Lower Blepharoplasty
Also known as under eye surgery, tear trough surgery
Addresses under-eye bags and hollowing. Technically harder and less forgiving than upper lid surgery.
US $4,000–9,000.
How it works
Herniated orbital fat is either removed or, in modern technique, repositioned over the orbital rim to fill the tear trough. A transconjunctival approach works from inside the lid leaving no external scar; a transcutaneous approach allows skin removal but risks lid retraction.
How it's used
Fat repositioning generally beats fat removal — excising fat can hollow the eye and age it. Choose an oculoplastic surgeon. If the problem is volume loss rather than fat herniation, filler may be the better and far less risky first step.
Trade-offs
In favour
- Removes genuine under-eye bags that no cream or concealer touches
- Transconjunctival approach leaves no visible scar
- Fat repositioning smooths the lid–cheek junction
- Long-lasting
Against
- Technically demanding with a meaningful complication rate
- Over-resection creates a hollow, aged look that is hard to fix
- Does not improve dark pigmentation, only shadowing from contour
- Longer swelling than upper lids
Risks and side effects
- Lower lid retraction or ectropion — the lid pulling down and away
- Chemosis (conjunctival swelling)
- Persistent asymmetry
- Hollowing from over-resection
- Rare vision-threatening haemorrhage
Recovery
Week 1: significant swelling and bruising, worse than uppers. Week 2: bruising fading, back to work with concealer. Weeks 3–6: contour settles. Months 2–6: residual swelling and any chemosis resolve.
How good is the evidence?
Well-established, but with a higher complication and revision rate than upper blepharoplasty and more variable outcomes.
Sources
Sources point to guideline bodies and literature searches rather than single papers, so they stay accurate as the evidence moves.