Lower Eyelid Blepharoplasty

Lower Eyelid Blepharoplasty


The lower eyelids are one of the first areas of your face to show signs of aging. The eyelid skin is extremely thin and susceptible to the forces of gravity, genetics, and sun damage. In youth, we have a smooth youthful contour from the lower lash line to the cheeks. As we age, this smooth transition from the lower eyelashes to the upper cheeks gives way to hills and valleys. Fatty bags may appear and bulge. The cheeks also age and descend, exposing the bony rim of our eyes, creating a hollowed, skeletonized appearance to your face.  These changes may make you appear older and more fatigued than you really are!

In lower blepharoplasty –also known as lower eyelid surgery– excess skin and fat may be removed and/or repositioned around your eyes to create a natural, more awake, more vibrant appearance without changing your face’s shape.

It has been said that the eyes are the windows to our souls.  Our eyes are the defining features of our face and shape our interactions with others.  For these reasons, blepharoplasty is an extremely popular procedure. With the advanced techniques used by Dr. Chung, your blepharoplasty may be safely and effectively performed in the office under local anesthesia, with the expectation that you would be able to return to work within a week. Dr. Chung has performed countless eyelid procedures on her patients from the Boston area, including Brooklime, Wellesley, Newton, Needham, Andover, North Andover, Waltham, Salem, Peabody, Lynnfield, and the surrounding communities.

Am I a good candidate for blepharoplasty?

If you have excess lower eyelid skin and/or puffy bags around the eyes, you may be an excellent candidate for blepharoplasty. The best candidates for this procedure are healthy patients who do not smoke and do not have any serious eye conditions.

What happens during the initial consultation for blepharoplasty?

During your initial consultation, Dr. Chung will discuss your concerns about your eyes: are you concerned by the amount of loose skin? Does the texture of your skin bother you? Do you have puffy bags under your eyes? Do your friends and loved ones say that you “look tired?” Dr. Chung will also carefully evaluate your medical history, noting any prior history of eyelid surgery, dry eyes, or the use of blood thinners. She will also pay special attention to the surrounding anatomic structures such as the upper eyelids, cheeks, as well as the strength of the lower eyelid muscles.

What happens during the blepharoplasty procedure?

Typically, your lower eyelid surgery may be performed in the office under local anesthesia.  The procedure takes approximately one to two hours, depending on the type of procedure performed. You may take an oral medication such as Valium to help you relax during the blepharoplasty, and all patients need a ride home after the procedure.

Dr. Chung is skilled in all types of blepharoplasty procedures. For most patients, an incision is made on the skin just below the lash line. This allows excess, wrinkly skin to be removed. For others, the incision for the eyelid surgery may be placed on the inside of the lower lid. This procedure, called transconjunctival blepharoplasty, is best for those patients who only need fat removed and/or repositioned.  Ultimately, the decision regarding which procedure will provide you with the best results will be made after careful evaluation and discussion, carefully considering your goals and personal preferences.

During the procedure, Dr. Chung will measure and draw out the planned incision using a special surgical marking pen. The skin is then cleansed with an antiseptic.  Local anesthetic will be placed carefully in the eyelid skin. An incision is made just below the lash line and a conservative amount of excess skin is removed. Any fatty bags may also be removed or repositioned. Dr. Chung never removes too much fat, as she does not want your eyes to appear hollowed. Bleeding is usually quite minimal. All incisions are closed with tiny, meticulously placed stitches. An antibiotic ointment is then applied to the incisions.

Advanced techniques

  • Fat repositioning and arcus marginalis release

Dr. Chung may also incorporate advanced techniques, such as fat resositioning and arcus marginalis release, in the appropriate candidates. The arcus marginalis is a fibrous attachment of the lower eyelids to the bone of the infraorbital rim. (Insert pic) When the arcus marginalis is released from its bony attachments, the orbital fat may be released to cover up this lower bony rim, this creating a smoother transition from the lower eyelids to the upper cheeks, in essence covering up the infraorbital hollows. This helps to soften the lower eyelid skeletonization and may also help with the dark circles.

  • Canthoplasty and Canthopexy

In some patients with weak lower eyelid muscles, Dr. Chung may also perform a canthopexy or canthoplasty at the same time as the lower eyelid surgery.  In this advanced technique, the tendons of the eyelid muscles are reconstructed to provide greater support and prevent drooping of the lower lids.

Complementary procedures

Many patients also benefit from a skin resurfacing procedure, such as a chemical peel or the fractional laser treatment, at the same time as their lower eyelid surgery to improve the texture and fine lines of the lower eyelid skin. Some patients may also choose to have upper eyelid surgery at the same time for total eye rejuvenation.

For patients with deep tear trough changes and hollowing of the lower lids, Dr. Chung may also recommend Restylane injections to fill in the hollows and some upper cheek fillers.

What is the recovery like?

Immediately after surgery, there will be some mild swelling and possibly some bruising. This will get a little worse over the next 2 days before it gets better. Blepharoplasty causes very little pain. It is unlikely you will need to take any pain medications the day after surgery. You will ice your eyes for the first 2 days after surgery and apply an antibiotic ointment such as Bacitracin to the incision line. Dr. Chung will allow you to get the incisions wet on the 2nd day after surgery. Most patients feel great after lower blepharoplasty, but Dr. Chung asks that you refrain from exercising or strenuous activity for one to 2 weeks. Stitches are usually removed in 5-7 days. Once the stitches are removed, you may use makeup but need to be careful when removing the makeup so as not to pull on the incision line. You may also wear your contact lenses approximately a week after surgery.

What will I look like?

The majority of the swelling and bruising will be gone in 1 -2 weeks, and there will be continued improvement for several months. The incision will also be slightly pink for a few months, but will fade and ultimately become barely visible. Most people will not even know you’ve had eyelid surgery!  You will have a wonderful refreshed quality, and those around you will comment that you look “rested” and “rejuvenated,” but will not be able to place their finger on the cause.    With blepharoplasty, you will experience firsthand how an improved look will inspire an improved outlook.


“The beauty of a woman must be seen from in her eyes, because that is the doorway to her heart…”

Audrey Hepburn