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  • Chris Thiagarajah MD

Lower Eyelid Blepharoplasty for Eyebags: The steps I perform


What are the steps for a lower eyelid blepharoplasty or cosmetic eyelid surgery?


Patients often ask about the steps of lower eyelid blepharoplasty. What exactly is done during that cosmetic eyelid surgery procedure?

There are steps that tend to be universal in lower eyelid surgery but the truth is that every patient is different and steps for a lower eyelid blepharoplasty are different. Some patients need fat removed. Some need eyelid fat repositioned. Some patients need eyelid skin removed. Some patients need all those steps. It is the responsibility of the eyelid surgeon to determine which components are necessary and to what extent.

Incision in the conjunctiva

This is the initial cut that made in the inside of the eyelid. The incision that is used to perform a blepharoplasty is on the inside of the eyelid. We often do not perform incisions on the outside of the eyelid unless necessary. That is because the inside approach is often cosmetically more appealing.

Excision of fat

Puffiness of the lower eyelid is caused by fat that has come forward with time. A lower eyelid blepharoplasty involves removing and repositioning some the fat. Not every patient has their fat removed but some do.

Incision of periosteum

To place the fat in the tear trough, an incision is carried out in the periosteum of the bone. That is the skin of the bone that sits against bone. Placing fat in this area allows for fat to soften an area without appearing lumpy.

Repositioning of fat

This is the step where fat is repositioned in cosmetic lower eyelid surgery into the tear trough. This step allows for fat to improve the hollows of the eyelid. We have limits on how much fat we can use since each patient’s puffiness only provides us with a certain amount of fat. Some surgeons leave the fat connected whereas others just separate the fat and reposition it.

Skin incision

After fat is removed from the eyelid, skin can be removed on the side of the eyeylid through an incision that is made under the eyelashes. This incision is hidden very well and heals almost imperceptibly. It is done is almost every blepharoplasty unless the patient is very young (<40) where the skin tends to shrink into position back again.

Lateral fat excision

Sometimes through the skin incision on the side, fat is removed or repositioned.

Skin tightening

Excess skin is removed and a stitch is placed to tighten it back into position.

Skin Closure

The incision is closed.

As can be seen these are the basic steps for lower eyelid blepharoplasty. It is the most common cosmetic procedure I perform. Lower eyelid blepharoplasty is best performed by an expert or oculoplastic surgeon. Eyelid specialists focus their entire careers on eyelid surgery and performing this procedure to create the best outcomes for their patient. Call for a consultation to find out the exact steps I would perform in you 303 468 8844.


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