Lower Blepharoplasty

Skin Resurfacing

Lower Blepharoplasty

Dr. Denise wong


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Aesthetic surgery represents a unique blend of science and art, both requiring creativity, manual dexterity, and great attention to detail. As a surgeon and artist, Dr. Denise Wong exemplifies these qualities and understands the concept of beauty in balance. She treats each patient individually and strives to provide the best, most natural look to obtain excellent cosmetic results.

Dr. Wong is double-board certified in Facial Plastic Surgery, by the American Board of Facial Plastic and Reconstructive Surgery and by the American Board of Otolaryngology — Head and Neck Surgery. An expert in the field, she has given multiple lectures, authored several publications, and actively teaches at the University of California, San Francisco.

Dr. Wong’s professionalism, sincere compassion for others, and enthusiasm to educate her patients, lend to the highest quality of patient care.

Our eyes are often the first feature that draws attention when we interact with others. Having bright, smooth, even, well-defined eyes are considered a sign of beauty and youth. With aging, the eyelid skin becomes droopy, loose, and uneven, making the eyes appear tired and aged. Because the eyelid skin is extremely delicate and susceptible to forces of gravity, genetics, and sun damage, the lower eyelids are one of the first areas of your face to show signs of aging.

The once seamless transition between the lower eyelashes and the upper cheeks becomes disrupted with uneven contour and “bags” begin to appear. Weakening of facial structural ligaments and laxity of the tissues leads to sagging of the cheeks, exposing the bony rim of the orbit which causes the face to appear hollow and skeletonized.

Lower eyelid surgery or lower blepharoplasty is a cosmetic procedure that removes excess skin and fat, and in some cases, repositions fat around the eye, to create a natural, refreshed, and rested appearance. At Wave Plastic Surgery, our plastic surgeons use the most advanced techniques to effectively rejuvenate your eyes and restore a youthful and energized appearance.

Who should get lower eyelid surgery?

If you have excess lower eyelid skin and/or puffy bags under the eyes, you may be a great candidate for lower blepharoplasty. The benefits of lower eyelid surgery include rejuvenation of your eyes and improvement in the skin discoloration or dark circles under the eyes. Surgical candidates should generally be healthy, nonsmokers, and without any serious eye conditions.

See more in our Before & After gallery!

Initial Consultation

At Wave Plastic Surgery, our surgeons will carefully review your medical history and perform a detailed evaluation of your eyes. We spend time listening to your individual concerns and provide an individualized treatment plan on how to give you the best results. Lower eyelid surgery can be done alone or in conjunction with other complementary procedures, such as upper eyelid surgery, lateral canthopexy or canthoplasty, and fat grafting to provide a more comprehensive eye rejuvenation.

Lower Eyelid Surgery Procedure

Lower eyelid surgery is typically done under local anesthesia with light intravenous sedation. The surgical procedure takes about one hour. Lower eyelid surgery can be performed with two main approaches: transconjunctival (incision made inside the eyelid) or transcutaneous (incision made on the eyelid skin). Once an incision is created, excess fat and skin from the lower eyelid can be removed or repositioned to create a smoother eyelid contour.

Goals: Remove excess skin and fat to create a natural, more refreshed appearance.
Operation Time: 1 hour
Anesthesia: Local Anesthesia with IV Sedation
Pain Level: 3/10
Stitch Removal: 7 days
Recovery: 10-14 days
Follow up: 5 times

The Wave Method

Many different types of techniques exist for lower eyelid surgery. At Wave Plastic Surgery, our surgeons are extremely knowledgeable on the most advanced techniques to ensure a successful outcome. We perform a transconjunctival approach to minimize scar formation and preserve the natural shape of the lower eyelid.

An incision is created inside the lower eyelid to access the excess fat that surrounds the eyeball. The fatty tissue can be removed or repositioned depending on the patient’s needs. Our surgeons understand the delicate nature of the eyes and know how much fat to safely remove from the lower eyelid without causing hollowing of the eyes.

If needed, a small, separate skin incision is made just under the eyelashes to remove any excess skin to create a smooth, seamless contour. Very fine sutures are then used to meticulously close the incision and are removed after one week.

Canthopexy and Canthoplasty

Sometimes the lower eyelid is weakened with aging and loses the elasticity required to maintain the eyelid shape. In these situations, we recommend performing an adjunctive canthopexy procedure to strengthen the lower eyelid. A canthopexy can help prevent sagging of the lower eyelid and the formation of an ectropion where the lower eyelid loses tone and does not fully contact the eyeball.

This procedure can tighten and improve the contour of the lower eyelid by anchoring the tendon of the eyelid muscle to the lateral orbital bone. In some patients, the outer contour or angle of the eyelid can be adjusted with a lateral canthoplasty to open up the eye, creating a more balanced and attractive eye shape.

Fat Repositioning

Some patients have a prominent tear trough deformity or hollowing along the orbital rim that may require fat repositioning as an adjunctive procedure. Fat repositioning involves rearranging the orbital fat to recontour the hollow or depressed areas around the eye. The arcus marginalis, a fibrous attachment of the lower eyelid to the infraorbital bone, is released and the orbital fat is repositioned to fill in areas along the bony rim that are hollow or sunken in. This adjunctive procedure can help restore a smooth and seamless transition from the lower eyelids to the upper cheeks to create a more youthful and refreshed appearance.

Upper Blepharoplasty

Upper eyelid surgery can also be performed in combination with a lower blepharoplasty for total eye rejuvenation.

See more on our Before & After gallery!

Lower Blepharoplasty Recovery

Lower eyelid surgery is well tolerated. Patients have minimal discomfort and a quick recovery process due to our meticulous surgical techniques. Mild swelling and bruising typically resolves within 2 weeks and can be minimized with ice packs or cool compresses and consuming a low salt diet. Sometimes dry eyes can occur while healing after eyelid surgery which can be treated with artificial tears to lubricate the eyes. The incisions heal extremely well and are essentially inconspicuous once fully healed.

When choosing the most appropriate method, individual characteristics of the eyelids, such as the amount of excess skin, heaviness of the eyelids, asymmetry, ptosis, eye shape, as well as the type of double eyelid desired must be considered. The recommended surgical approach to accomplish your specific goals and desired results will be discussed in detail during your initial consultation.

Lower eyelid surgery is well tolerated. Patients have minimal discomfort and a quick recovery process due to our meticulous surgical techniques.  Mild swelling and bruising typically resolves within 2 weeks and can be minimized with ice packs or cool compresses and consuming a low salt diet.  Sometimes dry eyes can occur while healing after eyelid surgery which can be treated with artificial tears to lubricate the eyes.  The incisions heal extremely well and are essentially inconspicuous once fully healed.  

Lower Eyelid Surgery Results

Although the aging process persists, the longevity of our results typically lasts about 7-10 years. Lower blepharoplasty is an effective surgery that can provide you with a natural, rejuvenated, and refreshed appearance that can boost your self-image and confidence.

See more on our Before & After gallery!

Common Questions About Lower Blepharoplasty

If this is your first time undergoing surgery, even minimally invasive surgery, you likely have many questions. Here are the most common questions that patients ask.

Recovery typically takes about 2 weeks. During the healing process, it is important to do frequent cold compresses, minimize salt intake, and rest your eyes to minimize any swelling or bruising.

Lower eyelid surgery is not considered a painful procedure. Most patients have minimal to no pain after surgery. Over-the-counter Tylenol is typically adequate to relieve any discomfort.

Many different surgical techniques exist to perform lower eyelid surgery. At WAVE plastic surgery, our plastic surgeons are extremely experienced and use the most advanced surgical methods. Using a transconjunctival approach, we place the incision inside the eye to remove the lower eyelid fat to minimize any scarring. Adjunctive procedures are sometimes performed in combination with lower eyelid surgery based on individual patient needs to provide the best surgical results.

Lower blepharoplasty is a very safe surgical procedure. Our WAVE plastic surgeons have extensive knowledge and experience to ensure patients have a safe and successful outcome.

Patients of varying ages may benefit from lower blepharoplasty depending on their lower eyelid condition. During the consultation, our WAVE plastic surgeons can determine if you are a good candidate for lower eyelid surgery. Although there is no specific age to perform a lower blepharoplasty, on average, patients tend to be in their mid-30s and older.

However, even younger patients in their twenties who are impacted by genetic predisposition, lifestyle or other health conditions may be candidates for lower eyelid surgery. Ultimately, the decision to undergo lower eyelid surgery is based on your individual needs and eyelid condition.

Lower Blepharoplasty is performed under local anesthesia and light intravenous sedation to ensure patients are comfortable and without any pain.

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