Lower blepharoplasty

Lower blepharoplasty is surgery on the lower eyelid. It addresses the puffiness caused by fat that has come forward beneath the eye, and, where present, excess lower-lid skin. It is a surgical procedure, not an injectable treatment, and it involves incisions, a recovery period and the risks that go with operating close to the eye.

What it may help with

• Under-eye bags caused by fat prolapse.
• Excess or crêped skin of the lower lid.
• A tired appearance around the eyes that persists regardless of sleep.

It does not treat dark under-eye pigmentation, which has other causes and other treatments, and it does not address the upper eyelid — that is a separate procedure with a separate assessment.

Assessment and suitability

Assessment covers eye health, dry-eye symptoms, lower-lid tone and position, skin quality, the distribution of fat, your medical history, medication including anticoagulants, smoking, and what you want the outcome to be. Photographs are taken and written consent is obtained. Where an eye condition or a lid-laxity problem is found, an ophthalmological or oculoplastic opinion is sought before anything is planned.

Surgery is not appropriate for everyone who asks for it. Where the assessment points to a non-surgical option — or to no treatment — that is what we will tell you.

What usually happens

The approach depends on what the assessment finds. Where the issue is fat alone and the skin is good, an incision may be made inside the lower lid, leaving no external scar. Where excess skin also needs addressing, an incision is made just below the lash line. Local anaesthetic with or without sedation is usual. The procedure commonly takes around an hour, and stitches, where used externally, are generally removed within about a week.

How many visits to expect

A consultation, the procedure itself, a review within the first week and at least one further review. Visible bruising and swelling commonly take two to three weeks to settle enough for ordinary social activity, and the final result settles over several months. If you are travelling, this is treatment to plan a trip around rather than fit into the end of one.

Limitations, risks and alternatives

• Bruising, swelling, watering, temporary blurred vision and dry or gritty eyes are common in the early period.
• Recognised risks include bleeding, infection, scarring, asymmetry, dry eye that persists, and changes in the position of the lower lid such as rounding or pulling down.
• Very rarely, bleeding behind the eye can threaten vision. This is the reason for the post-operative instructions and for the urgency of the warning signs below.
• Further surgery is sometimes required to refine the result.
• The result is not permanent: the eyelid continues to age.
• Alternatives include no treatment, addressing the surrounding contour with filler where the assessment supports it, skin-quality treatments, or simply managing the factors that make puffiness worse.

After your treatment

Keep your head raised, use cold compresses as directed, avoid bending, lifting and strenuous activity for the period you are advised, and do not rub the eyes. Use any prescribed drops or ointment as instructed and protect your eyes from sun and wind. Seek help immediately — the same hour — if you develop sudden severe pain, rapidly increasing swelling or bruising, or any loss or change of vision.