What is Lower eyelid surgery or lower blepharoplasty?

Lower eyelid blepharoplasty surgery is a broad term to describe surgical procedures that specifically address ageing changes in the lower eyelid.

What are the features in the eyelid that make patients seek lower eyelid surgery? 

Patients seek surgery to address the following conditions
  • Eyelid skin – loose, crepey and wrinkly
  • Eyebags - bulging
  • Muscle – saggy and loose and bulging
  • Eyelid margin – sagging with the ‘white’ of the eyeball on show
  • Eyelid margin can be turned inwards (entropion) or outwards (ectropion)
  • Deep grooves in the under-eye area such as a prominent ‘tear trough’
  • Combination of the above as a part of the ageing process.

What are the benefits of Lower eyelid blepharoplasty surgery?

Lower eyelid surgery or lower blepharoplasty can remove loose, excess and crepey skin, remove eyebags, tighten the lower eyelid, address the deep under eye grooves.  It can reduce puffiness and eyebags in the area of your lower eyelids.


Can men undergo lower eyelid blepharoplasty surgery?

Yes, men and women commonly undergo lower eyelid surgery.
In fact, men undergo lower eyelid surgery to address bulging eye bags more than addressing loose skin or wrinkles.


At what age does eyelid puffiness and eyebags appear?

Most people end up with sagging eyelid skin after the ages of 40 and 50.
Sometimes people experience eyelid puffiness and skin sagging at even earlier ages, due to genetic traits they inherited from parents or grandparents. Eye bags that are small puffy looking fat bulges under your lower eyelids are often seen in older people and is a well-known feature of the ageing eyelid.

Lower eyelid blepharoplasty surgery can help puffy looking skin bulges.

What causes puffy-looking skin bulges under your eyes?

Three (3) key contributors to eyelid area laxity, eyebags and puffy eyelids are:
  • A general weakening of the support structures and skin around the eyelids (leading to laxity, droopiness, puffiness and fat pad redistribution)
  • Repeated facial expressions 
  • Bone changes around the eyes (ageing-related skeletal atrophy)
This can occur all around the eyes, when atrophy occurs beneath the eyes, eye bags often form; and lower eyelid surgery may be indicated.



eyelid guide snapshot (2)





Lower eyelid blepharoplasty surgery to reduce puffy eyes and eyebags is one of the top requested cosmetic facial surgery procedures in Sydney. Lower eyelid surgery is one of the eyelid surgery procedures that expert Plastic Surgeon, Dr Naveen Somia, provides through his Sydney eyelid surgery and facial rejuvenation clinic.

A well designed and precisely executed lower Blepharoplasty Surgery by a Specialist plastic surgeon with expertise in eyelid surgery can help:

  • Correct skin laxity, structural weaknesses and reduce eyebags.  The eyes appear more open without leaving you with a startled expression.
  • Redistribute fat precisely to blend the lower eyelid and cheekbone. 
  • This surgery should only be done by an expert. In the hands of a less trained Surgeon, problems could lead to serious consequences such as malfunctioning tear ducts, the inability to close your eyes fully, a very uneven appearance, and more.


What are the 4 main types of lower eyelid blepharoplasty surgery? 

The 4 types of lower eyelid surgery are
  1. Pinch lower eyelid blepharoplasty
  2. Transconjunctival lower eyelid blepharoplasty
  3. Transcutaneous lower eyelid blepharoplasty
  4. Transcutaneous lower eyelid blepharoplasty +Midface lift

Pinch lower blepharoplasty

As the name suggests a very small amount ‘a pinch’ of skin is excised from the lower eyelid. Suitable for younger patients who have only a small amount of excess skin.


Transconjunctival lower eyelid surgery or blepharoplasty

In this approach the cut is made on the inner surface of the lower eyelid and there is no visible scar. It is useful to treat younger patients whose main complaint is eyebags and is a very effective way to reduce the bulging eyebags.
If the skin needs to be removed a pinch lower blepharoplasty technique can be used to remove small amount of skin.
This method is not suitable for older patients who have excessive amount of loose skin.

Transcutaneous Lower eyelid surgery or blepharoplasty

Here the cut is made 2 mm below the eyelid margin and extends past the outer corner for about 5-10 mm.
Using this method, you can effectively address loose and excess skin, tighten muscle and reduce the eyebags. A Canthoplasty or Canthopexy can be performed at the same time to tighten the eyelid margin. Suitable for patients over 45 who have significant ageing changes.

Transcutaneous Lower blepharoplasty + cheek lift or midface lift

In addition to the above, this approach allows one to address excess skin and muscle, address eyebags and comprehensively correct the deep grooves under the eyelid like tear trough and naso jugal groove. It also allows to reposition the cheek or malar mound. This approach can effectively treat festoons.


Can eyebags and festoons be treated with lower eyelid blepharoplasty + midface lift?

Eyebags and festoons are not one and the same. Eyebags occur directly under the eye, between the eye and the cheek bone. Festoons or malar bags occur ON the cheek bone. 
Festoons are formed due to the ageing process of the cheek bone (not the part immediately under the eye) together with the laxity of the skin and muscle.
Festoons in my opinion is the most difficult lower eyelid condition to treat. It is difficult because of many reasons. The anatomy is complex and not well understood, the results following any treatment be it dermal fillers, laser or surgery is unpredictable at best.
I have found that the best way to treat malar festoons is by Transcutaneous lower eyelid blepharoplasty + midface lift using multiple techniques. Wide undermining of lower eyelid and cheek skin, release of tough ligaments like arcus marginalis, tear trough, orbito malar ligament, zygomatico facial ligament or midface ligament, fat transposition, canthopexy with midface lift and malar fat pad elevation, tightening of lower eyelid with a skin muscle flap followed by redraping of skin.
Direct excision of festoons is an option that is reserved for very severe cases and for recurrence of festoons following surgery. The downside to this direct excision is a scar on the cheek that settles well in 12 months.

THE Cost of Lower Eyelid blepharolasty Surgery  WILL VARY dependING on several factors.

Unless medically indicated to correct lower eyelid conditions like ectropion, entropion, eyelid skin cancer or traumatic injuries, it is fair to assume that all lower eyelid surgeries are considered as cosmetic and hence not eligible for medicare or health fund cover.


How long does the lower eyelid blepharoplasty operation take?

  • The surgery usually takes from 1.25 to 2.5 hours. 
  • This can vary from patient to patient and depends on the specific procedure required to address your eyelid concerns and whether additional procedures are performed.


Do I have to stay in hospital overnight for lower eyelid blepharoplasty?

  • Lower Eyelid surgery is a complex plastic surgery procedure that must be performed precisely to reduce the risks of complications. 
  • It is best performed by an expert Plastic Surgeon with extensive experience in lower eyelid procedures, due to the high risk of complications if you choose a less-trained, less qualified surgeon.
  • An overnight stay in hospital is recommended.
  • Complications may require longer hospitalisation periods.

How long is the healing process?

  • Healing and recovery after eyelid surgery can vary from patient to patient.
  • On average, the healing process tends to take three to four (3-4) weeks or more; sometime longer depending on what you’re having performed; and how your body responds.
  • Please ensure you allow adequate healing and resting time after your eyelid surgery.
  • Check with Dr Somia for some helpful healing instructions and don’t try to do too much too soon; you will need to rest your eyes a lot during those initial weeks of healing.

Tips for a better outcome: Before, During and After Eyelid Surgery


BEFORE Blepharoplasty Surgery:

  • Book a consultation with Sydney’s top eyelid surgeon, Dr Naveen Somia
  • Read the materials provided and discuss your surgery objectives, desired outcomes and facial anatomy including surgery costs, surgery schedules, time frames, recovery care, healing times and risks
  • Consider the PROS and CONS of the surgery and what you want accomplished
  • Ask any and all questions you have about eyelid surgery including risks and your goals.
  • Only after doing your research into lower blepharoplasty, should you decide to proceed 
  • Schedule your surgery, work out your payment options and attend pre-consultations
  • Follow Dr Naveen’s recommendations for pre-surgery preparation
  • Stay healthy to enhance your healing period and help prevent healing delays


DURING Lower Blepharoplasty Surgery:

  • Avoid wearing contacts for the designated time (ask Dr Naveen for specific information on stopping wearing contacts before your eyelid surgery)
  • Before surgery, read and re-read your post-op instructions
  • Have the post-operative eyelid care instructions laminated and place them by your bedside, using very large font sizes, for when you get home after surgery
  • Have the proedure under general anaesthesia.
  • When you’re cleared by Dr Naveen or released from hospital, make sure you have someone to drive you home 
  • Have someone available to assist you for several days post-surgery 

After Blepharoplasty Surgery:

  • Stay out of the sun for the designated period of time
  • Make sure you’re choosing good nutrition and drinking plenty of water 
  • Rest your eyes and do not drive until you are cleared by your Surgeon
  • Care for your eyes and sutures as instructed by Dr Naveen
    • You may be asked to sleep in an elevated position 
    • You may be able to use gently applied cool packs to minimise swelling, but check with Dr Naveen as these must be used only according to instructions
  • You may feel your eyes appear swollen or your eyelids ‘tight-feeling’; you may have some bruising or discolouration around the eyes after surgery 
  • Some sutures are dissolvable; if any non-dissolvable sutures are used, these will be removed at a follow-up consultation with your Surgeon (around 8 days)
  • Report any concerns or questions 
  • Attend follow up appointments and have your sutures removed around a week later (this can vary slightly and frequently doesn’t hurt)
  • In approximately three to four (3 to 4) weeks’ time, your eyelids should be mostly healed, however, the scar may take up to 12 months to fully mature
  • Follow Dr Naveen’s scar minimisation instructions


You will generally see Dr Somia 3 times before your surgery.   If you prefer one of these consultations can be held via telehealth.    Two consultations are required by law before a date for surgery is scheduled.   This is to allow you plenty of time to ask questions and feel comfortable about the procedure.   Your third consultation will assist us to prepare you for your surgery (ie paperwork, pre-operative testing). 



The surgery takes approximately  1.5 hours to 2.5 hours depending on the procedure recommended and requires an overnight stay in hospital.  Our fees include specialist plastic surgeon, specialist anaesthetist, fully accredited hospital theatre, accommodation and 6 months aftercare. A formal estimate will be provided after you have discussed your goals and what is possible to achieve them with Dr Somia.  



Each patient recovers at a different rate and anothers recovery should not be compared with yours.

Generally, initial recovery from swelling and bruising is approximately 3-4 weeks.   A return to normal activities can usually be expected after 6 weeks.   Full results can be expected 3-6 months after.  

You can return to work when you feel well and if your employer has lighter duties for you and will allow you to take time to rest and move around.    Most patients take 2-3 weeks off work if they work in an office context.   Patients working outdoors or in a physical capacity may need to take up to 6 weeks off work whilst they recover.   Talk to us about your specific occupation and surgery.   

You can drive when the anaesthetic has worn off, your vision is clear, and you are pain free getting in and out of the care and whilst performing an emergency stop.   You should check your vehicle insurance policy for their requirements in this situation.  



All surgery carries risks. When travelling overseas on a plane whilst the expectation is a safe journey and arrival, it is understood things could go wrong. The choice of the airline based on safety record and flight path are important elements in determining risk. Similarly, for your surgery, the experience and expertise of your Surgeon, the skill of your anaesthetist and the standard of the hospital will determine the risk. Risks, both general and specific, will be discussed during your consultations and written information will be provided for you to take home.    

General risks include pneumonia, deep venous thrombosis and pulmonary embolism, stroke, heart attack, allergies, awareness, death, bleeding, infection, sensation change, haematoma and seroma, skin contour irregularities, damage to deeper structures, firmness, delayed healing and tissue death, exposed sutures, dog ears or additional skin golds, dressing issues, asymmetry, scars, lymphoedema and unsatisfactory results. 

Risks specific to Blepharoplasty (Eyelid) surgery are:  injury to the eye globe, need for extra tissue,  loss of vision, changes to tear secretion,  conjunctival oedema and chemosis, exposed sutures,  upper eyelid malposition, difficulty closing the upper eyelid and corneal exposure, lower eyelid malposition and eyelash loss.                                


Our practice privacy policy prevents sharing patient before and afters online. Indicative before and after photos can be viewed during your consultation.  

DISCLAIMERS:   All surgical procedures are performed by Specialist Plastic Surgeon, Dr Naveen Somia (MBBS PhD, FRACS - APHRA Reg:  MED 0001189889).  For full information on Dr Somia's qualifications and risk/recovery information on procedures please visit the procedure page on this website.  From July 1, 2023 all surgical procedures require a GP referral.
All surgery carries risks.  information provided is general only.  Outcomes experienced by one person do not necessarily reflect the outcomes of others given factors such as genetics, diet and exercise.  Please seek a 2nd opinion from a qualified Specialist Plastic Surgeon.  

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