Lower Eyelid Surgery, (Lower Blepharoplasty)

Overview of Lower Eyelid

Eyes are the focal point of one's face. They are the first thing people notice and are the key to facial expression. During the aging process, the region around the eyes shows the effects of aging much sooner than other areas. This is the main reason why so many people seek cosmetic eyelid surgery. Patients tell us over and over again that their eyes always look tired and old even when they feel wide awake. This is very profound because looking tired and old can make you feel the same way. How many times have you dressed up and prepared to go out feeling good about yourself only to look in the mirror to see that your eyes look older than you feel?

In the attractive, youthful lower eye lid, the lateral canthus should be
higher than the medial canthus. The lower lid should just touch the
colored part of the eye.

Aging affects the entire face but usually affects the eye region earliest. This is because early in life there is a large amount of fat surrounding the eyes. You can verify this yourself by looking at the cheeks of a newborn. They are round and full of fat. As we age, this fat can either descend on the face or go away completely. When this happens, it exposes the underlying facial skeleton and this results in the familiar gaunt appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler creating the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.

Skin With Aging


Youthful Lower Eye. Notice how high and subtle the crease is under the eye.	Aged Lower Eye. Notice how the lower eyelid crease has descended and has become very deep creating "bags." Also, notice how the lower lid and lateral canthus has descended producing a tired appearance.

Muscles With Aging

In the past, eyelid rejuvenation was based on tightening the skin via skin excision. This has changed dramatically in the past decade. Today, well-trained plastic surgeons realize that skin excision is just a piece of the facial rejuvenation puzzle. In fact, there are four major components that make up the face: skin, fat, muscle, and bone.


Youthful Eyes. Muscles around the eyes are circular in shape.	Aged Eyes. Notice how the muscles and the lateral canthus sag.

When Dr. Cruise examines a lower eyelid during consultation he evaluates all four components. Drawing on his experience, he determines which component or components is/are causing the problem and what is the best way to correct it.

The increased understanding over the past 10 years of how the underlying fat and muscle contribute to the appearance of aging has been revolutionary in the field of plastic surgery. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why Dr. Cruise feels it is so important to correct the problem itself and not just the effects of the problem. He advocates repositioning fat to where it once was, not removing it. The repositioning of cheek fat is called a cheek lift, and it can be done at the same time as a lower blepharoplasty. Once again, not everyone needs a cheek lift. This is determined during your consultation.

Fat with Aging

Another contributing factor to the appearance of old age within the eye region is the fact that the lower eyelid, especially toward the temple region, begins to descend. This gives a depressed, sad appearance. This is much different than the appearance that one had when he/she was younger. The lower eyelid of youth has a bright, elegant appearance with the lateral aspect being higher than the nasal aspect. Dr. Cruise feels that it is important to address this issue. Often, he will elevate the lateral portion of the lower eyelid to recreate that youthful, almond-shape appearance. This is a powerful and very effective maneuver and is well worth the additional time.


Example of how repositioning the muscles and fat can markedly improve bags under the lower eyelid	Oblique view of same patient.

Cheek fat in youth is located high underneath the lower eyelid. This prevents the formation of the lower eyelid crease that is characteristic of an aged face.	Aged Eyes. Notice how the cheek fat has descended creating a deep lower eyelid crease and a deep fold above the lips.

Eyelid surgery alone will not correct crow's feet. It will help but often a concurrent brow lift and/or face lift is necessary. Dr. Cruise, however, is able to reduce crow's feet significantly during his eyelid surgery by repositioning the underlying fat and muscle into a more youthful position.

It is often very useful to perform fat transplantation, as well as either chemical peeling or laser skin resurfacing, in addition to eyelid surgery. This allows Dr. Cruise to address all the components associated with aging around the eye. Remember, the aging eyelid is a result of problems within the skin, muscle, and fat.

Lower Blepharoplasty Cosmetic Surgery Information Resource for Southern California including Los Angeles, San Diego, Newport Beach, Orange County, and Beverly Hills.