Lower Eyelid Surgery

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Lower Eyelid Surgery

At Wave Plastic Surgery

Lower Blepharoplasty in Los Angeles, Orange County and San Francisco

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 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 lead to sagging of the cheeks, exposing the bony rim of the orbit which causes the face to appear hollow and skeletonized.

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Lower eyelid surgery at Wave

Lower eyelid surgery or lower blepharoplasty is a 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 surgeons use the most advanced techniques to effectively rejuvenate your eyes and restore a youthful and energized appearance.    

Lower eyelid surgery is often used for treating problems such as:

Are You a Good Candidate for Lower Blepharoplasty?

If you have excess lower eyelid skin and/or puffy bags under the eyes, you may be a great candidate for lower blepharoplasty. Lower eyelid surgery can rejuvenate your eyes and also help improve the skin discoloration or dark circles under the eyes. Surgical candidates should generally be healthy, nonsmokers, and without any serious eye conditions.

Initial Consultation

At Wave Plastic Surgery, our surgeons will carefully review your medical history, perform a detailed facial analysis, and evaluate the condition of your eyes. We spend time listening to your individual concerns and provide a detailed treatment plan on how to give you the best results.

Operative Procedure

The lower eyelid surgery is typically done under local anesthesia with sedation. The procedure takes about one hour. Lower eyelid surgery can be performed with three main approaches: Transconjunctival Blepharoplasty, Fat Removal with Skin Excision, and Lower Eyelid with Lateral Canthopexy.

Get Your Consultation Today

Give us a call today to schedule a consultation with one of the plastic surgery experts at Wave Plastic Surgery.

Transconjunctival Blepharoplasty (Fat Removal & Repositioning)

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.

During this procedure, 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. 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 used to meticulously close the incision and are removed after one week.

Fat Removal with Skin Excision

Adding Skin Excision to a Transconjunctival Blepharoplasty procedure allows the surgeon to remove excess skin and minimize fine lines and wrinkles around the eyes.  Patients who have protruding bags under their eyelids will often need procedure to smooth out any imperfections in the under-eye region. 

Who is a good candidate for this procedure?

Lower Blepharoplasty with Lateral Canthopexy

Sometimes the lower eyelid is weakened by the aging process 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 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.

Who is a good candidate for this procedure?

Get Your Consultation Today

Give us a call today to schedule your consultation with one of our plastic surgeons at Wave Plastic Surgery.

How Does Lower Blepharoplasty Work?

Removing Protruding Fat Beneath the Eyes

There are three separate compartments where the orbital fat resides. As we age, the tissues holding the orbital fat become attenuated, and as a result, the fat becomes more visible as it protrudes out more. Depending on the severity and whether there is a depression in the lower portion of the lower lid rim, each individual’s treatment will be different.

If excess fat is the only issue, we can remove it using a transconjunctival approach (inside the eyelid). This prevents unnecessary external scars, and there is less of a chance of disrupting the tissues that can cause eversion of the lower eyelid. The removal of the fat must be conservative to prevent unwanted hollowing.

If the fat is not too significant but does exist, the tissues holding the orbital fat can be simply tightened. This is called a septal reset. If there is a hollowness in the lower lid rim, called a tear trough, the fat can be mobilized and repositioned to the bony rim margin. This helps with the removal of the protruding fat as well as filling in the defect of the tear trough.

Smoothing Wrinkles and Depressions in the Tear Trough (the Lower Lid Margin)

Older men and women may also be facing problems with wrinkles or depressions in the tear trough (the area below the lower lid).

Factors that can be causing this condition include:

In this case, if only the orbital fat is removed, it may cause even more pronouncement of the tear trough depression. Instead, we transfer the orbital fat to the lower lid rim to fill in this area. We have found that, at times, fat is not enough and therefore, may need to lift the malar soft tissue with an endoscopic mid-facelift using Endotine.

Reshaping the Lower Lid Margin

A youthful lower lid margin should have a relatively straight, horizontal direction, with a slightly upward tilt towards the end. However, as we age, the lower lid margin tension becomes weak and stretched. This results in a very loose margin, giving the eye a more rounded appearance. Tightening and straightening the margin can achieve a more youthful appearance of the eyes.

The technique used to reshape the lower lid margin is called a lateral canthopexy, where the lateral tendon of the eyes is fixed to the orbital bone. This will provide for a better shape of the eyes and helps to protect against post-surgical ectropion (margin of the eyelid being pulled down), which can occur after removing excess skin.

Sculpting the Orbital Muscle in the Lower Lid:

One of the prominent features of a youthful lower eyelid is the prominence of the orbital muscle just underneath the lower eyelashes. As we age, this can appear less pronounced. We may recommend the Alloderm dermal matrix or a fat transfer to sculpt the orbital muscle and restore a youthful appearance.

Our Lower Eyelid Specialist

Plastic Surgeon Peter Lee

Peter Lee

M.D., F.A.C.S.

Dr. Peter is CEO and Chief Surgeon of WAVE Plastic Surgery Center with over 20 years of plastic surgery experience, overlooking 30K+ successful plastic surgery cases. He has mentored master surgeons around the world in state-of-the-art techniques, and has been inducted into the RealSelf 100 & 500 Hall of Fame.

His many accolades and shining results are evidence of Peter’s expertise.

Plastic Surgeon Ben Lee

Ben Lee

M.D., F.A.C.S.

Throughout 20+ years in aesthetic plastic surgery, Dr. Ben Lee has always been passionate about using his skills to impart a lasting, positive impact on the lives of his patients.

“Time and time again, I have witnessed dramatic improvements in a patient’s confidence and well-being after a relatively minor cosmetic or reconstructive procedure. As a surgeon, that brings me great joy.” — Dr. Ben Lee

Frequently Asked Questions About Eyelid Surgery

Blepharoplasty is the medical term for eyelid surgery. The purpose of the surgery is to remove the excess fat and sagging skin from the upper and lower eyelids.

The eyelid surgery is ambulatory, so patients return home the day of the surgery. After 7 to 10 days, the sutures are removed, and any swelling will quickly subside. The swelling usually dissipates completely 2 weeks after the Blepharoplasty. Patients typically return to work a week after the surgery.

The average price for eyelid surgery, or Blepharoplasty, is around $4,000 for upper eyelid surgery and $5,000 for lower eyelid surgery. Most Plastic Surgeons will bundle upper and lower eyelid surgery for a discounted price.

Dark circles or “bags” under the eyes are treated with lower eyelid surgery if they are the result of shadowing due to bulging or fat or sagging skin. If the dark circles are the result of pigmentation changes, skin lightening creams or light chemical peels may be able to treat the issue.

The development of wrinkles around the eyes is a natural part of aging. Over time, the skin around the eyes becomes less elastic, which causes the eyelids to droop. Once this process begins, a person may start tensing their forehead muscles to lift their drooping eyelids. This can cause headaches and fatigue. If you are experiencing these symptoms, or want a more youthful, energetic look, you may be a good candidate for a blepharoplasty.


Eyelid surgery typically begins with local anesthesia to numb the area, along with light intravenous sedation. Patients remain awake, but stay comfortable and do not experience any pain during the procedure. After any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients typically have very mild discomfort after their eyelid procedures.

Eyelid skin is the thinnest skin on the body. As such, it heals more quickly than any other skin on the body. The incisions made during an eye lift procedure are made along the eye’s natural creases. These incisions will heal quickly and be almost imperceptible and are typically only visible when the eyes are closed.

Blepharoplasty is a relatively quick and non-invasive cosmetic procedure. A plastic surgeon can perform the upper Blepharoplasty in an hour and the lower Blepharoplasty in another hour.

Give us a call today to schedule your Eyelid Surgery consultation with one of our plastic surgeons at Wave Plastic Surgery.

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