Lower Blepharoplasty & Midface Lift FAQ

Lower blepharoplasty is surgery that uses an incision just below the lower lashes to reposition or trim bulging under-eye fat, tighten sagging skin and muscle, and remove excess skin. It is mainly considered when bulging under-eye fat comes with skin sagging and fine wrinkles. If there is little skin sagging and only a fat bulge, it is often corrected with under-eye fat repositioning without a skin incision.

Hollowing after lower blepharoplasty can occur mainly when a lot of under-eye fat was removed or the fat was repositioned excessively. To reduce this, careful planning before surgery and repositioning an appropriate amount are important. If hollowing has already developed, restoring volume with a fat graft or another method is considered.

Because lower blepharoplasty tightens and removes loose skin, under-eye wrinkles caused by sagging skin often improve. However, expression lines that appear when smiling or fine lines in the skin texture itself may not disappear completely with surgery, so botulinum toxin or skin treatments are sometimes considered as well.

Lower blepharoplasty involves a skin incision, so it does leave a scar, but because the incision is placed just below the lashes, it is often not very noticeable after recovery. Redness may be present early on and gradually fades over several months, and how noticeable the scar becomes depends on skin type, constitution, and aftercare.

Returning to daily activities after lower blepharoplasty takes 1 week. The under-eye compression tape is removed 2 days after surgery, and stitches are removed around 7 days after surgery. Before stitch removal, wash your face while avoiding the under-eye and front cheek area; face washing and makeup on the surgical area are possible from the day after stitch removal. Swelling and bruising are worst on days 2–3. Wait 4 weeks before wearing contact lenses, using a sauna, or doing strenuous exercise.

Besides temporary swelling, bruising, watery eyes, and a foreign-body sensation, lower blepharoplasty can rarely cause the lower eyelid to droop or turn outward (ectropion), under-eye hollowing, asymmetry, or scarring. Most temporary symptoms improve within 1–6 months, but if symptoms persist, additional treatment or revision surgery may be needed.

Ectropion after lower blepharoplasty can occur when a lot of skin was removed or the lower eyelid has weak elasticity, as swelling or scarring pulls the lower eyelid downward. Mild early ectropion often improves as the swelling subsides, but if it persists, lateral canthopexy or a correction that adds skin may be needed. To prevent it, lower eyelid elasticity is checked before surgery, and when needed, orbicularis oculi suspension, a midface lift, or lateral canthopexy is planned in advance and performed together.

The results of lower blepharoplasty tend to last a long time. Because bulging fat is repositioned and excess skin is removed, it is uncommon to return to the pre-surgery state, but skin elasticity continues to decline with age, so some sagging may return over time. How long the results last varies with skin condition and lifestyle.

Lower blepharoplasty usually takes 1 hour to 1 hour 30 minutes, and both IV sedation and local anesthesia are available. It takes longer if a fat graft or another procedure is combined, and the anesthesia method is decided during the consultation after reviewing your health and the scope of surgery.

Upper and lower blepharoplasty can be performed together. If you have both upper eyelid sagging and under-eye fat or sagging, doing them at once means going through recovery only once. However, the surgery takes longer and swelling may be greater, so we decide whether to do them together or separately after checking your health and eye condition.

Lower blepharoplasty revision is considered when under-eye hollowing develops or a fat bulge remains, when the lower eyelid droops or turns outward, or when the scar is noticeable. Revision is usually done after 6 months, once the tissue has stabilized, and the method depends on the remaining skin and tissue condition from the previous surgery, so accurate diagnosis is important. If there is a functional problem such as the eyelid turning outward, it is best to see a doctor first regardless of timing.

The cost of lower blepharoplasty depends on whether fat repositioning or a fat graft is combined, the extent of skin removal, and whether additional corrections such as a midface lift or lateral canthopexy are included. The scope of surgery can differ greatly depending on your under-eye condition, so an exact cost can be provided after a consultation.

A midface lift is surgery that lifts and secures sagging tissue in the midface, the area from below the eyes to the front of the cheek. At Steady Plastic Surgery, through the lower blepharoplasty incision, the plane between the periosteum and the fat layer beneath the orbicularis oculi muscle (SOOF, suborbicularis oculi fat) is released, and the sagging tissue is lifted and secured with sutures. It is performed as an addition to lower blepharoplasty.

A midface lift is considered when the front of the cheek has descended with age, causing marked hollowing in that area, or when front cheek sagging has deepened the nasolabial folds. Lower blepharoplasty alone removes excess skin and repositions fat below the eyes but does not lift a sagging front cheek, so if midface sagging is also present, a midface lift is added to smooth the contour from below the eyes to the front cheek. It is also sometimes performed preventively when ectropion (the lower eyelid turning outward) is present or the risk of it is high.

Lower blepharoplasty removes loose skin and repositions bulging fat below the eyes, while a midface lift raises sagging tissue in the midcheek area below that. At Steady Plastic Surgery, the midface lift is performed through the lower blepharoplasty incision, so it is done together as an addition to lower blepharoplasty, and whether to add it is decided based on the degree of front cheek sagging and ectropion (the lower eyelid turning outward).

A midface lift is performed through the lower blepharoplasty incision, so it does not require any incision beyond the lower blepharoplasty incision line. Recovery is the same as for lower blepharoplasty: returning to daily activities takes 1 week, the under-eye compression tape is removed 2 days after surgery, and stitches are removed around 7 days after surgery. Swelling and bruising are worst on days 2–3. Wait 4 weeks before wearing contact lenses, using a sauna, or doing strenuous exercise.

After a midface lift, swelling, bruising, and a tight or stiff feeling in the front of the cheek can occur, and these gradually improve with recovery. Rarely, sensation around the front cheek may be temporarily reduced, or asymmetry or recurrent sagging from loosened fixation may occur. It is important to accurately assess the degree of sagging before surgery and plan how much to lift and where to secure the tissue.

A midface lift is added to lower blepharoplasty, and its cost depends on the scope of the lower blepharoplasty and whether combined procedures such as fat repositioning or a fat graft are included. An exact cost can be provided after a consultation.