Lower Blepharoplasty: What It Corrects and What It Doesn’t

La lower blepharoplasty es la cirugía del párpado inferior. Su indicación habitual es la bolsa de grasa que abulta bajo el ojo, a veces junto con un exceso de piel. No es un tratamiento de ojeras pigmentadas, ni un lifting facial, ni una forma de «borrar» el cansancio de una sola sesión. En consulta, el Dr. García Ceballos, MD, FCCP y MRCS I England, con 25 años de práctica en cirugía plástica, reparadora y estética, distingue primero qué componente predomina: grasa, piel, laxitud del borde palpebral o una sombra del surco. De esa lectura depende la técnica, no de una foto de referencia.

In Spain, the search term “eye bags” maintains a stable monthly volume in Keyword Planner (around 3,600 searches, with peaks of 4,400 between late 2025 and early 2026). This interest does not necessarily indicate a need for surgery. Many bags under the eyes are constitutional and stable; others appear or become more noticeable with age, loss of cheekbone volume, or laxity of the orbital septum. At Mallorca Medical Group, blepharoplasty is considered only when this anatomical factor—and not a filter or a product—explains the change the person wishes to address.

What Can Lower Blepharoplasty Change?

When the indication is correct, surgery can:

• reduce the bulge of fat pads in the lower eyelid;
• remove or redistribute some of that fat, depending on the crease and the support of the cheekbone;
• remove any actual excess skin, if present, through an incision just below the eyelashes;
• improve the continuity between the eyelid and the cheek, without promising a different facial contour.

The clinical goal is a clearer view, not an “operated-on” eye. The result develops over the course of several months. The swelling during the first few weeks is not the final result. Nor is millimeter-perfect symmetry: the two eyelids were not identical before the surgery.

What it doesn’t correct

It should be stated just as clearly as the instruction:

• A dark circle under the eye caused by skin pigmentation does not disappear when you remove oil.
• Upper eyelid ptosis is another issue. If it is the predominant problem, upper blepharoplasty—either alone or in combination with other procedures—is considered. This is not the subject of this article.
• Dynamic crow’s feet are not treated by resecting eyelid skin.
• A sunken tear trough can worsen if too much fat is removed. Sometimes the fat is preserved or repositioned, rather than removed.
• Eyelid margin laxity (an eyelid that separates from the eyeball) requires consideration of additional support. Performing surgery on the lower eyelid bag alone, without addressing this support, increases the risk of retraction or a round-eyed appearance.
• Surgery is no substitute for sleep, allergies, or contact dermatitis. These factors are evaluated before any treatment is prescribed.

The classification of the lower eyelid published on the clinic’s blog categorizes dark circles, bags, and excess skin to avoid mixing treatments. This classification is a conversation guide, not a rigid protocol.

Two approaches, not two “styles”

There are two common approaches. Neither is superior in theory.

Transconjunctival approach. The incision is made on the inner surface of the eyelid. There is no skin scar. This approach is appropriate when the eyelid pouch consists of fat and there is no excess skin, or only a very small amount of excess skin. On its own, it does not allow for the removal of a prominent skin flap.

Transcutaneous (subciliary) approach. The incision is made below the lash line. This allows for the simultaneous treatment of fat and skin. The scar, which is well-placed and free of tension, is usually barely visible, but it is still a scar. We cannot promise that it will be invisible on all skin types or under all lighting conditions.

Choosing the surgical approach is an intraoperative decision prepared during the consultation, not a marketing preference. If the skin is thin and the eyelid margin is lax, removing skin “just in case” is a bad idea. SECPRE’s patient information on eyelid surgery describes the procedure in general terms and notes that the indication is determined on a case-by-case basis. Mallorca Medical Group does not substitute that information with a promise of specific results.

Who is eligible to run, and who is not

It usually makes sense to consider surgery when the pouch is stable, causes discomfort in daily life or in front-facing photographs, and cannot be explained solely by morning swelling. It is also an option when excess skin causes the lower eyelid to fold and the person has come to terms with the fact that it will not change.

It is advisable to postpone or rule out the procedure if the patient has uncontrolled dry eye, active thyroid-related eye disease, an untreated allergy that causes the eyelid to swell every week, or plans to change the shape of the eye. Active smoking impairs healing; this should be discussed during the consultation, without turning it into a catchphrase. Each case is decided based on a physical examination, not an online questionnaire.

Recovery, without a marketing calendar

In the first few days, there is swelling and, often, bruising. Sunglasses help with light and protection; they do not “speed up” the healing process. Intense activity and exertion that increase venous pressure in the face are resumed gradually, once a physical examination allows it. Makeup is not a clinical milestone. The final appearance of the scar and facial contours is assessed over the course of months, not within the first week.

Possible complications include hematoma, infection, residual asymmetry, temporary dry eye, lower eyelid retraction, and, rarely, a visual disturbance requiring urgent follow-up. Listing these complications is not a disclaimer: it is part of the informed consent process. A “natural” result is not guaranteed. The goal is the best possible result for that individual’s anatomy.

Relationship to Other Eye Surgeries

Yesterday’s focus was on facelifts and when they are indicated. Today’s focus is solely on the lower eyelid. A facelift is not a substitute for blepharoplasty, and blepharoplasty does not tighten the cheeks or the neck. If sagging in the middle third of the face is what causes the groove, sometimes the bags aren’t the main problem. Combining procedures “just because you’re already in the operating room” prolongs recovery and does not improve the outcome.

A consultation at Mallorca Medical Group is not free, nor is it a no-cost evaluation. It serves to explore options, explain limitations, and determine whether surgery can offer something that skincare cannot. Anyone interested in scheduling an appointment can do so at mallorcamedicalgroup.com.

La entrada Lower Blepharoplasty: What It Corrects and What It Doesn’t se publicó primero en Mallorca Medical Group.