Blepharoplasty - Lower Lids? (photo)

56 year old woman. Blepharoplasty done on upper & lower lids in 1996. Considering getting both my upper & lower lids done again. Consulted several surgeons - different opinions on lower lids. One surgeon does not recommend surgery but filler in tear trough area; 2nd surgeon recommended a transcutaneous blepharoplasty on my lower lids with skin removal; 3rd surgeon recommended transconjunctival blepharoplasty with laser resurfacing on my lower lids. Any feedback would be helpful.

Doctor Answers 5

Blepharoplasty - Lower Lids?

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 Despite the fact that you had upper and lower eyelid surgery previously, the photos reveal evidence of lower eyelid fat bags.  The upper eyelids however seem to have gotten a good result, from the previous surgery and at this particular time, the eyebrows are low making the upper eyelids falsey appear full.  In that scenario, repeat upper eyelid surgery is not recommended but a Brow lift would be to raise the eyebrows to their aesthetic position.  Hope this helps. 

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Technique for Secondary Blepharoplasty: The Options and Patient Safety

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Patients who have undergone previous blepharoplasty need to carefully consult with a plastic surgeon to determine best approaches for secondary surgery.  A patient who underwent initial surgery in the mid-1990's likely had lower eyelid surgery with an external incision.   It is important to know the technique utilized, and a careful physical examination will demonstrate the techniques used.   The examining surgeon should look at the conjunctiva to see if a transconjunctival approach was used before with an external incision for removal of skin.  If only an external incision is present, then only the external approach was used.   The reason that this is important is scar tissue.  It is much more difficult to do a transconjunctival procedure when that approach was used before.

In your case, your lower eyelid shape is nice, and the problem seems to be fatty excess which has reaccumulated in the lower lids.  Excess skin is present in the upper lids.  Assuming your physical examination is similar to the impression on the photos, I would recommend a transconjunctival blepharoplasty with laser tightening of the skin.  I do not see enough excess skin in the lower to recommend skin excison.  The uppers will do well with traditional upper blepharoplasty. This plan minimizes trauma to the lower eyelid support muscles and decreases the risk of lower eyelid drop.  I would also combine these procedures with a canthopexy, which is a procedure that supports the lower eyelid position during the healing process.   Best wishes!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Blepharoplasty Options

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Well, you saw three different surgeons and got three different answers.  No one is right or wrong as there is not a correct answer.  In my opinion, I would suggest either the transcutaneous blepharoplasty with skin removal or the transconjunctival blepharoplasty with laser.  However, I would have to examine you in person to give you more specific recommendations.  Filler is temporary option, would make your lower lids look fuller and is not addressing the underlying problem.


Good Luck.

Lower Lid Blepharoplasy

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I am sorry that you are getting so many different opinions, and understand your confusion, so allow me to add my opinions!  For your lower lids I suggest a transconjunctival approach to manage the fat pads.  Laser resurfacing is an option to tighten up the skin, but in my opinion is not critical for you.  Treating the tear trough could be managed by using the excess fat from the lower lid and re-draping it into the area to fill the trough.  Best wishes!

Brian Howard, MD (retired)
Alpharetta Plastic Surgeon


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Based on your photos, you would benefit from an upper and lower Blepharoplasty.  As for your lower eyelids, I would base my decision on surgical technique by the skin.  Is it loose,do you have too much skin, or is the fat pockets the problem?  Or Both??  You said you have had a few consults, but  I recommend that you consult with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons (ASPS) to address your concerns. 

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.