Lower Blepharoplasty

Lower blepharoplasty is a surgical procedure that removes excess skin folds, under-eye bags, and treats dark circles on the lower eyelids.

Under-eye bags are pockets of fat that are not the same as the fat found in areas like the abdomen. This fat is independent of weight gain or loss. The goal is to reduce the tired appearance caused by the sagging of the lower eyelids. This procedure can be performed with (external approach) or without scars (internal or transconjunctival approach) depending on the case.

Lower blepharoplasty is for patients who present with:

• Under-eye bags
• Hollow dark circles
• Excess skin folds
• Pigmented or blue dark circles

Lower blepharoplasty is not recommended for patients with:

• Significant exophthalmos (protruding eyes)
• Glaucoma (elevated intraocular pressure)
• Ectropion (significant weakness of the lower eyelid)

• Younger Patients: These patients have had under-eye bags since teenage period or even childhood. These fat pockets are hereditary and tend to worsen over time. The fat in these bags is independent of the rest of the body and of weight gain. Once removed, it does not return
• Older Patients: These patients often experience skin laxity in the eyelid, leading to unsightly folds, which are more or less associated with under-eye bags and hollow dark circles. In such cases, in addition to the techniques mentioned above, a lower eyelid lift may be required

The principle of lower blepharoplasty is to remove the fat pockets under the eyes either through a transconjunctival approach (without visible scars) or a sub-ciliary approach (with a very discreet scar under the lashes). Dr. Lyor HANAN specializes in transconjonctival approach technique with eye bag fat repositioning.

When, in addition to the fat pockets, there is an excess of skin folds on the lower eyelid, a lower eyelid lift is performed by cutting away the excess skin. The scar is almost invisible, just under the lashes.

Often, the hollow dark circle needs to be treated as well, through injections of your own fat (lipofilling) harvested from the abdomen or thighs with liposuction, or by spreading (repositioning) the fat pocket along the hollow dark circle.

In some cases, if the eyelid is slightly weak or if the eye is round (scleral show), an external canthopexy is required to strengthen the eyelid and prevent complications such as ectropion, round eye, or scleral show.

Technically, Dr. Lyor HANAN makes an incision with a scalpel in the conjunctiva or on the skin just under the lashes, then identifies the internal, medial, and external fat pockets. The excessive fat is repositionned in a little pocket made into the cheek in order to volumize the cheekbone and blend the transition from the orbital rim to the cheek. Thus, we can treat the eye bag fat volume by reducing it, and the hollow tear through by adding your own fat from the eyebags The incision is then closed with sutures, either on the skin if the sub-ciliary approach was used, or on the conjunctiva if the transconjunctival approach was chosen.

Sometime we need to add more volume. A small amount of fat (around 50 mL) is harvested using micro-cannulas at the inner aspect of the knees. The fat is then purified and washed before being injected via minimal 1-millimeter incisions around the dark circle, cheekbone, and eyes.

This procedure is performed in the operating room, usually under general anesthesia or sometimes under local anesthesia with mild sedation.

The post-operative course for lower blepharoplasty is generally straightforward. There will be bruising and swelling around the eyes for 7 to 15 days.

There is little to no pain, and any discomfort can be managed with paracetamol.

Patients may experience temporary vision disturbances in the first few days, and a sensation of dry eyes, which can be relieved with ointments and drops prescribed by your surgeon. Most patients can return to work within a few days. The stitches are non-absorbable and are removed after 7 days by your surgeon. Scars fade quickly over a few weeks and are invisible within 3 months.

Post-operative care is simple: an ointment should be applied to the scars and in the eyes morning and night. Artificial tear drops and saline solution should be applied to the eyes several times a day to prevent dryness.

Post-operative complications are extremely rare but can include bleeding (hematoma), infection of the scar, or reopening of the scar.

The results of lower blepharoplasty include:

• Opening of the eyes
• A less tired appearance
• A refreshed look
• A less hollow and less sad face

Results are visible within 10 days and are permanent after 3 months. The results typically last around 10 years.

The cost of lower blepharoplasty ranges from 20 000 – 26 000 AED.