Lower Blepharoplasty - SM Plastic Surgery

Fat repositioning rearranges the under-eye fat through the conjunctiva; with no skin incision, it is considered mainly for younger people with little laxity. Lower blepharoplasty opens along the lower lash line and refines stretched skin and descended muscle as well, considered mainly for mature skin with laxity and wrinkles. Which suits varies with the under-eye, so the decision follows a detailed assessment.

It is judged less by age than by the degree of skin laxity, wrinkles and fat protrusion. Where elasticity remains and only the fat is the problem, repositioning is considered; where skin and muscle laxity is clear, lower blepharoplasty suits. The under-eye is assessed for each person and the necessary extent decided.

The incision follows the line just beneath the lower lashes so the scar hides in the lash line, becoming less noticeable with time. How well it heals varies with constitution and care, however, so it cannot be assumed there will be none at all.

Rather than removing fat outright, it is repositioned into the hollow of the tear trough or the amount left is adjusted, aiming for a smooth curve. Removing too much can bring hollowing, so fat volume and the degree of hollowing are examined together. Results vary from person to person.

It varies, but a return to daily life is generally possible from about 7 days after surgery, with sutures out after 5–7 days. It can take longer for swelling and bruising to subside fully and look natural. The pace of recovery varies with the skin and the extent of surgery.

Lower blepharoplasty is performed through an incision along the line just under the lower lashes, tidying sagging under-eye skin and loosened muscle while bulging fat is either removed or moved into the hollow so the under-eye area looks smoother. Unlike under-eye fat repositioning, which treats only the fat through the conjunctiva without a skin incision, it also addresses skin laxity and wrinkling. The approach varies with skin elasticity and fat volume, and results and recovery differ from person to person.

For lower blepharoplasty we generally guide about seven days to return to daily life and about seven days for the swelling to settle. Because an incision is made, swelling and bruising can last longer than with transconjunctival under-eye fat repositioning, and the pace of recovery varies from person to person. The course is monitored at follow-up visits.

In lower blepharoplasty, sagging skin and loosened muscle are tidied while the bulging fat is not simply removed; instead it may be moved toward the tear-trough hollow or its remaining volume adjusted. The aim is to soften the step between the bulge and the hollow together. If midface hollowing is also present, combining another method may be necessary, so this is decided after a detailed examination.

After lower blepharoplasty, swelling, bruising, infection and asymmetry may occur, and ectropion in which the lower lid is pulled down can also appear, so how much skin to remove is designed carefully. The extent of excision is set after assessing the supporting tissue and skin elasticity together, and if you feel tightness under the eye during recovery it is best to come in for a check. Results and recovery differ from person to person.

About a week is the standard for stitch removal, sometimes as early as day five and as late as two weeks. It depends on how the incision is healing and on the condition of the under-eye area, so the timing is set while following your progress. We generally guide two to three follow-up visits.

As lower blepharoplasty tidies sagging under-eye skin and loosened muscle, it aims to soften the wrinkles that formed where the skin folded. Wrinkles that appear with facial expression, and skin texture itself, do not necessarily change to the same degree, so how far they can be addressed is explained after assessing skin elasticity and wrinkle depth. Results differ from person to person.

Transconjunctival fat repositioning is considered when bulging is the main cause, so it cannot address skin and muscle that loosen over time. When skin laxity becomes pronounced, lower blepharoplasty with an incision is reviewed as well. Whether an additional operation is needed in your current condition is judged after examining the under-eye area directly.

The operation takes about an hour and is performed under local or sedation anesthesia. We generally guide two to three follow-up visits, for stitch removal and to monitor the course. This may vary with the under-eye condition and the extent of excision, and is explained during the consultation.

If the under-eye area looked dark because of the shadow created by sagging skin and bulging fat, smoothing that contour may soften the shadow. Dark circles caused by pigmentation, however, are difficult to address with surgery alone, so other methods are reviewed together. The method is chosen after separating out the underlying cause.

Lower blepharoplasty addresses not only sagging skin but also the loosened muscle beneath the eye and the bulging fat together. An approach that treats only fat through the conjunctiva cannot address muscle laxity, so in that case lower blepharoplasty with an incision is reviewed. The plan changes according to which of the three elements is the main cause.