How is lower blepharoplasty completed?

Written by Dr. Julian De Silva

  • Dr De Silva prefers to use hidden incision (termed trans-conjunctival blepharoplasty) in most lower eyelid cases as the surgery, although technically more challenging, avoids a scar in the skin. The figure shows an incision being made on the inside lining of the eyelid with a specialised instrument (CO2 laser or monopolar electrocautery machine) this technology prevents bleeding instantaneously, thereby reducing swelling and speeding up recovery. The soft tissues are then supported both superiorly and inferiorly to enable the fibrous septum to be seen in the lower eyelid.
  • A fibrous layer known as the orbital septum is opened, this reveals the orbital fat pockets, the fat pushes forwards resulting in the appearance of bags beneath the eyes. There is controversy between surgeons whether the fat should be removed or repositioned, known as tissue-sparing, removal of excessive fat may result in a hollowed appearance that is unsatisfactory and difficult to treat. Dr De Silva utilises both techniques depending on the individual patient, no two people have identical eyes and facial ageing is dependent on many individual factors. Dr De Silva’s preferred technique is conservative approach to transpose fat immediately below the eyelid at the cheek, termed fat transposition. In patients where there is a large volume of fat prolapsing forward both transposition of some fat and excision of the remaining fat may be the preferred option.
  • Dr De Silva uses state of the art technology including a US-manufactured CO2 laser or monopolar electrocautery to establish meticulous control of bleeding, key to reducing bruising and preserving vision after surgery.
  • Dr De Silva often utilises a supporting stitch during the healing period to improve the final result. In the figure, a canthopexy support stitch has been used to support the lower eyelid to the bony orbital rim this stitch is completely hidden and dissolvable, the stitch dissolves a few weeks after surgery.
  • All our patients are able to see immediately after the surgery and able to return home thirty minutes after the procedure is completed. No patients require overnight hospital admission with the Dr De Silva’s techniques.
  • The older method of lower blepharoplasty, termed trans-cutaneous blepharoplasty, involves making an incision immediately below the eyelid. This method always leads to a scar, can change the shape of the eyelid and rarely result in eyelid retraction. Although this is the traditional method by which surgeons completed for reconstructive plastic surgery, Dr De Silva advises against this technique to ensure a natural result with faster recovery and healing.
Lower Eyelid (Blepharoplasty) Technique
Lower Eyelid (Blepharoplasty) Technique
Blepharoplasty Animation – How is Lower Blepharoplasty/ Eyelid Surgery completed?

Before & After Photos

Woman's face, before Blepharoplasty treatment, front view


Woman's face, after Blepharoplasty treatment, front view


View More Results *Results May Vary

Facial procedures with blepharoplasty

A lower blepharoplasty restores soft tissue changes in the lower eyelid. To enhance the results, Dr De Silva combines lower blepharoplasty with other procedures complimentary procedures to give a longer lasting natural looking result. His philosophy is that is better to spend longer time doing the procedure once, than have to undergo additional top up procedures in the near future.

  • Skin Resurfacing. The skin around the lower eyelids often has wrinkles, lines and changes in colour as a consequence of accumulated sun damage. Fine wrinkles may be smoothened, skin quality improved, and the skin tightened slightly with laser skin resurfacing techniques. Dr De Silva tailors the type of skin resurfacing to the individual and includes the use of trichloroacetic acid (TCA chemical peel) and controlled laser resurfacing.
  • Volume replacement. One of the commonest changes in the lower eyelid is a semi-circular depression, termed the tear trough, between the eyelid and the cheek. This can result in the appearance of a dark circle under the eyes. Dr De Silva customises each individual’s results with focalised fat grafting as an effective technique to rejuvenate the appearance of the lower eyelid at the same time as blepharoplasty. Dr De Silva pioneered this technique in the UK as way of giving patients and enhanced result. The alternative technique may require yearly non-surgical filler treatment.
  • Facelift surgery, often ageing changes around the eyelids are mirrored with changes in the jaw line and neck. Dr De Silva commonly completes blepharoplasty with a deep plane facelift to rejuvenation a patient’s appearance.
  • Nose reshaping, rhinoplasty, is a common procedure Dr De Silva completes at the same time as blepharoplasty.
Lower Eyelid (Blepharoplasty) Technique

Revision Lower Blepharoplasty

Over 30% of Dr De Silva’s patients have undergone previous surgery, termed revision eyelid surgery or revision blepharoplasty

Click here to read more about Revision Lower Blepharoplasty.

Lower Eyelid (Blepharoplasty) Technique

Lower Blepharoplasty Patient Experiences

Watch Video: About blepharoplasty surgery eyelid lift, video 1
My personal experience of hidden scar lower blepharoplasty with Dr. Julian De Silva
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My personal experience of upper and lower blepharoplasty with Dr. Julian De Silva
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