Lower Eyelid Surgery: Under‑Eye Bags & Tear Trough Treatment Guide

Lower Eyelid Surgery: Under‑Eye Bags & Tear Trough Treatment Guide

Many people notice changes under the eyes, puffiness, hollowing or loose skin, but are unsure whether these concerns are best managed with non‑surgical treatments or when lower eyelid surgery (lower blepharoplasty) may be appropriate. These changes may appear early due to genetics or develop gradually with ageing and shifts in mid‑cheek support.

A helpful starting point is understanding why these changes occur. Clarifying whether they relate to skin quality, volume loss, fat pad prominence or reduced structural support creates a clearer path for deciding between non‑surgical care and lower eyelid surgery.

What Are the Most Common Lower Eyelid Concerns and How Do They Develop?

Under‑eye bags (puffiness)

Bulging fat pads or reduced eyelid support often contribute to puffiness under the eyes. These changes can be inherited or developed over time.

Tear troughs (hollowing)

A groove between the lower eyelid and cheek may appear when mid‑cheek support decreases or when natural volume reduces.

Skin laxity and fine wrinkling

The lower‑eyelid skin is thin and prone to creasing. Reduced collagen, sun exposure and ageing can make the area appear crepey or loose.

Most people experience a combination of these factors, which is why a structured assessment is important before discussing treatment options.

Understanding Lower Blepharoplasty: Assessment, Anatomy and Planning

When deeper structural changes, such as bulging fat pads, pronounced hollowing or reduced support are present, lower eyelid surgery should be part of the discussion. Non‑surgical treatments may have limited effect when anatomy plays a primary role.

A comprehensive assessment for lower eyelid surgery (lower blepharoplasty) looks at how different anatomical factors interact, rather than viewing each concern in isolation.

• Skin quality – Elasticity, thinning and fine creasing influence how smooth the lower‑eyelid surface appears and can make shadows more noticeable.
• Fat pad position – Fat pads may bulge and descend with age, contributing to puffiness or a more marked lid‑cheek junction.
• Eyelid support – Ligaments and muscle tone help maintain eyelid position and contour; reduced support can change the way the lower eyelid sits.
• Mid‑cheek anatomy – Volume or positional changes here can deepen grooves or exaggerate transitions between the eyelid and cheek.
• Swelling and fluid dynamics – Puffiness can also result from previous non-surgical treatments, lymphatic congestion, allergies or general fluid retention.

Using this information, a personalised plan may include:

• Non‑surgical options – May include treatments that support skin quality, improve texture, enhance hydration, assist muscle function or provide subtle volume support.
• Surgical techniques – Fat repositioning, selective fat reduction, ligament release, fat transfer and muscle or skin tightening can address deeper anatomical contributors by working directly on the structures involved.
• Mid‑cheek support – Supporting tissues such as the malar fat pad, or in some cases strengthening the underlying bony framework, can help improve the transition between the eyelid and cheek.

No single technique suits everyone. The aim is to match the approach to the underlying cause and how these factors interact for each individual.

Choosing the Right Approach

Once the causes are understood, the decision becomes which approach aligns better with your anatomy, preferences and long‑term expectations.

How non‑surgical approaches are often used

Non‑surgical treatments suit mild changes or individuals who prefer gradual, less invasive care. Because the effects are temporary, repeat sessions are needed. Over time, this can mean ongoing maintenance and cumulative cost. Some reports highlight issues such as persistent swelling, texture or pigment changes, which are uncommon but more likely after multiple treatments. In some cases, treatments may also become less effective over time as the tissues respond differently with repeated use.

How surgical approaches are often used

Lower eyelid surgery (lower blepharoplasty) directly addresses deeper anatomical changes by working with the underlying structure and focusing on the tissues that contribute most to the concern. For suitable candidates, it may offer a more stable and longer‑lasting contour. Surgery is, however, an invasive option and carries risks such as infection, scarring, lid position changes, asymmetry or the need for revision. It generally involves one defined recovery period and a higher upfront cost, but usually fewer repeat treatments over time.

A consultation provides an opportunity to explore these questions in the context of your anatomy, preferences and overall goals. Every person’s situation is unique, and outcomes vary.

Understanding Lower Blepharoplasty Recovery

Recovery varies between individuals and depends on personal healing patterns. The outline below provides a general guide for what to expect after lower eyelid surgery (lower blepharoplasty).

First Week — Early Recovery

Swelling, bruising, tightness and mild discomfort are common. Resting, keeping the head elevated and using cold compresses may help. Avoiding eye strain supports healing.

Weeks 2–4 — Gradual Improvement

Swelling and bruising typically lessen. Many people resume light activities, depending on their occupation and healing. Follow your surgeon’s guidance on makeup and sun protection.

Months 1–3 and Beyond — Ongoing Settling

Contour continues to refine over several months. Scars soften gradually. Follow‑up appointments support monitoring.

Practical Tips to Support Recovery

• Keep your head elevated when possible to help reduce swelling.
• Avoid smoking or vaping, as these can slow healing.
• Use sun protection and follow your surgeon’s scar‑care guidance.
• Attend all scheduled follow‑up appointments.
• Contact your surgeon promptly if unexpected symptoms occur.

Is Lower Eyelid Surgery the Right Option for You?

People may consider lower eyelid surgery (lower blepharoplasty) when puffiness, hollowing or skin laxity persist despite non‑surgical care, or when deeper anatomical factors are the main contributors.

Before exploring surgery, think about:

• whether the concern relates to temporary swelling or deeper structural changes
• whether you prefer ongoing non‑surgical care or one defined recovery
• whether your expectations align with what surgery can realistically achieve

A consultation with Dr Rodrigo Teixeira (MED0001650480), Specialist Plastic Surgeon (Specialist Registration in Surgery – Plastic Surgery) can help clarify contributing factors and outline options suited to your circumstances.