Lower Eyelid Surgery

Lower eyelids may suffer from loss of skin/muscle tone and fat accumulation over time, which can cause bulging beneath the eyes and hence the formation of eye bags. Surgery (known as lower blepharoplasty) helps rejuvenate lower eyelids by relocating or removing excess fat, and where indicated, tightening and strengthening loose or sagging tissue. The results are softened wrinkles, tightened skin and improved eyelid function.


There is a wide range of possible procedures performed under local anaesthesia, sedation or general anaesthesia. Incisions are placed either under the lash line, providing a quickly fading scar or inside the lid (transconjunctival surgery), resulting in instant invisibility.


The lower eyelid with associated canthal ligaments and cartilage (tarsal plate) is among the finest and most complex of facial structures. It protects the eye and helps to keep the eyeball moist and healthy.

Muscle-conserving lower eyelid surgery

Though there are several approaches to the lower eyelid, the optimal strategy is to spare or redistribute tissue rather than remove it, and to retain fullness of the lid and the periorbital area.

For most cosmetic lower eyelid surgery, Dr Sorensen employs the transconjunctival approach, a technique which involves cutting along the inside surface of the eyelid rather than through the outer skin. Fat is then conservatively removed or repositioned to restore eyelid fullness. This method of access conserves the structural integrity of the eye muscle and nerves, leaving motor function intact. Furthermore, the healing process is enhanced and it results in no visible scarring of the skin.


Several options for treating loose skin may be considered along with transconjunctival eyelid surgery. These include microsurgical skin trimming, skin peel or laser skin resurfacing.


Canthopexy can be one of the most important and rejuvenative components of lower eyelid surgery. It is a surgical tightening of the outer corner of the eye, which may become loose or rounded with age. The procedure can restore the shape of the eye and improve the tension of the lower eyelid. Canthopexy is a tissue-conserving procedure that reinforces the existing tendon without cutting or detaching it. The restoration of tension within the tendon and muscles reduces the amount of fat that requires removal, which helps prevent the future development of lower eyelid hollowness.


Canthopexy is frequently combined with a light surgical tightening of the Orbicularis Oculi muscle, as improved muscle tone will help raise sunken eyelid tissue and soften the border between the eyelid and cheek.

Treatments to improve on eyelid functionality

Lower eyelid surgery may also be combined with fat grafting to the eyelid tissues, periorbit and cheek. Additionally, a number of specialised oculoplastic procedures are available to treat eyelid asymmetries, decreased eyelid tension, rounded eye, eyelid hollowness or functional eyelid problems related to facial palsy.

Suitable candidates for lower eyelid surgery

Lower eyelid surgery can benefit any person with functional and aesthetic concerns related to the lower lids, independent of age. Procedures are performed with intravenous sedation (TIVA). Recovery is relatively short (usually only a few days) and most patients return to normal activities after a week. Some swelling, bruising or skin-discoloration may last for up to 4 weeks.