Lower Eyelid Aesthetics (Lower Blepharoplasty)
Correction of under-eye bags, volume loss, and lid–cheek junction line
Lower eyelid aesthetics is a procedure that aims to surgically correct under-eye bags, volume irregularity, and skin laxity. Most of the under-eye bags arise from fat pads that shift forward with age. Therefore, the aim in modern surgery is not to completely remove the fat but to move it to the correct anatomical level (fat repositioning) and make the lid–cheek transition smoother.
This approach both provides a more natural appearance and prevents the formation of sunken or hollow under-eyes.
Who is it Suitable For?
- Patients with significant under-eye bags
- Individuals with depression, shadowing, or tired appearance at the lower lid–cheek junction line
- Patients with mild to moderate skin laxity
- Individuals with genetic early-age bagging
- Patients seeking a younger and smoother under-eye contour
Before surgical decision, lid position, lid–cheek relationship, skin quality, and fat pad distribution are evaluated.
Stages of the Procedure
1. Anesthesia
The procedure can be performed under sedation or general anesthesia. However, since some stages of the operation can be painful, it is more preferred to be performed under general anesthesia.
2. Determination of surgical approach
There are two basic approaches in lower lid aesthetics:
- Transconjunctival (from inside): The lower fat bags are reached from inside the eyelid without making a skin incision. Fat pads are regulated or repositioned. It is a scarless approach frequently preferred in young patients.
- Transcutaneous (through skin): Preferred in cases accompanied by excess skin. The necessary minimal skin removal is performed at this stage. If needed, midface lift can also be added through this incision without needing a new incision.
3. Regulation / repositioning of fat pads
In current surgical principles, instead of completely removing the fat, the goal is to fill the depression by moving it forward. This way, the under-eye has a more natural transition and the “sunken” appearance is prevented.
4. Strengthening of supporting tissues
If lid tension and position are insufficient, lateral support procedures can be applied.
5. Sutures and closure
In the transconjunctival method, there is no visible external suture. In techniques performed through the skin, fine and regular sutures are used.
Recovery Process
- Swelling and bruising may be seen in the first 3–5 days.
- Cold application and keeping the head elevated reduce complaints.
- Sutures, if any, are removed within 7 days.
- Most of the edema in under-eye tissues subsides within the first week.
- Final contour settling may take a few weeks.
Daily activities can usually be resumed in a short time.
Advantages
- Under-eye bags and shadowing significantly decrease.
- A more natural and younger lid–cheek transition is achieved thanks to fat repositioning.
- In the transconjunctival method, no external scar is visible.
- Contributes to the improvement of tired and sunken appearance.
Limitations
- Skin-on approach may be needed in patients with advanced skin laxity.
- Lateral support procedures should be added in those with lid laxity.
- Genetic tendency to swelling may continue in some patients.
- Proper patient selection is important for results to be natural and balanced.
Lower eyelid aesthetics is a procedure that significantly improves the under-eye contour and provides natural results when applied with appropriate planning and correct surgical technique.