Lower Blepharoplasty: Greek for ‘Please take my Bags!’

girl with moschino bags under eyesWhen under eye bags become the norm and not just the aftermath of a gluttonous evening, then it may be time to consider lower blepharoplasty.

What is Lower Blepharoplasty?

Well, blepharoplasty is the surgical reconstruction of the top or bottom eyelid. Lower blepharoplasty focuses under the eyes to alleviate under eye bags by removing extra skin, repositioning, removing or adding extra fat, or tightening and lifting the under eye muscles.

Lower blepharoplasty works, and because it does, has a high satisfaction rate among both men and women. This procedure was actually ranked the 3rd most popular cosmetic surgery procedure in the U.S. in 2014, right in between nose reshaping and liposuction. (The first was breasts. Of course.)

When to Consider Blepharoplasty

I always like to advise my readers to consider less invasive options such as fillers or the Thermismooth laser before jumping into surgery but when those don’t work, well that’s just a waste of time and money.

There are certain situations that can only be corrected with a lower blepharoplasty. I mean, if you have excess fat under your eyes, there’s no sure way to get rid of that without taking it out or possibly distributing it more evenly.

Like this:


Before and After Lower Blepharoplasty

If you have a lot of extra skin down there that’s gonna take a lot more than a little bit of filler to puff it up. This is another situation where lower blephaporasty could be your savior.

But if what you actually have are minor hollows and no extra skin or fat pads, then you can try light tear trough fillers like this girl:

before and after tear trough fillers

Minimal Bags Treated with Dermal Fillers

But, if you find that a lower blepharoplasty is your best option, don’t be nervous girls! It’s not so scary I promise! If you’re thinking you may be in the ‘lower bleph’ camp, then see a plastic surgeon.

Get some professional opinions! Just in case this is the best option for you, let me give you a minor education on what to expect.

Cost of Lower Blephalorplasty

If you’re anything like me, cost is certainly a factor in the decision. Can I afford it? Is there another route I can take for the same results? Pricing depends on may variables:

  • Who is quoting you? Is it a ‘high society’ surgeon who’s worked on Madonna or one that you’ve never heard of but has streams of positive before and after photos? (the high society will cost more)
  • Do you live in NYC or Buford, Wyoming? (it will cost more in NYC, as everything does)
  • The extent of the work being done.
  • Will you be using general anesthesia or an IV drip?
  • Will the procedure take place in a hospital or an in office OR

How it Goes Down

If you do decide to take the leap, then let’s talk about what happens next. Well, you’ll pay of course. I don’t know a surgeon that will book a date without full payment.

Some offices offer a type of payment plan called Care Credit and you can find a list of providers here.

Preparing for Lower Blepharoplasty

Before and After Lower Blepharoplasty

Before and After Lower Blepharoplasty (so you remember why your doing this!)

Of course there’s the mental preparation of letting another mortal human being, with good days and bad days, put a scalpel near your eyeball. That’s a given. I’m not trying to scare you but any plastic surgery should be taken seriously.

Nobody expects to have bad outcomes and everyone heals differently so it’s important to always keep this in mind when making a decision to cut.

So let’s talk about some of the other pre-surgical preparations of which you should be aware. Different surgeons have their own lists of do’s and do not’s but these things you can expect from them all.

3 Weeks Prior to Surgery

Three weeks before surgery you will have to get some bloodwork done. Some surgeons will accept previous blood tests if you have done them within 6 months.

2 Weeks Prior to Surgery

  • Do not take anything containing Aspirin or Ibuprofen which can prevent your blood from properly coagulating (many pain relievers and sinus medications contain these)
  • Do not take Vitamin E
  • Don’t smoke (um, nicotine), chew tobacco or use a nicotine patch  as it interferes with your blood circulation and puts you at a higher risk for complications with anesthesia
  • Start taking 1,000mg of Vitamin C three times a day as it helps with healing

1 Week Prior to Surgery

No alcohol for the week before.

1 Day Before Surgery

Do not eat or drink anything after midnight including gum chewing or sipping water. Some doctors will actually cancel the surgery if you admit to not following that rule. The ONLY exception is when you’re taking any meds prescribed.

The Day of Surgery

Yay! You made it to the day of the surgery! So let’s talk about what happens during the surgery which you will probably not be aware of since you’ll be unconscious through most or all of it (if your smart).

Step 1:  Anesthesia

You can discuss with your doctor whether you will be put under general anesthesia or just get IV sedation. I did my upper lids in my 20’s and I made sure I was down for the count. It really depends on the extent of the procedure and what your doctor recommends.

heart.jpgTIP: DO NOT FORGET to make sure your anesthesiologist adds a nice anti-nausea med to your pre-surgical cocktail. Believe me, it’s not worth the risk of vomiting your guts out post surgery. Not pleasant.

Step 2: Incision

lower blepharoplasty incisions

LASH LINE INCISION                                                      TRANSCONJUNCTIVAL INCISION

(I was going to post a pretty graphic real life photo there but I figured, it’s kind of like meat, if you saw how it got to your table you probably wouldn’t eat it – so this illustration will do nicely.) 😉

There are two types of incisions that can be used when getting a lower blepharoplasty. One on the inside of the lower lid (transconjunctival incision) and one just below the lower lash line. You get one or the other, not both.

The transconjunctival incision (the one to the right) is used if the doctor feels she can get the desired effect by simply removing or redistributing the under eye fat. A fancy word for that procedure is ‘transconjunctival blepharoplasty‘.


Lower Blepharoplasty Lash Line Incision

The lower lash line incision (above) is used when the doctor would also like to remove some extra skin. This part of the procedure is called ‘pinch blepharoplasty’. This is also the incision they use for ‘lateral canthoplexy’ which is when they put a permanent internal suture in the tendons on the outside corner of the eye to hold the muscles up.

Before the surgery your doctor will ask you to look up to mark exactly how much skin to remove. This is important because removing too much skin can cause a lower lid malpositioning. That’s when the lower lid hangs off your eyeball. Normally seen in really old men and not very attractive on anyone.

It seems like that would leave an obvious scar but it doesn’t at all. It just blends in with your regular skin fold. Plus you have your lower lashes to cover it up.

Step 3: Close the Incisions

Your doctor will close your incisions using removable sutures, skin adhesives or surgical tape.

heartIMPORTANT: Some of us are sensitive to skin adhesives. If so make sure to let your doctor know. If you get a rash when you use a band-aid is a good indication. I had a NIGHTMARE situation with my breast incision adhesive so don’t forget!

What to Expect Post Blepharoplasty


ICE, ICE Baby.  Ice Your Eyes 15-20 mins per hour for the first 48 hours (use frozen peas or a frozen eye mask)

Standard Post Surgical Instructions

  • For the first 48 hours ice your eyes 15-20 mins every hour while awake.
  • Apply Cold Compresses in between icing. Just place sterile gauze, that have been dipped in ice water, gently on your eyes.
  • Bedrest with head propped up to avoid more swelling. Sleep on your back too! Not your face.
  • Don’t rub your eyes (duh!)
  • Avoid bending over, reaching down, or straining which could incite bleeding
  • Don’t pull on your incisions (I mean seriously.)
  • Avoid Aspirin or Ibuprofen for 3 days
  • Do not shower or wash your hair until the next day
  • Use meds as prescribed
  • No pets in the bed for the first few days to avoid infection

Swelling – Bruising – Cold Compresses – Morning Worse Than Evening

  • You will be swollen. Since we all heal differently, it could be minor under eye swelling to crazy chipmunk cheek swollen.  Many doctors prescribe prednisone or other oral corticosteroids to minimize that for you. Or you could use Arnica Montana orally which you can buy at your local health food store.
  • You can also expect bruising and in the worst case scenario, it can go all the way down to your chin area.
  • You may itch but don’t scratch. If you itch more than you can handle then try putting cold compresses.

Step 4: Recovery Time

Give yourself time to heal. Everyone has a different personal timeline so don’t expect to heal like your aunt did when she got her eyes done.

You will be swollen for about ten days but it may not even feel that way since the bags have been removed or repositioned! Pretty awesome right?? But, for every yin there’s a yang and this is no exception. Let’s discuss the risks of lower blepharoplasty.

Risks of Lower Blepharoplasty

Extropion in the Lower Eyelid

Lower Lid Malpositioning (Exropion) in the Lower Eyelid

Lower lid malpositioning is a risk with any lower blepharoplasty procedure. Also referred to as extropion, where your lower lid actually turns outwards.

  • Cutting too much skin out
  • Scar tissue. Treatment: Wait to see how it pans out. If the scar tissue doesn’t dissipate over time then it may be necessary to have a corrective surgery.
  • Skin Laxity that wasn’t properly accounted for in the procedure. Meaning, the good doc didn’t pull the muscles up at the corners to counteract your skin laxity. Solution: a second procedure to ‘touch-up’ the first.
  • Swelling – you may have excessive swelling that pushes out the lower lid keeping the skin from bouncing back. Taking anti-inflammatories is the best treatment for this just as long as you catch it early.


TIP: If you do notice post surgical extropion contact your doctor ASAP. A lot of time, if surgical adhesive is applied to the lower lid to hold it up this can heal properly without incident.

Chemosis is another risk. This is when your eyeball swells, sometimes making it impossible to close your eye causing dryness and making your eye look as if it’s moving slightly upwards. This is generally treated with either natural or steroid eye drops. Avoid this by keeping your eye’s super moist post surgery.

Infection is rare because a responsible human being like yourself will surely use the antibiotic ointments and oral antibiotics that are prescribed to you by your doctor. There are exceptions to the rule though so just be careful, if you think the pain meds will make you loopy then have a caretaker keep you on task.

Well, 1,800 words later, this about sums up all you need to know about lower blephoraplasty. I hope it was helpful!


P.S. If you’re private about your rejuvenation procedures, and you need some friendly input, I’m happy to offer mine! I’m not a doctor, not even a nurse, but if you’re suffering from baggage under your eyes I can certainly give you my unbiased opinion on what I think would be the best way to proceed.

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