Changing the Deepest Roots,
Leaving No Traces Behind

A.With age, fat beneath the eye prollapses, and both the skin and orbicularis oculi muscle descend and wrinkle. Lower blepharoplasty addresses all three components — fat, skin, and muscle — to restore the under-eye area to a more youthful state. Through an incision immediately below the lash margin, prolapsed fat is excised, the orbicularis oculi is released from its periosteal adhesions and the fat repositioned, then the skin and muscle are each dissected and lifted using a dual-plane approach before redundant tissue is excised and the incision closed. Because the deeper structural layers are addressed rather than just the surface, the result is a fundamental rejuvenating effect.

A.The scope of treatment is entirely different. Transconjunctival fat repositioning accesses the fat through the inner surface of the eyelid and repositions it only — it is appropriate for patients before their mid-30s, leaves no external scar, and has a faster recovery, but cannot address skin or muscle laxity. Lower blepharoplasty, performed through an incision below the lash margin, comprehensively manages fat, skin, and muscle. It is recommended from the mid-40s onwards (or from the late 30s when laxity has begun). Rather than simply relocating fat, the dual-plane lifting approach produces a fundamentally rejuvenating outcome.

A.The lower eyelid functions like a hammock, with the tarsal plate suspended between the periosteum on either side. As the supporting ligaments loosen with age, canthopexy or canthoplasty must be performed simultaneously with lower blepharoplasty in more significantly lax cases. The degree of lateral canthal laxity is assessed during consultation using the snap test and distraction test. Performing lower blepharoplasty without addressing lateral canthal laxity when it is present can alter the eye shape, so simultaneous management is carried out whenever required.

A.Because the incision follows a natural crease line immediately below the lash margin, it is barely visible after healing. Micro-suture closure distributes tension evenly, and the incision line blends with the natural crease during recovery to become almost undetectable. The vast majority of patients find the incision line imperceptible even without make-up.

A.Dark circles caused by shadows from prolapsing fat (structural dark circles) are reliably improved through fat repositioning. Where dark circles are accompanied by laxity, lower blepharoplasty offers a more significant improvement than transconjunctival repositioning alone. However, pigment-type dark circles (melanin deposition) cannot be directly eliminated surgically — if further brightening is desired, combining the procedure with a laser toning treatment is recommended.

A.Major swelling and bruising subside within 1 week, and sutures are removed on days 5–7. A return to everyday activities is typically possible at 1–2 weeks, with residual swelling and the final natural result settling over 2–4 weeks. The full outcome can be assessed at 1–3 months. Where lateral canthal fixation is performed simultaneously, the recovery period may be slightly extended.

A.Because lower blepharoplasty involves skin excision and repositioning, deeper wrinkles and lax skin are reliably improved. However, dynamic lines — wrinkles that form when the eyes are closed — are caused by muscle movement itself and will not be entirely eliminated. For those who wish to further address dynamic lines, combining the procedure with botulinum toxin is an option.

A.Yes, and this combination is often an effective approach. A facelift addresses the sub-SMAS mid-to-lower face, while lower blepharoplasty addresses the under-eye region — the two areas are distinct, so performing both simultaneously does not significantly increase the burden. The convenience of a single shared recovery appeals to many patients seeking comprehensive rejuvenation. Suitability for the combination and the recovery plan can be discussed in detail during consultation.