Lower Blepharoplasty

The eyes are our most important facial feature and a critical factor in perceived attractiveness. Eye bags and dark circles under the eyes are common ageing concerns and can make you feel tired and drawn, even when well-rested. Younger men and women can also be genetically predisposed to protruding fat pads under the eyes. A lower blepharoplasty will address these concerns, resulting in a more youthful and dynamic appearance.


As we age, the underlying tissue structure and muscles supporting the eyelids weaken. As the skin sags, the fat pads under the eyes push forward. Fluid can also pool under the eye, causing it to look puffy and swollen.

In the mid-cheek, the fat pads start to shrink and descend, and this can result in a deepening groove at the junction between the under eye and upper cheek, whereas previously it was smooth. This is known as the tear trough.

Certain lifestyle factors can exacerbate these ageing changes, such as sun damage, which accelerates collagen and elastin breakdown or alcohol consumption that dehydrates the delicate tissues below the eye.

Lower eyelid blepharoplasty aims to improve the appearance of the under-eye area, making you look younger and more vibrant.

Ophthalmic and Oculoplastic surgeon Dr Nick Koutroumanos has undergone extensive training in a wide range of expertise in various eyelid surgery techniques, allowing him to consistently achieve natural-looking results for his patients. He offers several lower blepharoplasty techniques.

A transcutaneous lower blepharoplasty involves a fine incision just below the lash line through which the supporting tissues are tightened and any excess skin and fat removed. A transconjunctival blepharoplasty involves an incision made from behind the lower eyelid and addresses excess fat deposits when there is good skin elasticity. A fat redistribution lower blepharoplasty may be required to address under-eye hollows by repositioning the fat to fill hollows and smooth the junction between the lower eyelid and upper cheek.

Sagging eyes treatment

Procedure at a Glance

Procedure time
1-2 hours

Local or General

Length of Stay
Day case

Up & Mobile
Same day

1 week

Back to Work
1-2 weeks

1 week

Post-op Care
Ice pack for first 2 days

On back, sleeping upright for 1 week

Resume Exercise
2 weeks

Full Recovery
4-6 weeks

Final Results
3 months

Lower Blepharoplasty FAQs

A lower eyelid blepharoplasty can be carried out under local anaesthesia, intravenous sedation or general anaesthesia, depending on your preference and what is deemed safest based on your medical history.

It is a more challenging procedure than an upper blepharoplasty. Dr Koutroumanos will make a fine incision just below the lashes in the lower eyelids, running to the corners of the eye. Excess fat can be removed or repositioned through this incision, and any redundant lower eyelid skin is removed or tightened.

Younger patients who are genetically predisposed to eye bags but with no excess skin at this stage may benefit from a transconjunctival blepharoplasty or scarless lower eyelid lift. Dr Koutroumanos will make a small incision on the inside of the lower eyelid. This avoids an external scar altogether.

Afterwards, antibiotic cream is applied over this area, and you will be asked to use this ointment three times a day for up to a week after your operation to prevent infection.

Bandages or padding are very rarely used after a lower blepharoplasty, and if they are required for a short period after surgery, Dr Koutroumanos will remove them before you

You are encouraged to start walking on the same day of your procedure. Pain is minimal after a lower eyelid lift and can be easily controlled with simple painkillers.

Lower lid blepharoplasty may require up to four weeks for swelling reduction, but this varies from individual to individual. Cold compresses and sleeping in an upright position can speed up the disappearance of any bruising and swelling.

Apart from the antibiotic ointment that you will be asked to apply regularly in the first week, wound care is very straightforward. Dr Koutroumanos will advise you to keep the wounds dry for the first 48 hours. After that, you can gently wash – but not scrub – the area.

You can resume normal washing after the sutures are removed – typically between days six and ten. You will be advised not to wear make-up for the first two weeks.

Eyelid position

For the first few days after your procedure, it is common for the eyelash of the lower lid to be pushed away from the eye. This is typically temporary and the result of swelling of the tissues.


Scarring after a lower eyelid lift depends on the technique used. A transconjunctival blepharoplasty involves an incision behind the lower eyelid, so there will be no external scarring afterwards. The other approach consists of an incision made just below the lash line and, once healed, should be virtually invisible.


Significant bleeding after a lower eyelid lift is a rare but severe complication that could result in permanent vision loss.


The use of antibiotic cream for the first week after surgery means you should avoid this rare complication.

Allergic reaction

In rare cases, an allergic reaction to the tape, stitches or solutions used has been reported. If you have an allergic reaction, you may require extra treatment.

Increased or reduced sensation

This is a common change that happens after any surgical procedure but is usually temporary.


Everyone has some degree of asymmetry between the eyes, but a significant difference in appearance after eyelid surgery may require revision eyelid surgery. Dr Koutroumanos meticulously plans each procedure, taking precise measurements under high magnification, with patients sitting upright and lying down to avoid this potential complication.

Unsatisfactory result

Sometimes patients are not satisfied with the results of a lower eyelid lift, which is often due to unrealistic expectations about what can be achieved. During your consultation, Dr Koutroumanos will discuss your concerns before he explains what is possible to achieve and ensures you are fully informed about every aspect of surgery.

Eyelid surgery expert
Oculoplastic surgeon London


Dr Nick Koutroumanos

Dr Nick Koutroumanos is a London-based Ophthalmic & Oculoplastic surgeon, with particular subspecialty expertise in ophthalmic plastic & reconstructive eyelid, orbital and lacrimal surgery.

His private practice, based at The Hospital of St John & St Elizabeth in St John’s Wood complements his work in charge of a large NHS oculoplastics practice at the Royal Free Hospital in Hampstead.

A qualified senior trainer and Royal College Examiner in ophthalmic plastic surgery, cataract surgery and general ophthalmology, he runs an Oculoplastics Fellowship training programme that is highly sought-after by both UK and international candidates.

Kind Words from Our Patients


A true perfectionist

Words are not enough to express my sincere gratitude for the care and dedication Dr Koutroumanos put into my journey. I felt safe and secure in his hands. This is someone who truly cares about outcome and ethics of practice. A true perfectionist. I would not hesitate to wholeheartedly recommend him.

100% worth it

I had surgery a few days ago with Dr Koutroumanos for congenital ptosis. It’s early days but I don’t think it’s too early to say the results will be life changing for me in terms of confidence levels. I struggled at school due to the condition and have learnt to live with it – that is until I saw the doctor who was reassuring from the start and has just done the best job. 100% worth it and amazing to know I was in such safe hands. I can’t thank him enough.

I’m really happy with my results

I’ve recently had a brow lift and blepharoplasty with Mr N Koutroumanos. The whole process from start to finish was handled professionally and each process was very informative. I’m still at the recovery stage, so far I’m really happy with my results. Highly recommend using Mr N Koutroumanos services.