What is lower eyelid surgery?
The lower eyelid is one of the most visible and most complex areas of the face. The lid-cheek junction changes significantly with age: the orbital septum weakens, fat pads prolapse forward creating bags, and the supporting ligaments loosen, contributing to hollowing at the tear trough.
Lower eyelid surgery (lower blepharoplasty) addresses these changes. Modern techniques favour a tissue-preserving philosophy rather than simple fat removal: fat is repositioned into hollowed areas, the orbital septum is managed with care, and the lower eyelid support structures are strengthened where needed.
Dr. Issa chooses between two primary approaches based on your anatomy. The transconjunctival approach — placing the incision inside the lower eyelid — leaves no external scar and suits patients with fat prolapse but limited excess skin. The infraciliary approach — an incision just below the lashes — is used when skin removal is also required. In many cases, the techniques are combined.
Because Dr. Issa is an oculoplastic specialist, she pays particular attention to lower eyelid laxity, tear film quality, and Bell's phenomenon during assessment — factors that are important to safety around the eye.
Considering lower eyelid surgery? Discuss your options with Dr. Alia Issa.
Who is a candidate for lower eyelid surgery?
Dr. Issa will confirm your suitability after a thorough examination of your lower eyelids, tear film and facial structure. Candidates typically have:
- Prolapsed orbital fat creating visible bags or puffiness under the eyes
- Redundant lower eyelid skin causing wrinkling or a crepey appearance
- Hollowing at the tear trough or nasojugal groove giving a fatigued look
- Malar deflation or volume loss at the lid-cheek junction
- Lower eyelid asymmetry
- Previously inadequate results from injectable fillers
Lower blepharoplasty is not appropriate for everyone — for example, patients with significant dry eye, poor lower eyelid support (laxity), or prominent eyes (negative vector). Dr. Issa discusses all of this openly at consultation.
How the procedure works — before, during and after
Every case is individual. The following is a general outline of what patients can expect.
Dr. Issa assesses the amount and distribution of fat, skin quality, eyelid laxity, tear film, and the lid-cheek relationship. A personalised surgical plan is created — approach, fat management strategy, and any additional steps such as lateral canthopexy if lower lid support is needed.
Surgery is performed under local anaesthesia, with sedation available for comfort. For the transconjunctival approach, fat is accessed through the inner eyelid surface and repositioned or conservatively removed. For the infraciliary approach, skin, muscle and fat are addressed together. The procedure typically takes 60–120 minutes.
Cold compresses in the first 48 hours help reduce swelling. Where non-absorbable sutures are used they are typically removed at 5–7 days. Strenuous activity is generally restricted for 2–3 weeks. Many patients feel ready to return to work at around 10–14 days.
The result typically becomes apparent at around 3 months, once swelling has resolved and the tissues have remodelled. Dr. Issa follows up throughout recovery.
Why choose an oculoplastic surgeon for lower eyelid surgery?
Lower eyelid surgery is widely regarded as one of the more technically demanding eyelid procedures, because the lower lid has less structural support and complications such as lid retraction can follow an over-aggressive approach. An oculoplastic surgeon assesses lower eyelid laxity and tear film before surgery — factors that are central to a safe result around the eye.
Related reading in the Journal: “Lower eyelid surgery in Dubai: fat repositioning vs fat removal” and our guide comparing eye bag removal in Dubai: surgery vs non-surgical options.
Frequently asked questions
What does lower eyelid surgery correct?
Lower eyelid surgery addresses under-eye bags (fat prolapse), excess skin, hollowing at the tear trough, and laxity of the lower eyelid. The aim is a smoother, more rested transition between the eyelid and cheek.
What is the difference between transconjunctival and infraciliary approaches?
The transconjunctival approach places the incision inside the eyelid, leaving no external scar — suited to fat prolapse without excess skin. The infraciliary approach, placed just beneath the lashes, is used when skin removal is also required. Dr. Issa selects the approach for your anatomy.
How long does recovery take?
Many patients return to daily activities within 10–14 days. Swelling and bruising generally settle over 2–3 weeks. The result usually settles at around 3 months. Individual recovery varies.
Can lower eyelid surgery be combined with upper eyelid surgery?
Yes. Upper and lower blepharoplasty are frequently performed together in the same session. Dr. Issa assesses both eyelids at consultation and advises on whether a combined approach suits you.
Will lower eyelid surgery leave a visible scar?
With the transconjunctival approach there is no external scar. With the infraciliary approach the scar sits just below the lashes and generally becomes difficult to see once healed.
Is lower eyelid surgery safe?
In the hands of a qualified oculoplastic surgeon, lower blepharoplasty is a well-established procedure. Dr. Issa performs a thorough preoperative assessment — including lower eyelid laxity, tear film and Bell's phenomenon. As with any surgery, individual risks are discussed at consultation. She has performed over 3,000 periorbital procedures.
Book your lower eyelid surgery consultation in Dubai with Dr. Alia Issa.