Lower Blepharoplasty

What causes bags, sagging skin, and dark circles under the eyes?

The lower-eyelid blepharoplasty surgery targets the appearance of under-eye bags, dark circles, and skin redundancies. But what causes these conditions? Several factors can contribute to bags, dark circles, and sagging skin under the eye:

• Age: As we age, our skin loses its elasticity, and the tissues and muscles that support the eyelids begin to weaken. As a result, the muscles around the eyes can start to droop, and the skin can begin sagging. This can also cause the fat around the eyes to shift and move downward to the area below the eyes, which contributes to the puffiness that appears as under-eye bags.
• Genetics: Family history can also be to blame. Some people are predisposed to darker pigmentation under the eyes, which results in dark circles, while under-eye bags and puffiness can stem from a genetic predisposition to fluid retention.
• Fluid retention: When not caused by genetics, fluid retention can occur situationally — for example, after a salty meal or when you first wake up.
• Medical conditions: Several medical conditions can cause or contribute to under-eye issues. For example, under-eye bags can be caused by the inflammation that accompanies common food and seasonal allergies, which can also cause the blood vessels around the eyes to dilate, leading to darker-looking skin. More serious conditions such as dermatitis, dermatomyositis, thyroid problems, and kidney disease can also be to blame.
• Lifestyle factors: Several lifestyle choices can contribute to or worsen the appearance of bags, loose or excess skin, and dark circles. Smoking, overexposure to sunlight for prolonged periods, and even prolonged screen time can play a part.

What does the procedure entail?

The techniques used in lower blepharoplasty procedures can vary depending on the patient’s health needs and the extent of the corrections needed to achieve the desired results. Likewise, individual doctors may have different approaches to operating. If you’re considering a lower blepharoplasty, your medical provider will consult with you about what you should expect from the procedure during your preliminary appointments.

Despite the variations, however, there are a few constants. When you undergo a lower blepharoplasty, you’ll be given either local anesthesia along with sedation or general anesthesia.

In general, here’s what you can expect from the procedure itself:

• The doctor begins by making a series of tiny incisions along the inside surface of the lower eyelids. Incisions are made to the inside of the eyelids to help reduce the appearance of scarring following the procedure.
• Next, the doctor makes the necessary adjustments. This may involve repositioning fat deposits that have shifted, removing fat and/or loose skin, or a combination of both.
• Once the doctor has performed the modifications required to achieve the desired outcome, they’ll close the incisions using sutures.

Like the specific techniques involved in a lower blepharoplasty, the duration of the procedure can vary from patient to patient. Typically, a lower blepharoplasty takes about 90 minutes. If your lower-eyelid procedure is combined with an upper-eyelid blepharoplasty to correct similar issues, the procedure can last up to two and a half hours altogether.

A popular under-eye surgery technique is transconjunctival blepharoplasty. Whereas as some lower-eyelid blepharoplasty procedures target excess skin, transconjunctival blepharoplasty procedures target excess fat that accumulates under the eyes. The fat is either removed or, in many cases, repositioned to correct the appearance of bags under the eyes.

What are the post-surgical care needs and recovery period like?

Compared to many other cosmetic procedures, the recovery period and care needs following a lower blepharoplasty are minimal and not long-lasting. Immediately following the operation, you’ll be taken to a recovery room, where your care team will monitor your vital signs and begin pain management, which will be most intense on the day of your surgery. That said, a lower blepharoplasty is among the least painful cosmetic procedures you can have. Still, expect to be sent home with a prescription for medication to help you manage any discomfort.

In addition to some mild discomfort following the procedure, you should expect to experience some swelling and bruising around the eyes. These are entirely normal and are not a cause for concern, although they may increase your level of discomfort. In most cases, swelling and bruising will peak a few days after your surgery and should subside within one to two weeks. Until they do, your doctor will suggest:

• Prescription eye drops to prevent dryness and minimize the risk of infection
• Prescription eye ointments to keep the incisions and sutures clean
• Cold compresses to help reduce swelling and post-surgical pain

You’ll also receive instructions for caring for yourself after the procedure. Again, these instructions are likely to vary from patient to patient. In most cases, your doctor will advise you to get plenty of rest, keep your head elevated, and avoid strenuous activities, especially anything that involves heavy lifting. It’s also important to keep your eyes shielded from direct sunlight, so be sure to have sunglasses and a brimmed hat on hand.

Most patients can resume normal activities in about two weeks, depending on the doctor’s recommendations. In rarer situations, it can take up to six weeks before you can resume your routine. Finally, your doctor will schedule a few follow-up appointments to ensure that no complications arise and to monitor your progress.

Who makes a good candidate for lower-eyelid blepharoplasty?

Because sagging skin, dark circles, and under-eye bags are usually age-related, the best candidates for a lower blepharoplasty are people 30 years of age and above. Your health history can also determine whether a lower blepharoplasty is right for you. Good overall health is an important factor. People with certain medical conditions, including diabetes, heart disease, and high blood pressure, may be discouraged from undergoing eye-bag surgery and lower-eyelid operations.

Eye health is another important determinant. Good candidates for a lower blepharoplasty are people without pre-existing eye conditions unrelated to the focus of the procedure, including:

• Glaucoma
• Dry eyes
• Detached retinas
• Thyroid disorders like Graves’ disease, hypothyroidism, and hypothyroidism

Your doctor will administer a physical examination to determine whether a lower blepharoplasty is right for you. They’ll check your visual acuity and examine the pupils. They’ll also check the strength and rate of your blink and evaluate the condition of the layer of oil, mucin, and water that covers your eyes. In most cases, doctors will check for signs of Bell’s phenomenon, a condition that causes the eyes to move outward and upward when you attempt to close them. Other exam focuses include:

• Eyelid laxity
• Infraorbital hollowing
• Malar fat atrophy
• Globe prominence
• Skin evaluations to rule our Fitzpatrick skin type, lesions, and dyschromia
• Canthal tendon dehiscence

If you’re considering a lower blepharoplasty, it’s crucial to discuss your health history with your cosmetic surgeon. You should also consult with your primary care physician beforehand.

What are the benefits of lower-eyelid blepharoplasty?

The benefits of a lower blepharoplasty are numerous and, in most cases, can be long-lasting. Under-eye surgery reduces the presence of eye bags, wrinkles, excess skin, and other signs of aging, which can lead to a younger-looking appearance. As such, among the most desirable of the benefits is the boosted confidence in the appearance of your eyes and improved self-esteem overall.

Other benefits include:

• Smoother, more youthful-looking eyes
• Eyes that appear refreshed, shapely, and alert
• Enhanced facial balance

The potential benefits of a lower-eyelid blepharoplasty are not exclusively cosmetic. Aside from improving the appearance of your eyes, an eyelid lift surgery can improve their function and help you see better. This is because the procedure removes excess skin and fat that could be blocking the eye and impacting vision. Moreover, eye-bag surgery can lessen the strain that the excess skin puts on your eyes and alleviate related headaches.

How long do the improvements last?

Once the swelling and bruising subside, you can expect the most noticeable results of a lower blepharoplasty to become apparent within a few months or less. While everyone’s situation is unique, the improved eye and facial appearance can last for many years, or even for the rest of your life. If your procedure focuses on removing excess fat (as opposed to procedures that focus on the removal of excess skin around the eyes), the results tend to be longer.

What are the possible complications of the procedure?

As with any surgical procedure, a lower blepharoplasty is not without the risk of postoperative complications. Eye infections are a possibility, so following your doctor’s recovery instructions and taking any prescribed medications is very important to alleviate that risk.

Other potential complications of the procedure include:

• Retrobulbar hemorrhage: This complication is rare but can be quite serious. It refers to the accumulation of blood behind the eyes, which can cause optic nerve compression and a condition known as proptosis, or bulging eyes.
• Pyogenic granuloma: These are lesions, or clusters of tissue and white blood cells, that grow on the conjunctiva (the membrane that covers the eye and interior of the eyelids) and on the cornea. They are not cancerous and can be treated with steroids, though some may be surgically removed.
• Chemosis: This condition manifests as swollen tissue. It can make it difficult to close the affected eye completely. The inability to completely close your eyes is known as lagophthalmos.
• Diplopia: In rare cases, a lower blepharoplasty can injure the inferior oblique muscle. The result is a lag in movement between the inferior oblique and the yoke muscle with which it’s paired. This causes diplopia or double vision.
• Suture cysts: Also known as Schloffer tumors, these occur when the body’s immune system tries to separate eyelid tissue from sutures by surrounding them with cell clusters.
• Hypertrophic scars: These are thick, red, raised scars, similar to keloids. They’re an immune system response to an overabundance of collagen and connective tissue.
• Eyelid retraction: In situations when too much skin tissue is removed or the surgical wound doesn’t heal properly, the lower eyelid may sag, leaving a larger area of the eye exposed.
• Ectropion: Although it’s generally not serious, this condition causes the lower eyelid to droop away from the eye.

Is a lower blepharoplasty worth it?

When you’re assessing whether undergoing a lower blepharoplasty is worth it, the most important thing is to ensure that your expectations for the procedure are realistic. A blepharoplasty has the potential to improve the appearance of your eyes and the constitution of your whole face. However, anyone expecting the procedure to result in a drastic transformation is likely to be disappointed. A blepharoplasty can tighten the skin around the eyes and reduce discoloration and puffiness, but there are features that it won’t address.

For example, you shouldn’t expect a blepharoplasty to correct the natural asymmetry of the eyes. This commonly occurs when your eyes are in the development stages. As such, misalignments between the shape and size of your eyes won’t go away after a blepharoplasty, nor will the procedure result in large-scale changes to the overall structure of your face. During your consultations, be sure to discuss your expectations for the procedure with your doctor. They can explain the results that you’re likely to experience and help keep your expectations in line with realistic outcomes.

That said, if your expectations are achievable, a blepharoplasty may be entirely worth it. The face we present to the world is important to most people, and feeling that you look your best can have a tremendous impact on not only how others see you, but also how you see yourself.

FAQs

• How much does a lower-eyelid blepharoplasty cost? On average, a lower blepharoplasty costs between $6,000 and $10,000. This includes not only the cost of the procedure itself but other fees as well, such as anesthesia and facility fees. The experience level and expertise of the plastic surgeon can affect the overall cost, as can the geographic location and the surgery setting, such as whether you receive the procedure at a private clinic or in a hospital.
• Is a lower-eyelid blepharoplasty painful? A lower blepharoplasty is one of the least painful cosmetic procedures available. Patients should expect to experience some pain and discomfort immediately following the operation, especially on the day of, as well as further discomfort from swelling and bruising during recovery, but this should generally subside after two weeks or so.
• How long does the procedure take? A lower blepharoplasty generally takes around 90 minutes, not including time spent in the recovery room. Depending on the extent of the procedure, it can last up to two-and-a-half hours.
• How long do the results of a lower-eyelid blepharoplasty last? The longevity of the results of a lower blepharoplasty can last for many years. For some patients, the results can last for the rest of their lifetime.
• What is the best age range for a lower-eyelid blepharoplasty? The best patients for a lower blepharoplasty are typically in their 30s at least.
• What makes a good candidate for a lower blepharoplasty? The best candidates for a lower blepharoplasty are those who are in good physical health and do not have pre-existing eye conditions such as glaucoma, thyroid conditions, or excessively dry eyes. People with cardiovascular issues, high blood pressure, and diabetes should consult their medical provider and their cosmetic surgeon before undergoing a blepharoplasty.