Lower blepharoplasty (lower eyelid fat reduction) can help to tighten the area under the eye by removing fat and excess tissue and creating a more youthful look. Undergoing lower blepharoplasty will not eliminate wrinkles from under the eye, however, it can make the skin smoother in appearance, look more rested, younger and friendlier.

Most people who have lower blepharoplasty have upper blepharoplasty as well, but it is possible to treat only the under eye area. The incisions made from a surgeon will follow the natural lines and creases of the eyelids.

There are different approaches to lower blepharoplasty:
• Transconjunctival, which actually removes the excess fat.
• Tissue-Sparing, a newer surgical approach that moves orbital (under-eye) fat to its normal ‘compartment’ and does not actually remove the fat.

Transconjunctival Lower Eyelid Blepharoplasty (with or without Pinch Blepharoplasty)

Other common names: Posterior approach, lower blepharoplasty

Primary goal: Thinning of bulging fat, often called lower eye bags

Secondary goals: Fat transfer to hollowed areas

Special anatomy: The "conjunctival" is the thin clear membrane of tissue that lines the back of the eyelid and then reflects onto the front surface of the eyeball to cover the sclera (the "white").

Anesthesia: Local anesthesia with oral or intravenous sedation

Variations: The surgery may be accomplished with the laser or any other cutting tool. An optional "skin pinch" excision may be added, if indicated (see below), and the orbicularis muscle may be tightened as well through the same skin incision. Less commonly, fat may be redistributed around the orbit or reflected over the orbital rim rather than being removed.

Advantages: The advantages of this operation over transcutaneous (through the skin) lower eyelid blepharoplasty are substantial and include:
• No external scar
• Less invasive to middle layers of eyelid, leaving them functionally intact
• No risk of lower eyelid retraction (lower eyelid pulled down)
• No chance of lower eyelid ectropion (lower eyelid pulled away from eye)
• More precise fat sculpting during removal
• Less bruising and swelling
• Less chance of major orbital bleeding and vision loss
• More rapid recovery
• Safer for reoperations in patients who have had previous lid surgery
• No chance of aggravating lid retraction as the mid-face sags with age

Limitations: The big question to ask about this operation is obvious: if only the fat bag is addressed, what happens to the skin? In patients with minimal or no excessive skin, the skin and muscle layers previously extended out over the bulges simply returns to a more normal position with little or no evidence of redundancy or wrinkling. In patients with more significant skin excess, a strip of skin just below the lashes can be pinched without dissection and then excised (pinch blepharoplasty) and/or the skin can tightened slightly using chemical peel or laser resurfacing over the lower eyelid and upper cheek.

Care and recovery: In general, bruising and swelling are minimal, and recovery is rapid.

Risks and complications: There is a higher risk of temporary conjunctival swelling ("chemosis"), which can make the thin membrane of tissue over the white of the eye look slightly "blistery" for several weeks.