Dr. Steven Fagien & Dr. Elbert Vaca

Lower Blepharoplasty / Lower Eyelid Lift


Lower blepharoplasty surgery, or a lower eyelid lift, provides the most effective and longest-lasting improvement for under-eye bags and the tear trough. Lower eyelid surgery must be carefully tailored to each patient’s unique needs. There are several factors to consider when deciding on the most appropriate surgical plan including how prominent the lower eyelid bags and tear trough are, if there is excess lower eyelid skin, and if there is loosening of the lower eyelid and/or changes in the shape and position of the lateral corner of the eye.

Boca Raton oculoplastic surgeon Dr. Steven Fagien & plastic surgeon Dr. Elbert Vaca use a variety of safe and effective treatments to improve the appearance of sunken or hollow eyes, under-eye bags and dark circles. They will tailor the best treatment plan to address the underlying causes of each individual patient’s eye-area concerns.

Common Lower Eyelid Aging Concerns

Hollow or Sunken Eyes

Often the result of genetics, lifestyle factors and aging, hollow or sunken eyes occur in patients with thin skin and very little fat to serve as padding due to volume loss. More common in those with slim faces and less body fat, this condition can cause a tired appearance.

Under-Eye Bags

Visible fat deposits called ‘eye bags’ that develop under the eyes are a natural result of the aging process. Over time, the skin below the eyes loses its elasticity while the fat behind the eyelids begins to bulge causing noticeable puffiness. This combination of changes leads to the development of more prominent under-eye bags that can contribute to a tired appearance.

Periorbital Dark Circles or Tired Eyes

Genetics, allergies, lack of sleep, diet; salt intake, and skin aging can contribute to the appearance of shadows or discoloration under the eyes. Over time, with advanced sun damage, fat loss and collagen breakdown, skin thins making blood vessels beneath the eyes become more visible, which causes discoloration or dark circles.

Shape and Position of the Outer Corner of the Eye

Due to genetics and aging, the outer corner of the eye can appear to “open” and lower in position, giving the eye an aged and sad appearance. World renowned oculoplastic surgeon Dr. Steven Fagien has developed a minimally invasive lateral canthoplasty technique that helps lift the lateral corner of the eye, giving the eye more youthful appearance, if needed.

What is Transconjunctival Lower Blepharoplasty?

A specific technique called transconjunctival blepharoplasty is often used to remove or reposition eye-area fat through incisions made inside the lower eyelid (no visible scar). If excess skin needs to be removed, an additional incision is made just beneath the lower lash line (which is nearly undetectable once healed). After excess skin and/or fat are addressed, the tissues surrounding the tear trough are reshaped and repositioned as needed to create a smooth contour between the lower eyelid and cheek. If there is drooping of the lateral corner of the eyelid, a canthoplasty can help lift the outer corners of the eyes, correct drooping lower eyelids and provide extra eyelid support after upper or lower blepharoplasty. Canthoplasty is ideal for improved a tired or sad expression and creating a more youthful look to the eye area. These techniques can offer comprehensive rejuvenation for the entire under-eye area.

What Does Transconjunctival Blepharoplasty Treat?

The effects of age and gravity can cause fat around the eyes to shift, often leading to under-eye bags and puffiness or hollow, sunken areas. Transconjunctival lower blepharoplasty is used to treat these concerns and restore a more youthful and rested appearance to the eye area by removing excess fat and repositioning fat to smooth hollow areas.

Is Transconjunctival Blepharoplasty Safe?

In the hands of an experienced oculoplastic surgeon, transconjunctival blepharoplasty is an extremely safe procedure with minimal risks. As with any eye surgery, dry eyes, tearing and minor bleeding are possible after surgery and will resolve rapidly. Dr. Steven Fagien is world-renowned for his innovative transconjunctival blepharoplasty techniques, and all potential risks and complications will be thoroughly explained during the pre-surgical consultation. This technique offers several advantages over traditional lower blepharoplasty surgery:

  • Less risk of ectropion (where the lower eyelid pulls away from eye)
  • Results can be assessed and refined during surgery
  • Less post-surgical bruising and swelling
  • Safe for patients who have had prior lower eyelid surgery
  • No visible scarring
What is the Tear Trough?

The tear troughs are the depressions between the eye and nose where your tears naturally flow down. Their appearance often becomes more pronounced over time, as fat around the eyes shifts and creates a hollow look and/or under-eye bags. This combination of age-related changes lends a fatigued look to the entire eye area, and it’s important to understand the underlying causes behind these common eye-area concerns when considering treatment.

Dr. Steven Fagien’s Expertise in Treating the Lower Eyelids

If you’re considering surgery or non-invasive treatment to improve the appearance of tear troughs, under-eye bags, dark circles or a hollow appearance, the next step is finding an oculoplastic surgeon with the expertise and artistic eye necessary for optimal results. Dr. Steven Fagien is one of the foremost oculoplastic surgeons in the United States and he has built his reputation on challenging traditional techniques and developing cutting-edge advances for a variety of procedures. In addition to participating in many of the clinical studies that led to the FDA approval of various injectables, Dr. Fagien has authored over 300 publications, penned his own bestselling textbook on Cosmetic Oculoplastic Surgery, and has given more than 1,000 lectures about his techniques to surgeons around the globe.

Meet Dr. Fagien

Dr. Fagien

Dr. Steven Fagien is one of the foremost oculoplastic surgeons in the United States and the world. He completed his medical training at the University of Florida and a fellowship in oculoplastic surgery at the University of Illinois Eye and Ear Infirmary.
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Meet Dr. Vaca

Dr. Vaca

Dr. Elbert E. Vaca is a Plastic & Reconstructive Surgeon who completed his medical training at The Johns Hopkins University School of Medicine and Northwestern Memorial Hospital.
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