • Palpebral bags or baggy eyelids are may also be called herniated intraorbital fat. They are {the} result of intraorbital fat bulging outward against an attenuated or weak orbital septum of {the} upper or lower eyelid. They are {the} most common aesthetic deficiency of {the} eyelids.

Indications of Lower Eyelid Blepharoplasty

  • A lower eyelid blepharoplasty is considered appropriate management for palpebral or malar festoons, mounds, or bags that reflect an appreciable aesthetic defect in an otherwise physically and psychologically healthy patient. When well executed, it is highly rewarding for both {the} surgeon and {the} patient.
Contraindications of Lower Eyelid Blepharoplasty
  • Absolute Contraindications: Any pathologic condition of {the} eyelids or orbital structures is an absolute contraindication for blepharoplasty. This might however be relaxed if agreed upon by both {the} patient and {the} surgeon.
  • Relative Contraindications: Any medical conditions that might alter {the} patient’s response to anaesthesia or sedation or a patient with unrealistic expectations.

Lower Eyelid Blepharoplasty – The Procedure

  • A blepharoplasty usually requires about 1 to 3 hours and might be done under local anaesthesia or under general anaesthesia.

A lower eyelid blepharoplasty involves {the} following steps:

Step 1. Local Anaesthesia: The procedure is done under local or modified local anaesthesia and patient co-operation is of utmost importance in achieving a symmetrical surgical outcome.

Step 2. Making {the} Skin Incision: Incision lines are made below {the} lower eyelashes in a discreet manner such that {the} incision is hidden from plain view.

Step 3. Skin Excision: The skin overlying festoons, malar mounds and baggy eyelids might or might not be removed depending on {the} outcome desired.

Step 4. Fat Removal and Redistribution: Excess fat is removed or redistributed to obtain a smooth and younger-looking surface above {the} cheek and under {the} eyes. When present, muscle laxity is also corrected during this step. Fat might also be transferred or dermal fillers applied to hollow areas for a plump, healthy looking face to correct sunken eyes.

Step 5. Haemostasis: Bleeding is less of a problem with lower eyelid blepharoplasty but must be tackled instantaneously if it occurs.

Step 7. Closure: The wound is closed using either absorbable or non-absorbable sutures. Sutures should be removed at 7 to 8 days following surgery. The wound heals with scars blending with {the} surrounding natural creases.


Complications of Lower Eyelid Blepharoplasty
  • Complications are rare with lower eyelid blepharoplasty but might include pain, swelling, scarring, ectropion, haematoma, infection, excessive tearing, adverse reaction to anaesthesia, and blurred or double vision.

What can you expect from a Lower Eyelid Blepharoplasty?

  • Lower eyelid blepharoplasty removes festoons, malar mounds and baggy eyelids thus providing a highly improved, younger-looking eyes that is immensely gratifying for both {the} patient and {the} surgeon. The contrasting looks in {the} pre-surgery and post-surgery photos is quite dramatic with well sculpted lines and creases with obvious absence of baggy eyelids, festoons and malar mounds.
  • The effects of blepharoplasty usually last 5 to 7 years, but might even provide lasting effects for decades. It is best to be optimistic yet set realistic end-points before undergoing {the} surgery for best results.
  • However, keep in mind {the} recovery period immediately after surgery during which there is swelling, pain, redness and irregularity of surface. These changes are transient and will resolve to form a smooth, glowing and accentuated surface that is free of irregularities.





Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape {the} upper eyelid or lower eyelid by {the} removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.

  • Eyelids (and your eyes) are, perhaps, what other people notice initially.
  • Eyelid surgery to improve {the} appearance of {the} eyelids is often called 'eyelift' or 'blepharoplasty'.
  • As we age, your eyelids (both upper and lower) might become 'droopy' or 'baggy'. The eyelid skin stretches and muscle tone weakens
  • In addition, your eyebrows might also droop.
  • Your droopy upper eyelids and droopy brows might give you {the} appearance of being sleepy, tired and aging prematurely
  • In addition, this sagging, might lead to brow/eyelid strain
  • Excess skin can hang over {the} eyelid and interfere with vision

This surgery can be performed on both {the} UPPER and on {the} LOWER eyelids - or both.

  • Patients with a less severe amount of excess skin might have a similar procedure performed for cosmetic reasons.
  • Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce {the} wrinkling of skin.
  • Blepharoplasty is performed through external incisions made along {the} natural skin lines of {the} eyelids, such as {the} creases of {the} upper lids and below {the} lashes of {the} lower lids, or from {the} inside surface of {the} lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until {the} final result becomes stable.
  • Depending upon {the} scope of {the} procedure, {the} operation takes one to three hours to complete.

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