Why Would A Surgeon Be Reluctant to Perform Under Eyelid Surgery?

I have visited a plastic surgeon with a view to getting an upper and lower eyelift. The surgeon agrees that I would benefit from an upper lift but says I do not have eyebags and the skin under the eyes is not perfect and is loose but would not benefit from surgery. However, I definitely do have puffy bags under my eyes and people I have asked agree with me. Why would a surgeon be reluctant to operate.

Doctor Answers 6

Fools rush in where Angels dare to tread.


There are hundreds of thousands of bad eyelid surgery results out there.  Arrogant surgeons imbue themselves with the attitude lower eyelid surgery is supposed to pull the lower eyelid down or alter the shape of the lower eyelid or leave the lower eyelid paralyzed.  Whatever your post-surgical concern is that is what surgery is supposed to do.  Others recognize that there is something wrong with our surgical paradigms.  They try to be very selective in offering lower eyelid surgery to avoid the many foreseeable issues with lower eyelid surgery.  Generally, here are the issues that cause surgeons to go awry with lower eyelid surgery: 1. Negative vector lower eyelid- this means that there is poor cheek bone structure with inadequate support for the lower eyelid.  2. Loss of deep buccal fat with a mid-ckeek fold.  This volume deficit is poorly addressed with lower eyelid surgery. 3. Fullness in the lower eyelid not caused by fat.  Believe it or not sometimes the lower eyelid fullness is caused by the orbital rim that can be seen as an outline in some lower eyelids. 4. Disrespecting the motor nerve supply to the lower eyelid.  Lower eyelid surgery performed through a skin incision below the lower eyelid lashes can damage the nerves that supply the muscle along the edge of the lower eyelid.  This causes the lower eyelid to slump after surgery. 5.  Removing too much skin in the lower eyelid. 6. Removing too much fat from the lower eyelid. 7. Improperly correcting weakness of laxity in the outer corner of the eyelids. 8. Over laser resurfacing the lower eyelid skin.  9.  Improperly placing fat into the very thin tear trough hollow area.

It is reasonable therefore for surgeons to be reluctant to operate on lower eyelids.  They are simply telling you that they personally do not believe they can help you.  This does not necessarily mean that no one can help you.  However, you need to be very careful in this because inevitably you are going to find someone who feels they have been anointed by a higher power to perform your lower eyelid surgery but their confidence in their own surgical abilities does not meet the difficulties presented by your lower eyelids.  So sure interview more surgeons, just be very careful about the process.  There is often a suitable compromise to be had and a pre-surgical consultation should be all about the limitations of these surgeries.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eye bags

  There is ABSOLUTELY no question that surg8cal correction of lower eye bags is more tricky than surgery to correct upper eyelid skin.  That is the only explanation I can give you.  My best advice would be to consult a well-trained specialist in oculofacial plastic surgery.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 134 reviews

Bags Under Eyes

One way you can tell if you have significant bags under eyes is to gently pushon the eyeball with eye closed while looking with the other eye. If you see enough eye bags, these can be removed. The pictures you have provided are hard to evaluate. As to why a surgeon might be reluctant to do the lower eyelid? The lower eyelid surgery is more complicated and if there is no fat but only a small amount of skin, then it is not worth doing the surgery.

If you have doubts you can always get a second and a third opinion and be upfront with your question.


Disclaimer: This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 104 reviews

Why Would A Surgeon Be Reluctant to Perform Under Eyelid Surgery?

The surgeon probably believes that he will not be able to improve your appearance.  If you think otherwise, you are entitled to receive another opinion.  See an Oculoplastic surgeon.  Good luck.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Not a good surgical candidate for lower lid blepharoplasty

Millie, Perhaps the are issues that only a complete evaluation would clear up. If I were to guess perhaps your lower lid anatomy puts you at greater risk of lower eyelid malposition post op or you may have malar bags and not the more common fat buldges. Did you ask the surgeon directly? You already paid for an opinion so ask. Good luck

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 32 reviews

Why not correct my lower lids?

Confused millie,

From your description,I am confused also. There are a myraid of ways to treat the lower lid; take away fat, pinch skin, excise skin and muscle, add fat, tighten the tarsal plate, etc. It is a complex procedure in any event. For you to be comfortable with your surgery you must be comfortable with your surgeon. Take some time to explain your concerns to your surgeon. If heor she does not seem to be hearing you, then consult one or more other physicians. Be sure the physicians you seek are Board Certified with the American Board of  Surgical Specialties
 I hope that this is helpful for you . Jon Sattler, MD Board Certified Plastic Surgeon, Glendora, California.


Jon Sattler, MD
Glendora Plastic Surgeon
3.5 out of 5 stars 22 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.