Inside Lower Eyelid

inside-lower-eyelid01Inside Lower Eyelid Surgery Introduction

As key elements in facial expression, the eyes convey messages of emotion, vitality, and age. Over time, the eyes undergo changes that often make people feel as if they appear sad or tired. The aging process can cause the eyelids to sag and droop, which in combination with bags and puffiness can make you look tired and older than you really are. Eyelid surgery can help freshen and revitalize your face by reducing the appearance of heavy and sagging eyelids, puffiness, and bags under the eyes.

inside-lower-eyelid02What Causes Eyelids to Change?

Before you understand how eyelid surgery works, it is important to understand the underlying structure of the eyelids. Like the rest of the face, eyelids are composed of layers of skin, muscle, and fat. With time, age and environmental factors like sun damage, cause the skin’s support network in the dermis to break down. As a result, the skin loses its structure and elasticity and becomes lax.

The muscle layers also weaken, which with the skin’s loss of elasticity and the effects of gravity, cause the eyelids to droop and sag. Fat deposits normally give eyelids a full appearance. However, fat too is depleted over time and shifts in response to weakened, sagging muscles, which results in puffiness and bags around the eyes. While eyelid surgery addresses these problems, the procedure cannot correct crow’s feet, dark circles under the eyes, or sagging eyebrows. In these instances, eyelid surgery performed with other procedures may produce better results.

inside-lower-eyelid03How Does Inside Lower Eyelid Surgery Work?

While there are several different techniques that a physician can use to alter the appearance of the eyes, the standard surgical technique usually involves removing or redistributing fat deposits, as well as removing excess skin and muscle.

Bags and puffiness in the lower eyelid most often result from protruding orbital fat deposits. Normally, the orbital septum holds the fat deposits in place. However, over time the orbital septum loses some of its structural integrity and weakens, which allows the fat deposits to slide forward, creating bags and puffiness. The transconjunctival approach works by removing and sculpting excess orbital fat through an incision in the conjunctiva. If you have minimal skin laxity, or looseness, some physicians may remove the excess skin in conjunction with this approach. However, other physicians may instead perform a transcutaneous eyelid surgery to address all of the problem areas in the lower eyelid.

inside-lower-eyelid04Surgery Preparation

An eyelid surgery procedure may last approximately one to two hours, depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anesthesia will be administered. The procedure will most likely be performed under local anesthesia with sedation, in which the eyelids and surrounding areas are numb and you are in a relaxed state. Alternatively, the physician may choose to administer general anesthesia, in which you are asleep.


The physician will use a retractor to carefully pull the lower eyelid away from the eyeball and expose the conjunctiva, which is a thin membrane that lines the inside of the eyelid. A shield may be applied to your eyes in order to protect them during the procedure. The physician will make a small incision in the conjunctiva by guiding a cautery device along the conjunctiva, exposing the three orbital fat deposits.

inside-lower-eyelid06Fat Removal

In order to sculpt the orbital fat, the physician will carefully clamp each fat deposit with a pair of hemostats. The physician will then carefully remove any excess fat, reducing the appearance of bags and puffiness in the lower eyelid. After cauterizing the remaining orbital fat, the fat deposit will be allowed to recede back through the opening.

inside-lower-eyelid07Incision Closure

After sculpting the fat deposits, the physician may choose to close the incisions with one or two absorbable sutures. However, most often the physician will not use sutures, and the incisions will be allowed to close on their own.

inside-lower-eyelid08Inside Lower Eyelid Surgery Recovery

As with any surgical procedure, you will likely experience some discomfort, swelling, and bruising which can be alleviated with cold compresses and pain medication. You will begin to notice an improvement in the bruising around your eyes in seven to ten days. Although you will feel well enough to return to work in approximately a week, you should continue to avoid strenuous activity such as heavy lifting or exercise for at least two weeks following the procedure.

inside-lower-eyelid09Inside Lower Eyelid Surgery Results

You will start to notice the results from your procedure within a few weeks as the bruising and swelling continue to fade. In addition to being less invasive, and a faster recovery time, one of the benefits of the transconjunctival approach is that there is no visible external scar. While the results of an eyelid surgery are long-lasting, it is important to realize that your face will continue to age. However, eyelid surgery can successfully restore a youthful, revitalized appearance to your eyes for years to come.