What Is Lower Blepharoplasty (Eyelid Surgery)?
Lower blepharoplasty is a delicate cosmetic surgery designed to rejuvenate the under-eye area by smoothing puffiness, reducing wrinkles, and restoring a natural lid–cheek transition. It’s one of the most requested facial procedures today — but also one of the most feared. That’s because the skin here is the thinnest on your body, and poor technique can leave patients with visible deformities, dry eyes, or an unnatural hollow look.
Done correctly, though, it’s a transformative procedure with subtle, beautiful results.
Lower blepharoplasty targets the fat pads, loose skin, and wrinkles under the eyes. It is different from upper eyelid surgery (which focuses more on excess skin and vision obstruction). In this case, the goal is to remove or reposition bulging fat, tighten crepey skin, and smooth out the hollow area known as the tear trough.
Many people who seek this procedure complain of:
- Persistent under-eye bags
- A tired look even after rest
- Deep grooves between the lower eyelid and cheek
- Visible wrinkling or sagging under the eyes
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How It Works: Techniques Explained Simply
There’s no one-size-fits-all. Your anatomy — not just your age — determines the right method. Here’s what modern blepharoplasty offers:
Transconjunctival Approach (Scarless, Internal)
This “from the inside” method uses a small incision inside the lower eyelid.
- Fat is removed or repositioned, without cutting skin or muscle.
- It’s ideal for people with under-eye puffiness but little to no skin laxity.
- No visible scar, no muscle disruption, and lower risk of lid droop.
This approach has become the gold standard in younger patients and those with good skin elasticity. It can also be paired with laser skin resurfacing for a wrinkle-smoothing boost.
Transcutaneous Approach (Skin + Fat)
A traditional method using a discreet incision just below the lash line.
- Allows access to both fat and excess skin.
- Can include canthopexy (supporting the outer eyelid).
- Still widely used in older patients or when sagging skin is significant.
However, if done too aggressively — especially in patients with weak eyelid support — it can lead to ectropion (pulling down of the eyelid). This is why some surgeons now prefer transconjunctival + laser combo even in older patients.
Fat Repositioning vs. Removal
Rather than simply trimming fat (which risks a hollowed look), surgeons can redistribute it to fill hollows, such as:
- Tear troughs (just below the inner eye)
- Nasojugal groove (outer part of the orbital rim)
Preserving fat is now a key principle. Fat is a youthful asset — not something to eliminate carelessly.
Canthopexy / Canthoplasty (Eyelid Support)
In patients with weak or loose lower eyelids, this small adjustment reinforces the outer corner of the eye. It's essential in preventing:
- Downward lid pull (scleral show)
- Rounded eye shape
- Dry eye due to lid gap
Safety Starts With Experience
The success of lower blepharoplasty depends on precision — and the hands behind it. See certified surgeons who specialize in eyelid surgery →
Modern Touch: Laser-Assisted Lower Blepharoplasty
CO₂ laser–assisted surgery is growing in popularity. Instead of a scalpel, the laser creates precise incisions and gently tightens surrounding skin.
Benefits:
- Less bruising and bleeding
- Sterilization during incision (lower infection risk)
- Can be paired with 1540 nm laser for additional skin tightening
It’s especially useful in patients who need a transconjunctival approach + skin refinement without full external incisions.
What If I’m Not Ready for Surgery?
Not everyone needs surgery — and not everyone wants it right away. Several non-surgical treatments can improve the appearance of the under-eye area, especially in early aging:
- Fractional CO₂ or Er:YAG lasers: tighten skin and smooth fine wrinkles; often combined with transconjunctival blepharoplasty or used alone in early cases.
- Radiofrequency devices (e.g., Thermage FLX): stimulate collagen production with minimal downtime.
- Ultrasound-based tightening (Sofwave, Ultherapy): firm mild skin laxity without needles or peeling.
- Dermal fillers (e.g., Restylane, Juvéderm): reduce hollowing in the tear trough area; effective but must be injected with extreme precision to avoid puffiness or Tyndall effect.
- PRP (Platelet-Rich Plasma): uses your own blood to stimulate tissue regeneration and improve tone; subtle but popular for pigmentation and fine lines.
- PRF (Platelet-Rich Fibrin): next-generation PRP that releases growth factors slowly for more visible, longer-lasting skin rejuvenation.
- Skinboosters: microinjections of hyaluronic acid and nutrients to hydrate and plump thin, crepey under-eye skin.
- Polynucleotides (PNs): biologically active injectables like Nucleofill or Plinest that improve elasticity and stimulate deep skin repair.
- Botox: relaxes dynamic wrinkles like crow’s feet; often combined with other treatments but won’t address bags or skin laxity.
These non-surgical solutions can temporarily improve texture, tone, and volume — but they cannot remove fat pads or restore structural support like surgical lower blepharoplasty can.
Recovery and Results
Healing depends on your procedure type and your own biology — but here’s what most patients can expect:
- Bruising + swelling: peak around day 3–5, subside after 1–2 weeks
- Makeup: safe to use after 7–10 days (if no open stitches)
- Final result: appears between 2–3 months after surgery
- Contact lenses: wait at least 2 weeks
Stitches (if external) are removed after 5–7 days. Most patients return to light social life or work within 7–10 days — though minor swelling may persist a bit longer.
Is It Safe? And Is It Worth It?
When performed by a skilled oculoplastic or plastic surgeon, lower blepharoplasty is considered very safe. That said, it is technically complex due to:
- The thinness of the skin
- The dynamic movement of the eyelid
- The risk of over-removal of fat or skin
Risks Include:
- Lid malposition (ectropion or rounding of the eye)
- Under-eye hollowness
- Dry eye
- Visible asymmetry
- Rarely, orbital bleeding or infection
These risks are uncommon — but real. Choosing a certified surgeon with eyelid-specific training is key.
How Do Patients Feel After?
A large-scale peer-reviewed study analyzed 1,991 blepharoplasty patient reviews sourced from RealSelf.com and published in the Aesthetic Surgery Journal.
- 93.7% of reviews were positive, with satisfaction driven mainly by:
- Bedside manner (48.2%)
- Aesthetic outcome (46.1%)
- Negative reviews (6.3%) were mostly due to underwhelming aesthetic results — not complications.
This confirms what many surgeons already know: when lower blepharoplasty is done with precision, patients are overwhelmingly happy with their results — both physically and emotionally.
How Long Do Results Last?
Lower blepharoplasty typically lasts 10–15 years, and sometimes longer. Once fat is repositioned and skin is tightened, the improvements tend to hold — especially if you maintain good skincare and avoid significant weight fluctuations.
Unlike filler or laser, which require repeated sessions, this is a one-time investment with long-term payoff.
Lower blepharoplasty can offer years of visible improvement, but only if the procedure is done precisely.
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Cost of Lower Blepharoplasty in Belgium
Lower blepharoplasty pricing varies depending on technique (scarless vs external incision), surgeon’s expertise, use of laser, anesthesia type (local vs general)
Average range in Belgium: €1800–€3500
Laser-assisted or combined upper + lower procedures can increase the cost slightly.
