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Lower Lid Blepharoplasty (Bags Under Your Eyes)


Eye Bags or puffy eyes occur to almost everyone at some time in their lives, but when they become a chronic problem, these under eye bags, puffy eyes and sometimes drooping eyelids can become more than just a temporary annoyance.

There are many reasons a person can have under eye bags, drooping eyelids, and other aesthetic problems of the eye area. As we age, the eye area can have a huge impact on how our face looks, often creating a tired, bored, or even angry expression. For some, a tired appearance can be disheartening and even misleading, thus impacting one’s self-esteem. As a solution to this common problem, our offices in Austin, New Braunfels, Westlake, and Lakeway offer a popular procedure known as blepharoplasty (cosmetic eyelid surgery).

Most commonly, aging eyelids start to droop and sag as muscles weaken. When skin loses elasticity, and fat starts to press against the thinning skin of the lower eyelids, it may be a good time to consider a blepharoplasty consultation with Dr. Paul.

The purpose of eye bag surgery is to reposition facial fat and sometimes remove excess skin for a more rested and youthful expression. There are two basic types of eyelid surgery: upper lid blepharoplasty and lower lid blepharoplasty. The two can be performed combined or as singular procedures. They can also be performed with additional procedures such as a brow lift or face lift as part of a complete facial rejuvenation. Lower blepharoplasty is primarily used to address undereye bags and pockets of fat beneath the eye, while an upper blepharoplasty is to correct drooping upper eyelids that may be affecting one’s expression and/or normal vision.


Candidates for eye bag and eyelid surgery are healthy adults with excess skin, drooping skin, or puffy bags of fatty tissue around the eyes. Most patients are interested in blepharoplasty for cosmetic reasons, but there are some conditions that cause the upper eyelid to droop, impairing normal vision. In other instances aging may lead to malposition of the lower eyelid which can lead to drying of the eyes. Patients should have realistic expectations about the results of the procedure and be aware of the limitations of the surgery.
A lower eyelid correction is a relatively minor procedure but requires a oculoplastic surgeon to possess a great deal of experience and skill. Dr. Paul is an expert in the different operating techniques and know how to achieve the most natural results.


During your initial consultation, Dr. Paul will discuss your concerns about your eyes. He will also carefully evaluate your medical history, noting any prior history of eyelid surgery, dry eyes, or the use of blood thinners. He will also pay special attention to the surrounding anatomic structures such as the upper eyelids, cheeks, as well as the strength of the lower eyelid muscles.

About The Procedure

Typically, the anesthesia used will be tailored to the patient’s comfort level and the type of procedure(s) being performed. If only blepharoplasty is being performed, local anesthesia with oral sedation can be an excellent option in our office, however if combined with other procedures – or if the patient prefers – general anesthesia can be used at one of our outpatient surgical centers around the greater Austin area. Eyelid surgery takes about 1-2 hours on average when performed as a standalone procedure for both eyes.

A lower blepharoplasty is performed through small incisions hidden through the backside of the eyelid, also called a transconjunctival approach. Specifically, this area is underneath the lower lashes within the moist lining tissue on the inside of the eyelid. The main goal of this procedure to remove or re-position excess fat to smooth the area beneath the eyes and achieve a rested, youthful appearance.

Upper blepharoplasty usually involves the conservative removal of skin and occasionally muscle and fat of the upper eyelid and is performed through small incisions in the upper eyelid crease.
Scarring is minimal for both techniques, as the incisions are small and hidden within the eyelids and eyelashes. Major complications with blepharoplasty surgery are rare, and the procedure is considered very safe. Dr. Paul is always meticulous with his approach, avoiding the removal of too much skin and fat for a very natural appearance and beautiful results.


Patients usually have a short recovery time after blepharoplasty. Although bruising and swelling is usually worse on the day after surgery, they quickly begin to disappear. During the first 48 hours, the use of cool compresses can greatly reduce bruising and swelling around the eyes and face. Light activity such as walking will also help speed healing. Thin bandages are usually placed over the incision sites and removed in several days, while the stitches can remain in the skin for about a week. Sometimes self-absorbing stitches are used that do not require removal.

Most people return to normal activities after seven to 10 days following blepharoplasty. By two weeks after eyelid surgery, the majority of the bruising and swelling will resolve.


Other treatment may also need to be considered. If the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be recommended. Smoothing of the crow’s feet may be accomplished with Botox, Dysport, or chemical peel resurfacing procedures. For dark circles under the eyes, alternatives to surgery include filler. Juvederm and Restylane are two great options we use at Austin Oculofacial Plastics to improve the appearance of sunken eyes or dark circles as well as hollowing of the cheeks. Dr. Paul and his knowledgeable team would be happy to provide further information if you have an interest in any of these additional procedures.