Lower blepharoplasty is a surgery that cuts away the stretched, wrinkled lower eyelid skin and also tidies the bulging under-eye fat.
If your under-eyes look tired even after a good night's sleep, there is a reason.
With age, the lower eyelid skin stretches. The membrane that held back the under-eye fat also weakens. The fat is then pushed forward and the area under the eye bulges. A shadow falls beneath the bulging area. That is why you are told you "look tired."
The medical term is lower blepharoplasty.
Because there are surgeries with similar names that are easy to confuse, we will sort out what each is called.
In the medical literature, both surgeries are covered within the scope of lower blepharoplasty. At our clinic, surgery that cuts away skin is called lower blepharoplasty, and surgery that goes in from inside the conjunctiva to move fat is called lower eyelid fat repositioning.
Mechanism
Lower blepharoplasty is a surgery for skin laxity of the lower eyelid (a state in which the skin has stretched and sagged) and protrusion of orbital fat (the fat around the eyeball), in which excess skin is excised and fat is excised or repositioned. Orbital fat is pushed forward when the orbital septum (the thin membrane that holds the fat back in front) weakens. A review (a paper that compiles and explains multiple publications) on eyelid plastic surgery describes lower blepharoplasty as a surgery that selectively excises or repositions fat[1].
In plain terms — it is a surgery that cuts away the stretched skin and removes or repositions the fat that has been pushed forward.
How the under-eye ages
Skin usually begins to sag from the late 20s. At that time it is not very noticeable but gradually becomes prominent, and the first places to stand out are above and below the eyes. When the lower eyelid ages, the skin stretches and fat bulges out.
Lower blepharoplasty is the most commonly performed surgery to correct sagging under-eye skin, and it corrects the stretched skin, bulging fat, and hollow under-eye groove together.
Face PlusShould upper and lower blepharoplasty, which correct sagging eyes above and below, be done separately? Or together?
Face Plus Plastic Surgery's midlife eye surgery addresses the underlying cause. The plastic surgery specialist who performs the surgery personally handles everything from the consultation to the operation.
Face PlusFace Plus Plastic Surgery's midlife eye surgery addresses the underlying cause
The plastic surgery specialist who performs the surgery personally handles everything from consultation to operation
Addressing aesthetic and functional problems at the same time
No sign of surgery and a younger-looking effect
Improving wrinkles caused by sagging under-eye muscle and skin
Under-eye wrinkles and dark circles that make you look older (it may be difficult to eliminate them all, but depending on the cause they can improve considerably)
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When is lower blepharoplasty done?
It is done when the area under the eye bulges and the skin has stretched and is in excess.
Read the list below while picturing the area under your eyes in the mirror. If any apply, we will check at the consultation whether lower blepharoplasty is right for you.
The fat under the eye bulges out, casting a shadow beneath it
The under-eye skin stretches and forms wrinkles
Both bulging and skin laxity are present
You are often told you "look tired"
How does it differ from lower eyelid fat repositioning?
The two surgeries are similar in location and name, so they are easy to confuse.
The criterion for telling the two surgeries apart is whether the lower eyelid skin has stretched and is in excess.
To use a clothing analogy, what is inside bulging and the fabric itself being stretched out are different problems.
If almost no skin is in excess and only the fat bulges, lower eyelid fat repositioning, which goes in through the conjunctiva on the inner side of the eyelid to move the fat, is considered first. Details are in Lower Eyelid Fat Repositioning surgery information.
If the skin has stretched and is in excess, lower blepharoplasty, which cuts away skin, is considered. In this case as well, the bulging fat is addressed together.
Whether there is excess skin is hard to judge in a mirror. At the examination, we pinch the skin directly and also check the strength that supports the lower eyelid.
If lower eyelid fat repositioning is the right fit, we will tell you so.
A Word from the Doctor
"Not every patient is operated on in the same way. The method must differ according to each individual's condition. This is why a thorough examination and consultation are important."
Face PlusLower Blepharoplasty: Recommended in These Cases
When under-eye sagging due to aging is severe
When dark circles are pronounced because of sagging under-eye skin
When under-eye fat bulges out unevenly
When under-eye wrinkles are pronounced
When you want aesthetic and functional improvement at the same time
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Are there under-eye concerns that lower blepharoplasty does not solve?
Yes. If the cause of the dark under-eye is skin color or visible blood vessels, surgery does not change it.
You have probably heard "Your dark circles are bad lately" at least once. But there are three typical reasons the under-eye looks dark.
Cause
What the condition is
Changed by lower blepharoplasty?
Shadow created by bulging fat
A shadow falls beneath the protruding fat
This is what this surgery addresses
Pigmentation
The skin's own color is dark
Not changed
Visible blood vessels
The skin is thin, so the blood vessels beneath show through
Not changed
Sometimes all three are mixed. If color or blood vessels are the main cause, surgery does not produce the change you expect. That is why we first sort out the cause at the consultation.
If you only have fine lines under the eyes or hollowing is your main concern, non-surgical methods are considered as well.
Surgery takes 1 hour to 1 hour 30 minutes under local anesthesia or sedation. Hospitalization is not required.
Since it may feel vague the first time, we have laid it out step by step.
Step
Details
1. Design
The range of skin to be cut away and the places where fat will be addressed are marked
2. Anesthesia
Local anesthesia or sedation is given
3. Incision
The skin is incised just below the eyelashes
4. Fat and skin
The bulging fat is tidied and the excess skin is cut away
5. Suturing
Sutured with fine thread
6. Going home
You go home without being hospitalized
A systematic review (a paper that gathers and reviews multiple studies by a set method) comparing skin incision and conjunctival (the mucous membrane inside the eyelid) incision summarized that both approaches can be performed, but because studies differ in how they report results and complications, it is hard to conclude that one is better[3].
A Word from the Doctor
"The difficulty of lower blepharoplasty depends on 'how appropriately to excise and how much to preserve.'"
Face PlusLower Blepharoplasty Surgical Method
01Customized design consultation tailored to the patient's eye shape, degree of skin sagging, and other conditions02Incision of the stretched under-eye skin03Lifting the sagging muscle after removing and repositioning under-eye fat04Completing lively eyes after delicate suturing
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Where does the scar from lower blepharoplasty remain?
Because it is a surgery that cuts away skin, a scar remains. It is not a surgery that leaves no scar.
It is natural to worry about marks on the face. So we will first tell you plainly.
The incision line is placed just below the eyelashes. It may extend slightly toward the outer corner of the eye.
At first the incision line is red. It fades over time.
How to care for the scar (ointment, sun protection, tape):
If you have ever had a large scar from a previous surgery or wound, please tell us at your consultation.
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How long is recovery from lower blepharoplasty?
It is a surgery done without hospitalization, but a recovery period is needed for swelling and bruising to go down. Stitches are removed on day 7.
If you have work or an important appointment coming up, this is probably what you most want to know. We have written it by time point.
Time point
Status
Days 1–3
There is swelling and bruising
7 days
The stitches are removed
About 2 weeks
Swelling decreases. You can wear makeup
About 1 month
The redness of the incision line fades
3–6 months
The shape settles
The speed of recovery differs from person to person. If you have an important event coming up, please tell us in advance at the consultation.
So that you do not have to endure recovery alone, the doctor and the nursing team check your swelling, pain, and condition together. The third of our treatment principles is “We see patients more frequently after surgery.”
Precautions after surgery
After surgery you will visit the clinic 2–3 times over about 2 weeks, adjusted according to the surgery and your situation. Please keep your stitch-removal appointment as much as possible.
Cold compresses, sleeping position, when to start washing your face and wearing makeup, when to resume exercise, drinking, saunas, and contact lenses, artificial tears and prescribed medication:
Do not wait in these cases
If something feels wrong after surgery, do not put up with it on your own.
The changes below are ones you should tell us about without waiting until your next visit.
Of these, the following three are emergencies. Regardless of clinic hours, call 119 or go to the nearest emergency room.
When pain in the eye or behind the eye suddenly becomes severe
When you suddenly cannot see well or your vision darkens
When it feels as though the eye is bulging out, or the area around the eye swells rapidly and becomes hard
Bleeding behind the eye is reported to occur most often on the day of surgery, especially within the first few hours[4]. Some cases occurred several days later.
The following symptoms are also changes you should report without waiting until your next visit.
When you see double
When the eye is extremely sore and stinging, or the feeling that something is in the eye is severe
When the eye does not close fully
When the white of the eye swells like a blister
When the lower eyelid looks pulled downward or turned outward
When the incision area is red and swollen, with fever or pus
Some things are not urgent, but please be sure to mention them at your next visit.
When tears keep flowing
When the eyes continue to feel gritty and dry
When the left-right difference does not lessen over time
When the area under the eye looks hollow or a bulge remains
When lumps can be felt or the area under the eye is uneven
When the scar becomes more raised or itchy
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Face Plus Talk
Lower blepharoplasty and lower eyelid fat repositioning are under-eye surgeries that seem alike but differ.
— Dr. Park Jung Keun, Plastic Surgery Specialist · Face Plus Talk
Many people wonder about the difference between lower eyelid fat repositioning and lower blepharoplasty.
Unlike lower eyelid fat repositioning, a surgery that reduces the volume of fat without removing skin, lower blepharoplasty cuts away excess skin through a skin incision. Under-eye surgery for older people falls into this category. It is usually performed more often after middle age.
In this case, because the skin is stretched, the under-eye wrinkles may look severe. Only by removing the stretched skin can a neatly smoothed result be obtained. At the same time, excessive under-eye fat is reduced using lower eyelid fat removal or lower eyelid fat repositioning. Correcting under-eye fat and stretched skin together in this way is called lower blepharoplasty.
Even in middle age, when the degree of under-eye sagging is mild, whether to work on the under-eye fat alone or to reduce the skin as well... the specific surgical method must be decided through a thorough examination and discussion.
Through under-eye surgery such as lower blepharoplasty and lower eyelid fat repositioning, the dark-circle look can improve and the overall impression can look brighter. Of course, it is generally a procedure in which other people hardly notice yet a large improvement in impression can be obtained.
There are things to be careful about when performing lower blepharoplasty. Side effects such as 'ectropion' must be guarded against. This refers to the under-eye turning outward after excessive skin removal, and ectropion can also occur when there is heavy bleeding or inflammation. Therefore, lower blepharoplasty requires more careful attention. Because we thoroughly review and confirm in the operating room to guard against ectropion, it rarely actually occurs. It is a surgery that requires more experience and technique.
There is no single correct answer for a surgical method. After a thorough consultation, we proceed with a surgical method tailored to each individual. Online Consultation
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Frequently Asked Questions
What anesthesia is used for lower blepharoplasty?
It is done under local anesthesia or sedation. Which one is used is decided at the consultation.
Surgery takes 1 hour to 1 hour 30 minutes.
Which is the default, the criteria for deciding, and whether local anesthesia is also used during sedation:
Fasting time before surgery, and whether a companion is needed when you go home:
Please tell us at your consultation about the medications you take, the conditions you have, and any previous discomfort with anesthesia. Please feel free to tell us any concerns then.
What side effects can lower blepharoplasty have?
In addition to swelling and bruising, deformity in which the lower eyelid is pulled downward, an eye that does not close fully, dry eye, left-right differences, and scarring can occur. Blood collecting behind the eye can threaten vision and is an emergency.
Because this is something you must know before deciding on surgery, we have written it out in full without shortening it. Please decide after fully understanding the items below.
Side Effects
Lower eyelid retraction (a state in which the lower eyelid is pulled downward so more of the white shows) and ectropion (a state in which the lower eyelid margin turns outward): corrective surgery may be needed.
Lagophthalmos (a state in which the eye does not close fully): the eye surface may become dry and sore.
Chemosis (swelling of the membrane covering the white of the eye like a blister)
Epiphora (tears running over)
Dry eye
Corneal abrasion (scratching of the surface of the black part of the eye): the eye feels extremely sore and stinging.
Hematoma (a clump of collected blood) and retrobulbar hemorrhage (blood collecting behind the eye): retrobulbar hemorrhage can threaten vision and requires emergency treatment.
Diplopia (seeing objects as double)
Depression and residual protrusion: the area under the eye may look hollow or a bulge may remain.
Unevenness (the moved fat feels or looks uneven)
Asymmetry: the shape or recovery speed on the two sides may differ.
Scar: a scar remains along the incision line.
Infection
In plain terms — there is one thing to remember first. Blood collecting behind the eye can threaten vision, so you must not wait.
Other things that can happen are as follows.
The lower eyelid may be pulled downward or turn outward.
The eye may not close fully, the white of the eye may swell, tears may run over, or the eyes may become dry.
If the eye surface is scratched, it feels extremely sore and stinging.
Objects may also look double.
Hollowing under the eye, a remaining bulge, lumpiness of the moved fat, left-right differences, and scarring are matters that are checked over time.
How often were these reported in studies?
Side Effects
In a literature review that pooled and analyzed 49 studies on lower blepharoplasty published in 1997–2017 (10,698 patients), the combined frequencies were: revision surgery 0.77% (82 patients), scleral show (a state in which more of the lower white shows) 0.37% (39 patients), eyelid malposition 0.25% (27 patients), and ectropion 0.24% (25 patients). 29 studies reported follow-up duration, averaging 14.8 months. The authors pointed out that the studies did not adequately report follow-up results[5].
In plain terms — when studies of lower blepharoplasty are pooled, the following was reported.
Repeat surgery: about 8 of every 1,000 patients
Lower eyelid position problems: about 2–4 of every 1,000 patients
However, the authors pointed out that few studies followed patients for a long time after surgery.
Side Effects
In a single-surgeon study (one doctor) reviewing 2,007 patients who underwent lower blepharoplasty through a skin incision below the eyelashes (analyzed after applying exclusion criteria from 3,014 patients), chemosis occurred in 1.2% (24 patients) and symptomatic lower eyelid malposition in 0.4% (8 patients). These were patients who did not also have an eyelid-tightening procedure[6]. The frequency of chemosis has been reported differently across studies. In a study of 312 patients who had skin-incision lower blepharoplasty, chemosis occurred in 11.5%, the median (middle value) duration was 4 weeks (1–12 weeks), and all cases resolved[7].
In plain terms — swelling of the white of the eye was reported differently depending on the study, from 1 to 12 in every 100 patients. In one study it usually lasted 4 weeks, up to 12 weeks at the longest, and all cases resolved.
Side Effects
In a survey answered by 237 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (a total of 269,433 cosmetic eyelid surgeries), orbital hemorrhage (bleeding in the space around the eyeball) occurred in 149 cases (0.055%), and 12 cases (0.0045%) were accompanied by permanent loss of vision. Bleeding was most common within 24 hours after surgery, especially within the first 3 hours, and some cases occurred several days later. The authors noted as a limitation that the survey relied on doctors' recollection. These are data that do not separate upper and lower eyelid surgery[4].
In plain terms — these are the results of a survey of eye plastic surgeons.
Bleeding around the eye: about 5–6 per 10,000 eyelid surgeries
Permanent loss of vision: about 4–5 per 100,000 surgeries
Bleeding was most common on the day of surgery, especially within the first 3 hours, and in some cases it occurred a few days later. This is a survey compiled from doctors' recollections, and the figures count upper and lower eyelid surgeries together.
How does the research summarize this?
Side Effects
A review article (a paper that gathers and explains multiple studies) that organized the complications of eyelid plastic surgery by time period listed the following. Within 1 week after surgery: corneal abrasion (scratching of the surface of the dark part of the eye) and retrobulbar hemorrhage, which can threaten vision; at 1 to 6 weeks: malposition of the upper and lower eyelids, strabismus (the two eyes pointing in different directions), corneal exposure (the eye not closing fully, leaving the surface of the dark part exposed), and excessive tearing; after 6 weeks: problems with eyelid height and contour, asymmetry, scars, and long-lasting swelling[8]. This review covers upper and lower eyelid surgery together.
In plain terms — it is organized by time period as follows.
Right after surgery: the eye surface may be scratched or blood may collect behind the eye. Blood collected behind the eye is a problem that can threaten vision.
A few weeks later: eyelid position, misalignment of the two eyes, and tearing problems
After that: left-right differences, scarring, and prolonged swelling
Data counting major problems within 30 days after surgery
Side Effects
In a multicenter study (involving several medical institutions) that analyzed 6,126 people who underwent blepharoplasty (eyelid plastic surgery) and brow lift (surgery to raise the eyebrows), the rate of major complications was 0.4% for blepharoplasty, 0.7% for brow lift, and 0.4% when both surgeries were done together. In this study, a major complication meant a case that required an emergency room visit, hospital admission, or reoperation within 30 days after surgery. The most common major complication was hematoma, at 0.2% each in the blepharoplasty group and the combined-surgery group and 0.5% in the brow lift group. The data came from the 2008–2013 U.S. cosmetic surgery insurance database (CosmetAssure) and did not distinguish between upper and lower eyelid surgery[9].
In simple terms — The problems this study classified as 'major complications' occurred at a rate of about 4 per 1,000 in eyelid plastic surgery. When reading this figure, please keep three things in mind.
This counts only cases in which a person went to the emergency room, was admitted to the hospital, or had another operation within 30 days after surgery.
Problems that appear after 30 days, or problems that did not reach that level, are not included in this figure.
Because upper and lower eyelid surgeries are counted together, this cannot be read as a figure for lower blepharoplasty alone.
This is a study that analyzed U.S. cosmetic surgery insurance data (2008–2013).
How our clinic responds when each of these occurs:
How long do the effects of lower blepharoplasty last?
Lower blepharoplasty does not stop aging. For that reason, we do not promise that the effects will last a certain number of years.
Time keeps passing after surgery, and the skin continues to age. The range of what you can expect is explained at the consultation after we look at the condition of the area under your eyes.
Over time, the skin may sag again or the area under the eyes may bulge again.
We do not rush the decision to have surgery again. Revision surgery is considered at least 6 months after the first surgery. Revision surgery for the eyes is explained in Revision Eye Surgery information.
Are there cases in which lower blepharoplasty should not be done or should be postponed?
Yes. Typical examples are when the dark color under the eyes is caused by skin color or visible blood vessels, and when 6 months have not passed since a previous eyelid surgery. Criteria based on your health condition are checked at the consultation.
This surgery is not suitable for every under-eye area.
Contraindications
When under-eye darkness is caused by pigmentation or visible blood vessels: surgery does not change it.
Lower eyelid laxity (a state in which the force supporting the lower eyelid is weak): there is a risk of ectropion, so the surgical method is decided separately.
Severe dry eye: if the eye does not close fully after surgery, dryness may worsen.
Thyroid eye disease (a condition in which the eyes bulge or the eyelids retract due to thyroid disease)
If you are taking anticoagulants or antiplatelet drugs (blood thinners): because of the bleeding risk, you need to consult the prescribing doctor before surgery. Do not stop the medication on your own.
Uncontrolled high blood pressure or diabetes
Recent eye surgery (LASIK, cataract surgery, etc.)
In plain terms
If color is the cause, surgery is not the answer.
If the lower eyelid is loose, there is a risk of it turning outward.
If your eyes are very dry or protrude because of the thyroid, your eyes may become more uncomfortable after surgery.
If you take blood-thinning medication, bleeding behind the eye is a concern, so you must tell us beforehand.
If you have had eyelid surgery before, revision surgery is considered at least 6 months after the first surgery.
Please tell us about all medications you take and any conditions you have at the consultation. Even things that seem minor are fine to mention.
How long does lower blepharoplasty take? Do I need to be hospitalized?
1 hour to 1 hour 30 minutes. It is done under local anesthesia or sedation. Hospitalization is not required.
How is lower blepharoplasty different from lower eyelid fat repositioning?
The criterion that separates the two surgeries is whether excess, stretched skin remains on the lower eyelid. If stretched skin remains, we first consider lower blepharoplasty; if little skin remains and only fat bulges, we first consider lower eyelid fat repositioning. The actual distinction is made through an examination. This is explained in How does it differ from lower eyelid fat repositioning in the main text and in Lower Eyelid Fat Repositioning information.
If I need lower blepharoplasty again, when can it be done?
Revision surgery is considered at least 6 months after the first surgery. Revision surgery for the eyes is explained in Revision Eye Surgery information.
Is lower blepharoplasty covered by national health insurance?
Eyelid surgery for cosmetic purposes is not covered by national health insurance (non-covered).
Do you treat overseas patients?
Yes. Many patients come from countries with advanced medical care, such as the United States and Japan. Among overseas patients, about 60% are from Japan and about 30% are from the United States.
Upper and Lower Blepharoplasty Explained Simply | Separate Surgeries? Combined Surgery?Who Benefits from Upper Blepharoplasty? | Upper Blepharoplasty Recovery TimeClearing Up Misunderstandings About Scars After Lower Blepharoplasty (feat. Plastic Surgery Specialist, Upper and Lower Eyelids)Lower Blepharoplasty Side Effects | Lower Blepharoplasty Side Effects You Must Know Before Surgery?
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This links to a video on the Face Plus Plastic Surgery YouTube channel. View All FacePlus TV
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Surgeries and procedures worth considering together
These are surgeries and procedures often discussed together with this surgery during consultations. Whether to have them together is decided after an examination.
Vrcek I, Ozgur O, Nakra T. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. J Cutan Aesthet Surg. 2016;9(2):65-72. PMID 27398005. PMCID PMC4924417. doi:10.4103/0974-2077.184046
Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthalmic Plast Reconstr Surg. 2004;20(6):426-432. PMID 15599241. doi:10.1097/01.iop.0000143711.48389.c5
Wilson SC, Daar DA, Maliha SG, Abdou SA, Levine SM, Baker DC. Lower Eyelid Blepharoplasty: Does the Literature Support the Longevity of this Procedure? Aesthet Surg J. 2018;38(12):1289-1297. PMID 30084870. doi:10.1093/asj/sjy186
Maffi TR, Chang S, Friedland JA. Traditional Lower Blepharoplasty: Is Additional Support Necessary? A 30-Year Review. Plast Reconstr Surg. 2011;128(1):265-273. PMID 26052789. doi:10.1097/PRS.0b013e3182043a88
Weinfeld AB, Burke R, Codner MA. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg. 2008;122(2):579-586. PMID 18626377. doi:10.1097/PRS.0b013e31818001d0
Wormer BA, Rankin TM, Kaoutzanis C, Al Kassis S, Gupta V, Grotting JC, Higdon KK. Does Brow Lift Add Risk to Blepharoplasty? Answers From a Multicenter Analysis of 6126 Patients Undergoing Aesthetic Eye Surgery. Ann Plast Surg. 2023;90(4):288-293. PMID 29369102. doi:10.1097/SAP.0000000000001255
Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg. 2013;15(1):39-46. PMID 23329270. doi:10.1001/2013.jamafacial.1
Dr. Park Jung Keun · Plastic Surgery Specialist, PhD in Medicine
He personally consults on and performs facial aging treatments such as facelift, droopy eyelid surgery, and thread lift. The doctor personally sees you from consultation through recovery.
2004 Plastic Surgery Specialist2013 PhD in Medicine, Seoul National UniversityVice President, Korean Association of Plastic Surgeons
The content of this page is general medical information provided in accordance with the Medical Service Act, and the effects and recovery time of surgeries and procedures may vary by individual. All surgeries and procedures can cause side effects, so please make your decision only after a thorough consultation with a plastic surgery specialist.
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Facelift, droopy eyelid surgery, and thread lift: Dr. Park Jung Keun personally checks every stage, from consultation to recovery. Please schedule by phone or KakaoTalk, or leave a consultation request form.
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