Lower Eyelid Correction (Blepharoplasty)

More about the lower eyelid correction (blepharoplasty)

The eye area is most attractive when everything is in the right place and in balanced proportions.

If this harmony is disrupted, we are often asked uncomfortable questions about whether we are tired, sad, or suffering from allergies. Excess skin on the lower eyelids and fat pads forming under-eye bags dramatically change our appearance, making us look older, tired, or even unwell.

AESTHETICS THAT GIVE THE EYE A TOUCH OF YOUTH

An aesthetically pleasing lower eyelid should have just the right amount of volume and smooth, tight skin, with a slight upward tilt at the outer edge—this is known as the positive tilt of the eye fissure. This upward contour is what gives the eyes a youthful expression.

A smooth transition from the eyelid to the cheek is also very important. The soft tissues of the cheek should gently slide over the firm cheekbone. During the aging process, the bony rim of the eye socket becomes more visible and casts a shadow. Above it, a once-tight orbital septum weakens, allowing fat around the eyeball to protrude and form under-eye bags. At the same time, the skin of the eyelids becomes thinner and stretches.

AT WHAT AGE IS THIS TYPE OF EYELID SURGERY APPROPRIATE?

"Eyelid procedures can be performed at any age, but most commonly after the age of 40.
With lower blepharoplasty, an incision is made either just beneath the lower lashes or on the inner side of the lower eyelid, through the conjunctiva. For patients who have a significant amount of excess skin under the eyes, we make the incision just below the lashes to remove the redundant skin. At the same time, we can remove, reposition, or even add fat. The same incision can also be used to lift the midface area.

This technique allows us to tighten the lower orbital septum, which stretches and weakens over time, resulting in visible bulging of the lower eyelid — known as under-eye bags. The fat pad that protrudes through the septum can be reduced and repositioned to cover the sharply defined bony rim of the eye socket, creating a smoother transition between the eyelid and the cheek.

It is crucial to simultaneously support the lower eyelid with additional tightening of the outer corner of the eye (canthoplasty), which prevents unwanted complications such as eyelid eversion (pulling away from the eyeball) or a downward tilt of the eye fissure."

For patients who do not need skin removal and whose main concern is fat pads, we perform a transconjunctival blepharoplasty. The incision is made on the inside of the lower eyelid, through the conjunctiva. This approach can also be used to lift the entire midface region.

Both techniques improve the shape of the lower eyelid and under-eye area. Instead of removing fat around the eyelid, we prefer to add it in order to replace the fat that has diminished due to aging, migrated to undesired areas, or was never present in the first place.

Fat is removed via liposuction from parts of the body where there is an excess (waist, hips, inner knees) and transferred to areas where there is a lack — such as the cheeks, temples, or brows. To avoid the appearance of lumps, the fat must be injected deep enough. These issues can also be addressed more precisely and with a faster recovery using hyaluronic acid fillers.

RECOVERY AFTER BLEPHAROPLASTY

After the procedure, the patient applies antibiotic or vitamin ointment to the wounds — the same ointment is applied into the eye during surgery to protect it, which may cause temporarily blurred vision right after the procedure. The ointment prevents eye dryness and infection. Due to swelling and fine stitches, contact lenses cannot be worn for about a week, and glasses are recommended instead. Dark sunglasses not only conceal the signs when going home or running errands, but also protect the sensitive eyes from sunlight.

The thin skin around the eyes is very prone to swelling. To minimize swelling and promote healing, we recommend alternating cold compresses during the first 24–48 hours after the procedure (20 minutes on, 20 minutes off) and sleeping with your head elevated. The head should not be lowered below shoulder level. We also recommend lymphatic drainage massage under the guidance of a doctor or qualified beautician, but not earlier than 14 days after the surgery, once the stitches have been removed. Bruising is common due to the thin skin and rich blood supply of the eyelids, but it typically disappears within one to two weeks.

The stitches are removed 7 to 10 days after the procedure. Once the stitches are removed, it is important to let the scar rest — avoid rubbing, scratching, or pulling. In rare cases, patients may experience temporary tearing, redness, or discomfort, which usually resolves on its own.

Swelling usually subsides within 1–2 weeks, allowing the patient to assess the results for the first time. After 6 weeks, the appearance of the eyelids is considered final. If a canthopexy was also performed, swelling and a feeling of tightness in the outer corners of the eyes may last a little longer.

Side effects are rare. Patients may experience excessive or reduced tearing; dry eyes or a gritty sensation in the eyes are also uncommon. Both conditions are treated with artificial tears or therapeutic eye drops to reduce conjunctival swelling. These symptoms typically resolve on their own within a week.