Blepharoplasty recommendations? (photos)

Hello, I am desperately looking for recommendations on a great doctor who can fix my lower eyelids. I would rather not go with the transconjuctival approach, simply because I would like to remain awake and also because I have been told there is extra skin that would need to be cut. I am aware of the small scar I would be left with and am okay with it. I would really appreciate any input on this, and of course would love any recommendations. I have included some pictures. Thank you in advance.

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Doctor Answers 14

Lower eyelid blepharoplasty surgery

In our practice, we always recommend patients undergo lower eyelid surgery under a very brief general anesthesia for patient safety and comfort by board-certified physician anesthesiologist. It's very difficult and painful to get the fat deposits removed from the lower lids, since they do Numb up well to the lidocaine numbing medication. You will have significant pain and conscious awareness of the procedure.  The trans-conjunctival approach is the gold standard we have been using for over 25 years our practice to remove fatty deposits in the lower lids. It is very important not to violate the anterior muscle of the lower lids, and that's why that technique is so important. 

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews

Lower eyelid tuck

Yes, you do have some excess lower eyelid fat bags, which could be treated quite adequately via a trans-conjunctival approach or with an incision immediately below the lashes of the lower lids.  The main difference is that the trans-conj approach does not deal with any excess skin while the exterior incision will allow for removal of even a small amount of excess skin.

Obviously, the choice of approach will be determined by an in-person physical exam and then a thorough discussion of the pros and cons of each approach.

If you imagine the eyelids as the frame around the eyes, you may also want to explore possible surgery on the upper eyelids as well -- to complete the rejuvenation of the entire "frame."

Elliot W. Jacobs, MD, FACS

New York City

Elliot W. Jacobs, MD
New York Plastic Surgeon
4.5 out of 5 stars 35 reviews

Quad bleph

An upper and lower blepharoplasty would greatly improve your eyes.  A subciliary incision for the lower eyelids would adress the excess fat and a conservative skin excision.  An upper lid skin excision surgery would also greatly improve the appearance of your eyes.  Best wishes, Dr. T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

Lower blepharoplasty

You do appear to be good candidate for lower blepharoplasty, which can be done under local anesthesia or conscious sedation, EVEN IF transconjunctival (see video below). There are several advantages to transconjunctival approach. If there is extra skin to be removed, then additional skin pinch excision can be done.  See following link.  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

Lower blepharoplasty

Removal of fat from the lower eyelids can be accomplished through a sub-ciliary approach.  There are many good surgeons who can accomplish this.  It all depends on the location.  You should interview at least 2 different surgeons and then decide who you feel most comfortable with.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 106 reviews


Hello and thank you for your question. Based on your photograph, you are a great candidate for a lower eyelid blepharoplasty with fat removal.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 131 reviews


Likely you could benefit from some fat removal maybe some fat redraping and/or release along the lid cheek junction as well.  You might consider upper lids as well. Good luck

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Your eyes

You are an excellent candidate for a blepharoplasty. We use sedation for the surgery and the lower lids can be done either way -- but in your case it does not look as if you have any excess lower lid skin and the transconjunctival method has a faster recovery and no lower lid scar. 

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Blepharoplasty recommendations

Lower eyelid Blepharoplasty has evolved a lot over recent years.  There are different approaches and should be customized to each persons anatomy.  I understand the desire for less anesthesia to minimize its risks.  Skin incision vs transconjunctival should not make a difference in pain.  It is the fat manipulation that is most pain sensitive.  The surgeon should be at the ready to re-inject with local anesthesia once the fat pads are identified.  So please don't base your Blepharoplasty decision on pain of the entry point, but rather which approach gives you the maximum result with the minimum risk exposure.  From your photos it does not look like you have much excess skin at all and in fact your lower eyelid between your iris and the outer corner (canthus) has a slight bow downward.  Your problem seems to be more due to contour issues.  An in person evaluation would be best.  Please seek a qualified surgeon with experience in lower eyelid Blepharoplasty.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 22 reviews

Lower blepharoplasty

You appear to be an excellent candidate for this procedure. As long as you are healthy and have no medical issues regarding your eyes, there's no reason why you would not get an excellent result. The scar right under the eyelashes (subciliary) heals very well and as you stated this approach can be done while you're awake. 

Elan B. Singer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 25 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.