Will Lower Blepharoplasty Make Edema Under Eyes Worse?

I have protruding fat bags under my eyes which needs lower bleph to correct. My question is, I have been getting fluid retention under my eyes for the last few years that happens about every morning. Some mornings are really bad and others or manageable, but over the course of the day do go down. After researching I think its edema of some kind and have tried natural diuretics and doesn't seem to help too much. Will lower blef complicate the issue and what can be done about the fluid retention?

Doctor Answers 10

Lower Blepharoplasty and effect on edema

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With blepharoplasty, fat is removed and sometimes fluid can become worse. Unless fat really needs to be removed, filler under the eyes can be a better option than surgery. You should really consult with a surgeon who specializes in eyelid surgery (like an oculoplastic surgeon) to see if there is swelling and if surgery is necessary. The technique for removing the fat bags can make a difference, whether through the conjunctiva or through the skin.  It is a possibility that the swelling may get worse.

New York Oculoplastic Surgeon

Lower blepharoplasty and presence of edema

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The primary goal of a lower blepharoplasty is to remove the puffiness created by the 3 fat pads in the lower lids that create the puffy or tired look on the lower lids.  Malar edema, which is a fluid retention in the cheek pad, is not affected by the lower blepharoplasty.  If malar edema is present, it will not get any better or worse with a lower blepharoplasty.

Surgery can remove the fat but not the edema

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Lower blepharoplasty can be very helfull in removing bulging fat from your lower lid. Fluid that accumulates each morning however is fluid within you tissues. This fluid is not in a single descrete pocket that can be removed. Surgery will likely make the fluid bags worse during the healing phase but should return to the pre operative state with time.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Puffy eyes

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without photos can't tell. but if the swelling is malar bags, then beware, they will get worse. hard to say how long. post pics if u want more speific info

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Lower blepharaoplasty and skin puffiness

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It is hard to offer useful advice without seeing pictures, but here are some general thoughts.  It is important to distinguish between the puffiness that occurs in the lower eyelid as a result of herniation of the lower eyelid fat compartments and a much more superficial puffiness that occurs due to excess fluid under the skin at the eyelid/cheek junction.


This second more superficial type of fullness will not be corrected by a blepharoplasty and may even temporarily be made worse by the surgery.  It will usually settle down after a while.

There is no magic procedure that will correct this, nor is there a particular surgical approach that will avoid exacerbating this superficial swelling.  If you have this type of situation, often referred to as "malar puffs" in the plastic surgery literature, it may be temporarily aggravated by eyelid surgery, whether the approach is through an incision beneath the eyelashes or through a transconjunctival incision.


I hope this information is helpful to you.

Lower blepharoplasty and swelling.

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Lower blepharoplasty and swelling are temporary and the bags should be gone after surgery. I would need to see photos to give you a proper answer to your question to see exactly where the swelling is.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Recurrent lower lid swelling

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I am concerned with the history of the recurrent lower lid swelling and increasing fat herniation especially without a medical history or proper pictures. Medical etiology of this condition must be investigated prior to any surgery. Although transconjunctical approach will take care of most of the fat and minimize lymphatic disruption of the lower lid skin, you will still need to have skin removed for best result. I believe the recurrent edema will certainly worsen after surgical blepharoplasty for months and maybe years. If tear troughs are the main problem, you may consider soft tissue filler injection to improve the contour.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Lower eyelid surgery for bags: could swelling be worse?

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Morning Jay,


I have to agree with Dr. Amadi's approach and recommendations.  That being said, there is no substitute for a good physical and eval.  I'd see a good Oculoplastic surgeon before proceeding for a couple reasons:

1.  It's always good to get a few consults.

2.  You want to ensure there are no medical issues (thyroid disease, etc.) contributing to this.


Most likely you'd see a nice improvement with potential for occasional fluid retention but get an evaluation first.  As a double-trained Facial Plastic & Oculoplastic surgeon I want to stress the importance of the medical evaluation. 


Best of luck


Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

Post photos

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If you are having a blepharoplasty done, it would be best if a transconjunctival approach is used.

Making a skin incision approach will possibly damage the lymphatic drainage channels as well as adversely affect the eyelid muscle. This might lead to worsening "festoons".

The blepharoplasty will not likely change the swelling aspect of your eyelid problem. If you have thin, crepey, redundant skin, I would recommend an Erbium laser skin resurfacing approach to tightening the skin, without actual skin excision.

Posting a photo really would be ideal to get a better recommendation.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Lower Blepharoplasty and Edema Under Eyes

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If you are having a blepharoplasty it may become worse during the healing process but then it should return to normal. It is important to note that while a lower blepharoplasty will help with any loose or excess fat/skin someone may have under their eyes, it will not help with edema as this is a separate issue having to do with fluid building up in your skin.

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.