Outside Lower Eyelid

inside-upper-eyelid01Outside 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-upper-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-upper-eyelid03How Outside Lower Eyelid Surgery Works

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 transcutaneous approach works by removing and sculpting excess orbital fat through an incision on the outside of the lower eyelid. Unlike the transconjunctival approach, excess skin is also typically removed to correct laxity in the lower eyelid.

inside-upper-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.


Prior to making the incision, the physician may choose to place a suture in your lower eyelid to help keep your eye closed during the procedure. The physician draws incision guidelines along the fold of the lower eyelid to ensure that the resulting scar is hidden in the natural contours of your face. They then make a small incision in the skin exposing the underlying muscle.

inside-upper-eyelid06Exposing the Orbital Septum

To gain access to the orbital fat, the physician makes a small incision in the muscle layer. Through this incision, the physician dissects the skin and muscle away from the underlying orbital septum. This allows the physician to pull the skin and muscle layers away from the orbital septum and subsequently expose the orbital fat in the lower eyelid.

inside-upper-eyelid07Fat Removal

In order to sculpt the orbital fat, the physician carefully opens the orbital septum to expose the three orbital fat deposits of the lower eyelid. Then, the physician clamps each fat deposit with a pair of hemostats. They will then carefully remove any excess fat, reducing the appearance of bags and puffiness in the lower eyelid. After the remaining orbital fat is cauterized, it is allowed to recede back through the opening.

inside-upper-eyelid08Excess Skin Removal

If you have excess skin in the lower eyelid, a small amount will likely be removed. If you are under a local anesthetic, the physician may determine how much skin needs to be removed by asking you to look upwards. Once the amount of excess skin has been determined, the physician removes it with surgical scissors.

inside-upper-eyelid09Incision Closure

After sculpting the fat deposits and removing excess skin, the physician closes the skin incision with sutures.

inside-upper-eyelid010Outside 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-upper-eyelid011Outside 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. Although you will have a small permanent scar, it will fade to an inconspicuous line hidden along the contours of your lower eyelids. 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.