The eyes can say so much about you and are one of the first features that people notice. When the lower eyelids are puffy, sagging or drooping, it can make you look older, tired and sad. A lower eyelid lift, or lower blepharoplasty, can have a dramatic impact on the appearance of your eyes and face. Dr. Lesley Rabach is a double board-certified facial plastic surgeon at LM Medical NYC who offers rejuvenating lower blepharoplasty at our clinic in Manhattan.
Benefits of Lower Eyelid Lift Surgery
When the skin and tissue on the lower eyelids stretch and sag, it can result in circles and bags under the eyes. The bottom lid can also droop, changing the shape of the eyes. A lower blepharoplasty removes the extra skin and fat, tightening and firming the area under the eye. The benefit is diminished eye bags, circles and wrinkles under the eye for a more youthful and energetic appearance.
Lower Blepharoplasty FAQs
- What are the credentials of my surgeon?
Dr. Lesley is a world-renowned, double board certified facial plastic surgeon, and one of the few elite surgeons who specialize specifically in operating on the face and neck. She completed her internship and residency in head and neck surgery at Yale New Haven Hospital followed by an ABFPRS accredited fellowship in facial plastic surgery. With the most advanced surgical technique and an artistically trained eye, Dr. Lesley sculpts the upper or lower eyelid to achieve a natural, youthful look.
- What is the difference between the “transconjunctival” approach and the “subcilary” approach in lower eyelid cosmetic surgery?
In a transconjunctival approach, an incision is made inside the eyelid, and not on the external part of the lower eyelid. This is the preferred method and is advantageous because the incision is made inside of the eyelid, without requiring stitches, and the recovery time is much shorter. The disadvantage is that the excess skin cannot be corrected with this approach. Sometimes transconjunctival surgery is combined with laser resurfacing to improve skin texture and remove fine lines and wrinkles.
- Are the results of the lower eyelid surgery permanent?
Yes! Unwanted fat bags that are removed do not come back, and it is very uncommon to see patients return for revisions.
- What is the recovery time for the “transconjunctival” approach in lower eyelid cosmetic surgery?
There is a variable amount of bruising and swelling. Our optimized pre- and post-operative approach allows for minimized bruising and swelling and a faster recovery.
- How much does lower blepharoplasty cost?
The fee for lower blepharoplasty starts at $8,500. The fee will be discussed and agreed upon during your consultation and will be based on your individual circumstances and the procedures needed to create the best possible cosmetic result.
- Am I a candidate for a lower blepharoplasty?
A lower eyelift removes bulging fat and/or skin of the lower eyelid. Loose skin is usually seen in older patients and patients with a lot of sun damage while bulging fat is usually genetic and becomes more noticeable in your early forties. However, there are patients who begin to see bulging fat in their late 20’s early 30’s.
- What are the most important factors I need to consider when deciding whether or not to get a lower blepharoplasty?
If your goal is removing the bulging puffy fat and extra skin, then a lower blepharoplasty will resolve both. A lower blepharoplasty does not reduce the look or texture of sun-damaged or crepey skin. If these are additional concerns, you might consider adding a TCA peel to achieve lighter, smoother under-eye skin.
- What is the best age to have a lower blepharoplasty?
Deciding when to have a lower blepharoplasty is not an issue of age. It is purely a matter of when the bags appear and bother you. Younger patients do not have excesses of skin. The young lower blepharoplasty patients will notice bulging of fat in their lower eyelids. That would be the time to at least get a consultation.
- Where are the incisions made for the lower blepharoplasty?
To remove fat, the incision is made on the inside of the lower eyelid. The fancy name for this is transconjunctival blepharoplasty. If skin needs to be removed, then a small incision is made just beneath the lashes along the lower eyelid. In the past fat was removed from the external incision, but the problem with that is the surgery crosses all the layers of the eye, which can result in scarring throughout all of those layers, which can cause the lower eyelid to roll out. For this reason, many surgeons today make a separate incision inside the lower eyelid when they need to remove fat. And since it is invisible, it is not something that a patient ever notices.
- What about lower lid laxity?
Dr. Rabach tests for lower lid laxity on every patient by pulling gently on the lower eyelid to see how quickly it snaps back. If there is a lot of laxity, she will do a procedure that tightens the lower eyelid so that it can withstand the pull of the removed skin.
- What about fat repositioning?
In days past, too much fat was removed from the lower eyelid resulting in a hollowed-out appearance. Plastic surgeons now realize that the preservation of fat in the lower eyelids is important. If there is a pronounced bulge, then fat typically will be removed. But if there is not a lot of fat, but there is a so-called tear trough deformity, meaning a depression along the nose underneath the lower eyelid, then fat from the lower eyelid can be repositioned into this space to fill it up and smooth the contour of the lower lid.
- How do you decide how much lower eyelid fat to remove with a lower blepharoplasty?
Only enough fat is removed so that the contour is smooth and any outward bulging is removed. There was a time when surgeons sought to remove too much fat, thinking that if removal of some of a bulge is good removing more fat would be better. But if you think about the appearance of a young person’s eyes, they are usually full. Hollowed can make someone look thinner, but they will look older. Dr. Lesley is experienced at this and will have a good idea just from looking at someone before surgery to know how much lower eyelid fat will need to be removed with their lower blepharoplasty.
- Will there be scars?
For a transconjunctival blepharoplasty (for removal of just fat), fat is removed from inside the lower eyelid, so there is no visible scar at all. If skin needs to be removed, there will be a scar along the lower eyelid just beneath the lashes. This heals very well and is really not visible.
- Can I have other procedures done at the same time as my lower blepharoplasty?
A lower eyelid lift can be done as the sole procedure, but it is safe to do with just about any other plastic surgery procedure. Patients who need a lower blepharoplasty frequently have other issues of concern, such as their upper eyes or face. A younger patient may also have excess fat in their neck or want a rhinoplasty.
- Will a lower blepharoplasty get rid of the deep lines (crow’s feet) on the sides of my eyes?
A lower blepharoplasty only makes changes in the lower eyelid itself; it does not make changes out to the sides of the eyes in the crow’s feet area.
- Will a lower blepharoplasty get rid of the wrinkles and loose, crepey skin under my eyes?
Yes for some patients redundant skin will be removed. Our dermatologist/facial plastic surgeon team often tag teams to get you not only the best surgical results but also the skin looking its best. We often pair a lower blepharoplasty with a deep chemical peel to resurface the skin.
- Are the results of a lower blepharoplasty permanent?
The fat that is removed from a lower eyelid will never come back. As someone ages, there can be a bit more fat herniation, but that is fairly uncommon. Usually, this is a once in a lifetime procedure. The same is true with skin removal.
- Will I have dark circles under my eyes after a lower blepharoplasty?
If your circles are the result of a bulge creating a shadow underneath them, then there will be an improvement. For pigmentary improvements, we do chemical peels.
- What form of anesthesia will be used for a lower eye lift?
We use local anesthesia and an oral medication for relaxation. We will make sure you feel comfortable and ready before starting the surgery. Local anesthesia cuts down on recovery time and patients can resume their normal activities much faster.
- How soon can I go to work after a lower blepharoplasty?
When you feel ready to do your job is highly individualized. Many people go back to work in the days following blepharoplasty with makeup on. We suggest you plan for at least one week before going back to work.
- When can I resume exercise?
Light exercise and walking can be done right away but for heavy exercise, we suggest you wait two weeks.
- When can I shower/take a bath after a lower blepharoplasty?
You can shower or take a bath the same night as a lower blepharoplasty.
- Will I have bruising and if so, how long will it last?
If there is bruising, it is usually gone by about a week. You can put makeup on the day after the surgery and wear sunglasses if there is bruising.
- How long does the swelling last?
Swelling lasts a few weeks to a month but there often is some residual swelling that can last a few months.
- What do I have to do to care for the incision?
The recovery and the pain after a lower blepharoplasty are relatively minor. Just putting ice on the eyes is all that is usually necessary.
- What should I do to prevent scarring after blepharoplasty?
Eyelid skin heals better than any skin in the body so there is no reason to do anything on the incisions to prevent scarring.
Blepharoplasty can have a dramatic impact on the appearance of your eyes and face. If your eyes are making you look older and tired, consider the benefits of upper or lower eyelid lift surgery. Contact us at LM Medical NYC in Greenwich Village to schedule a blepharoplasty consultation.