Lower Eyelid Blepharoplasty

Our eyes are the focal point of the face. Many of our patients opt to have eyelid surgery to rejuvenate sagging, droopy eyelids and surrounding skin. Some people, often due to genetic influences, have more issues with their lower eyelids and under eye bags.

Dr. Eftekhari performs lower blepharoplasty to remove under eye bags and rejuvenate the eyes and face.

How does lower blepharoplasty surgery remove under eye bags?

Facial aging often starts in the lower eyelids. Lower blepharoplasty, colloquially known as under eye bag removal, is a procedure that rejuvenates this area to restore a natural, youthful appearance. The lower eyelids are one of the most delicate areas on the face. A procedure in this area requires careful attention to detail, an experienced surgeon, and knowledge of the anatomy to avoid long-term consequences. 

Who is a good candidate for lower eyelid surgery?

The thin skin on our lower eyelids does not age gracefully. This is especially true in the high altitude and consistent sunshine of Utah. We spend a lot of time outdoors here, and that contributes to wrinkles in eyelid skin and under eye bags.

If you have excess lower eyelid skin and puffy bags beneath your eyes, this could be an excellent procedure for you. Patients often come to Dr. Eftekhari seeking to specifically to address their under-eye puffiness. Patients describe feeling more "awake" and "refreshed" after lower eyelid surgery. 

How is lower blepharoplasty performed?

These are delicate surgeries, but Dr. Eftekhari is board-certified and specializes in these procedures. Under his care, you’ll be sure to love your rejuvenated eyes. In the lower eyelid, there are two options for the incision. It can be made just below the lower lid eyelashes (subciliary) or behind the lower eyelid on the pink tissue (conjunctiva). Going through the conjunctiva (transconjunctival blepharoplasty) is Dr. Eftekhari’s preferred way to access the lower eyelid fatty tissues because it is a scarless procedure. In some patients, excess skin can also be removed. Some patients also have a midface lift performed to tighten the lower eyelid and enhance the aesthetic result.

What about fat grafting?

If you have significant volume loss in your cheek and upper face, then you may want to consider fat grafting in this area to improve the result. Fat grafting is where Dr. Eftekhari removes fat cells from around your belly button and rejuvenates the areas where volume loss from aging can occur, especially in the cheeks. Some of the fat resorbs but stem cells within the fat will stay around and help volumize that area.

Is it better to remove to reposition the fat?

Dr. Eftekhari pays particular attention to fat in both eyelids, but particularly in the area under eyes. Some doctors remove too much fat, leaving the patient with a hollow appearance in that area. Dr. Eftekhari is focused on getting the a natural appearance with a fantastic aesthetic result. Instead of removing all the fat, Dr. Eftekhari can in some cases reposition the fat into the tear trough hollow below the eye to maintain a natural look. Some patients need even more fat transferred into the cheek area which is where fat grafting can help as an additional procedure. For each patient, Dr. Eftekhari develops a customized treatment plan.

To do the surgery, Dr. Eftekhari places incisions inside the eyelid to hide the scar. When needed, he removes skin to address lower eyelid wrinkles. These incisions heal very well without a noticeable scar in most cases.

What is the difference between upper and lower blepharoplasty?

The term blepharoplasty is used for both upper and lower eyelids, and in both cases it means improving your natural appearance to make you look less tired, angry or sad. The difference is in which part of your face most contributes to that -- is it the upper eyelids or the under eye bags? Most patients have obvious aging across both eyelids and under their eyes, and they opt for Dr. Eftekhari to work on both upper and lower eyelids at the same time. But some people have most of their visible aging on the lower lids and the area under the eyes. They opt for just lower blepharoplasty. Lower eyelid surgery targets the fat, ligaments and skin below the eyes, rather than just the eyelids.

Frequently Asked Questions

Are there non-surgical options to treat under eye bags?

For select clients, Dr. Eftekhari can treat dark circles under their eyes in a non-surgical fashion with filler made from hyaluronic acid gel. Hyaluronic acid is a natural component of our bodies -- think about it as the lubrication that allows the cells in our body to slide past each other (extracellular matrix). Hyaluronic acid filler products include Juvederm, Restylane, Belotero, Versa and Voluma. In these products, the companies cross-link the hyaluronic acid particles to make it more viscous - like maple syrup - and longer-lasting so that we can inject small amounts into the face to add volume. Dr. Eftekhari has extensive experience with filler treatments around the eyelids.

Which kinds of filler are used around the eyes?

There are certain products that perform better around the eyes, and Dr. Eftekhari will discuss this with you at your appointment. Dr. Eftekhari performs all filler injections himself. He is very careful about recommending filler because 1) it is only appropriate for certain candidates 2) it is not permanent - your body absorbs under eye filler after 1 year 3) if done poorly, it can cause boggy, bluish swelling in the lower eyelids.

Filler can treat certain kind of dark circles under the eyes, especially for patients in their 30s and 40s. But for patients that have a lot of excess under eye fat or wrinkled skin, lower blepharoplasty may be a better and longer-lasting option. This will restore the natural appearance better than filler in most cases.

Is under eye bag removal covered by insurance?

Some patients have a droopy lower eyelid or malposition called ectropion or retraction. If this causes severe dryness of the eye, then sometimes the lower eyelid can be tightened as a medical procedure. Unfortunately, insurance will not cover any procedure that is seeking to aesthetically rejuvenate the under eye area.

What is recovery like after lower blepharoplasty?

After surgery we will send you home with instructions for ice packs and eye ointment. Use of that compress can really make a difference in your swelling and any subsequent bruising. Over-the-counter pain medication is ok to use after surgery. Your stitches will dissolve on their own. Bruising peaks around 48 hours after surgery, and swelling is variable but can last from 1-4 weeks. Your full results will show over the next couple of weeks as the last swelling runs its course.

Most patients can return to work after three days.

How soon will I be able to see my results from lower eyelid surgery?

Swelling will hide your results for the first week, although you’ll be able to notice the changes almost immediately. Once you are past the bruising and swelling, you’ll be amazed at how much more alert you look.

Most people feel that eyelid surgery, whether upper or lower or combined, takes about a decade off of your facial age.

How long does lower eyelid surgery take?

These are not long surgeries. Lower eyelid surgery usually takes 30-45 minutes per side.

Can I get under eye bag surgery if I have had PRK or LASIK surgery?

LASIK and PRK surgeries address the shape of the cornea and in no way affect the eyelids. Patients who have had either of these vision correction procedures can have blepharoplasty. Dr. Eftekhari wants his patients to wait three months after having LASIK/PRK before having this procedure, just to be sure the cornea is healthy.

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