Lower Eyelid Surgery: Bags & Blepharoplasty

Why Does the Lower Eyelid Age the Face?

The lower eyelid is one of the first areas of the face to show signs of ageing. The skin is thin, the underlying fat compartments are mobile, and the bony rim of the orbit gradually recedes with time. This combination produces three distinct problems:

• **Under-eye bags:** The fat pads that cushion the eyeball herniate forward. In genetically predisposed individuals this can appear as early as the twenties.
• **Dark circles:** These may result from the shadow cast by fat herniation, visible vessels through thin skin, or pigmentation differences.
• **Laxity and hollowing:** Loose skin combined with volume loss creates a permanently tired appearance.

Lower blepharoplasty can address all three concerns in a single procedure.

Transconjunctival vs Transcutaneous Approach

### Transconjunctival (Internal) Approach The incision is placed on the inner surface of the lower lid, leaving no external scar. This approach is preferred when skin laxity is minimal, typically in younger patients with fat herniation but no excess skin. Fat is either removed or repositioned (transposition).

### Transcutaneous (External) Approach The incision runs just below the lash line and heals in the natural shadow beneath the lid. It is indicated when there is significant skin excess or muscle laxity. In experienced hands the scar fades substantially within a few months.

What Is Fat Transposition?

Traditional blepharoplasty removed the herniated fat entirely, which could result in a hollowed appearance. Contemporary facial plastic surgery has therefore shifted toward fat transposition. Rather than discarding the excess fat, it is repositioned over the tear trough — the depression beneath the fat bulge. The bag is flattened and the hollowing is simultaneously corrected, yielding a smoother, more youthful transition from the lower lid to the cheek.

Who Is a Candidate?

• Persistent under-eye bags despite adequate rest
• Structurally caused dark circles (not primarily pigmentation-related)
• Loose or sagging lower lid skin
• A pronounced hollow-to-bulge contrast beneath the eye

In some cases, a dermal filler can temporarily camouflage the fat bulge, making surgery unnecessary.

The Procedure and Recovery

The operation is typically performed under local anaesthesia with sedation and takes 45 to 90 minutes.

• **Days 1-3:** Swelling and bruising peak. Cold compresses are recommended.
• **Days 7-10:** Sutures are removed (transcutaneous approach); most bruising resolves.
• **Weeks 2-4:** Swelling subsides substantially; most patients resume social activities.
• **Months 3-6:** Final results consolidate; any scar continues to fade.

Achieving a Natural Result

• Fat volume is preserved through transposition rather than over-resection.
• Lower lid tension (canthal support) is carefully assessed; supporting procedures are added when necessary.
• Skin excision is conservative — over-resection is the primary cause of lower lid retraction (ectropion).

Lower Blepharoplasty in Istanbul

Op. Dr. Hüseyin Arslan practises facial plastic surgery from a foundation of ENT and Head & Neck Surgery. A thorough command of periorbital anatomy provides a meaningful safety and aesthetic advantage in lower lid procedures. Consultations are available at his clinic in Sisli, Istanbul.