Lower eyelid surgery (lower blepharoplasty)

Fullness under the eyes - commonly called under-eye bags - is usually not fluid. It is fat, held in compartments behind the eyelid, which becomes more prominent as the supporting structures weaken with age. There are two fat compartments in the upper eyelid and three in the lower.

Lower blepharoplasty addresses these fat pads, either by removing them or by repositioning them deeper, and where necessary tightens the skin.

What is actually causing it

Before considering surgery it is worth understanding which of these applies, because they respond differently:

Prominent fat pads - the bulge itself. This is what surgery addresses.
A hollow below the bulge (the tear trough). Part of what makes a bag look prominent is the hollow beneath it. Removing fat without addressing the hollow can leave the area looking gaunt - which is why fat is often repositioned into the hollow rather than simply removed.
Excess skin - fine wrinkling and lax skin. Addressed by skin tightening or excision, or by laser.
Pigmentation - genuine dark circles from pigment rather than shadow. Surgery does not change these.
Fluid retention - puffiness that varies through the day or with sleep, salt or allergies. Surgery is not the answer to this.

Most people have a combination. Which technique is appropriate is determined at consultation after examination.

The techniques

Transconjunctival

The incision is made on the inside of the lower eyelid. Fat pads are removed or repositioned through it, and there is no external scar. This approach is used where skin quality is good and skin removal is not needed. It also carries a lower risk of pulling the lower lid downward than external approaches.

Skin excision (subciliary)

Where there is excess skin to remove, an incision is made just below the lower eyelashes. The resulting fine scar sits immediately below the lash line and may be visible.

Laser resurfacing

Laser cosmetic surgery or laser skin rejuvenation can be used on the skin beneath the eye to improve texture and pigmentation and tighten the skin. This is often combined with a transconjunctival approach so that fat is addressed without an external incision, while the skin is treated separately.

Lower and upper eyelid surgery can sometimes be undertaken together, depending on your anatomy - with one recovery period and a lower combined cost.

Recovery

You may feel drowsy from the anaesthetic. Arrange for someone to drive you home and stay overnight, and rest that evening.
An after-hours direct number is provided.
Return to the clinic for your first post-operative check the next day or within a few days.
The area around the eye may be bruised and swollen for 7 to 14 days. Keep your head upright and apply cold compresses periodically. The lower lid tends to bruise more than the upper.
Sutures, where used, are removed at three to five days.
Avoid swimming until healing is complete - there is a risk of infection.
Skin generally heals within two to three weeks, though this varies.

Where the transconjunctival approach is used there is no visible external scar. Where conventional surgery was needed to remove excess skin, a fine scar sits below the lash line.

Surgeons and nurses monitor recovery through a number of post-operative check-ups.

Costs

Lower blepharoplasty at Me Clinic ranges from $9,000 to $13,000. Upper and lower eyelid surgery together range from $15,000 to $18,000 - combining is generally more cost-effective than two separate procedures, and lower eyelid surgery is often combined with laser treatment.

Each procedure is tailored to the individual, so an accurate figure comes from consultation. The quoted price includes fees for the surgeon, assistant if required, hospital, anaesthesia, recovery care and follow-up - quoted once, in full.

As at September 2024 and including GST, a consultation with a Specialist Plastic Surgeon is $350.

Referral requirement

Since 1 July 2023, all patients are required to have a referral from a general practitioner before seeing a plastic surgeon or doctor about cosmetic surgery. This is a national requirement, not a clinic policy. A cooling-off period applies after your second consultation before surgery can be booked. Appointments are generally available within 7 to 14 days.

Lower eyelid surgery performed for cosmetic reasons is not covered by Medicare. Unlike upper eyelid surgery, there is no visual-field pathway to a rebate for lower lid surgery in most circumstances.

Risks

All surgical procedures carry risks and potential complications. For lower eyelid surgery these include:

Infection
Bleeding and haematoma
Scarring where an external incision was used
Ectropion or lid retraction - the lower lid pulling away from or downward from the eye, exposing more white below the iris. This is the characteristic complication of lower blepharoplasty and may require further surgery to correct
Dry eye, grittiness and watering
Difficulty closing the eyes fully
A hollowed or skeletal appearance from removing too much fat
Residual or recurrent bulging from removing too little
Asymmetry between the two sides
Changes in sensation
Blurred or double vision
Loss of vision - rare, usually from bleeding behind the eye, and a surgical emergency
Anaesthesia complications
An unsatisfactory result and the possible need for revision surgery

Where laser is used, the additional risks include prolonged redness, pigment change, crusting and scarring.

Seek urgent medical attention for severe or increasing pain, rapidly increasing swelling or bruising, or any loss or change of vision after surgery.

Please read our information on the risks and complications of cosmetic surgery before proceeding.

Booking

Phone Me Clinic on 1300 852 050 or use the contact form. Me Clinic is at 4 Burke Road, Malvern East VIC 3145.

See blepharoplasty, upper blepharoplasty, before and after, volume enhancing treatments, or all face procedures.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.