Lower Blepharoplasty (Lower Eyelid Surgery) | Dr Deon Weyers
Lower blepharoplasty treats under-eye bags and the hollow that often sits beneath them. Dr Deon Weyers performs it at Life Fourways Hospital and sees patients from across South Africa.
Under-eye bags are mostly fat that has moved forward as the supporting tissues weaken. Lower blepharoplasty removes or repositions that fat, and where needed tightens loose lower-lid skin, for a smoother transition from lid to cheek.
The practice has one location at Life Fourways Hospital in Johannesburg. Every consultation, procedure and review is with Dr Deon Weyers personally.
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Lower Eyelid Surgery: Bags, Hollows and Lid Support
The lower lid is more delicate than the upper lid. Its support has to be preserved, which is why lower blepharoplasty is planned as its own procedure.
Three things are assessed: how much fat is bulging, whether there is a hollow or groove below it, and how firm the lid is against the eye. The answers decide whether fat is removed, moved into the hollow, or both, and which incision is used. Upper-lid surgery is covered on the main blepharoplasty page.
- Under-eye bags
- Tear trough hollow
- Fat repositioning
- Transconjunctival approach
- Lid support
Lower blepharoplasty can be done on its own or together with upper eyelid surgery. Where volume loss extends into the cheek, fat transfer may be discussed as part of the plan.
Patients from outside Johannesburg are seen at the same practice. The Johannesburg eyelid surgery page covers upper and combined surgery in more detail. Because the lower lid supports the eye, the plan always protects its natural position first and treats the bags second.
Two Incision Options
Transconjunctival: the incision is on the inside of the lower lid, leaving no visible skin scar. It suits patients whose concern is mainly fat rather than loose skin.
Subciliary: the incision runs just below the lashes, allowing loose skin to be tightened as well. The scar usually fades into the lash line. The choice is made at consultation. Some patients benefit from a small skin pinch through the lash-line incision even when fat is treated from inside the lid.
Removing too much lower-lid fat can leave a hollow, tired look. Preserving or repositioning fat is often the better plan.
Fat Repositioning vs Fat Removal
Fat Repositioning
The bulging fat is moved down to fill the groove beneath it, smoothing the lid-cheek junction.
Suits bags with a visible hollow below. Helps avoid a sunken appearance.
Fat Removal
A measured amount of bulging fat is taken out.
Suits prominent bags without a significant hollow below them.
| Aspect | Repositioning | Removal |
|---|---|---|
| Suits | Bags with a groove beneath | Bags without much hollowing |
| Effect on volume | Preserves it | Reduces it |
| Risk of hollow look | Lower | Higher if over-done |
| Combined with skin tightening | Possible | Possible |
| Decided by | Assessment | Assessment |
The Lower Blepharoplasty Process
Dr Deon Weyers performs each step himself.
Assessment
Fat, hollows, skin quality and lid tone are examined; the approach and incision are agreed.
Surgery
Through the chosen incision, fat is removed, repositioned or both. Loose skin may be tightened and the lid supported if needed. The procedure usually takes one to two hours.
First week
Swelling and bruising, managed with cold compresses, head elevation and pain relief. Keeping your head raised and avoiding bending forward helps swelling settle.
Review
Sutures, if external, are removed at an early visit.
Settling
Bruising fades over about two weeks; final contour develops over the following weeks.
Who Benefits From Lower Eyelid Surgery
Good candidates have persistent under-eye bags or a bag-and-hollow combination, healthy eyes and realistic expectations.
- Bags present all day – Not only on waking
- A visible tear trough – A groove below the bag
- Reasonable lid firmness – Assessed with a simple test at consultation
- No untreated dry eye – Or other eye conditions
- Bags present for years – Rather than a recent change, which may need medical review first
Fine wrinkles and dark pigmentation are not treated by lower blepharoplasty alone; other options may be discussed. Patients whose lower lids are already loose may need the lid supported during surgery, which is planned in advance rather than decided on the day.
What to Discuss at Consultation
These points shape the plan.
- Which incision suits me?Inside the lid or below the lashes, and why.
- Will fat be removed or repositioned?And how that avoids a hollow look.
- Is my lid support adequate?And whether it needs strengthening.
- Should the upper lids be done too?For balance, if they are also ageing.
- How visible will bruising be?And how long before you are comfortable being seen at work or socially.
Lower Blepharoplasty Cost
The practice publishes a range of R41,000 to R45,000 for lower blepharoplasty. See the lower blepharoplasty cost page.
Combined upper and lower eyelid surgery is published at R45,000 to R60,000. Your written quote follows consultation.
Lower-lid surgery for under-eye bags is cosmetic and generally self-funded.
Common Misconceptions
Under-eye concerns are often misread.
Risks and Possible Complications
Recognised Risks of Lower Blepharoplasty
Lid position changes, including the lid edge pulling down, are the main specific risk of lower-lid surgery.
Under- or over-correction of fat, contour irregularity and asymmetry.
Dry or watery eyes and light sensitivity, usually temporary.
Bleeding, infection and, rarely, bleeding behind the eye needing urgent treatment.
Risks related to the anaesthetic, discussed beforehand.
Protecting Your Result
- Follow the taping or massage advice – if given, to support the lid while healing.
- Avoid rubbing the eyes – during the first weeks.
- Hold off contact lenses – for about ten days.
- Wear sunglasses – outdoors while healing.
Call the practice urgently for increasing pain, swelling that keeps building, a hard or bulging eye, or any change in vision.
Medical disclaimer. This page is general information and does not replace a face-to-face consultation. Surgical decisions require an in-person assessment, a full consent discussion and the individual medical advice of your surgeon and anaesthetist.
Lower Blepharoplasty: Frequently Asked Questions
Will I have a scar?
With the transconjunctival approach the incision is inside the lid. If skin needs tightening, a fine incision below the lashes is used and usually fades well.
Can bags come back?
The fat that is treated does not usually return, but ageing continues and the area changes slowly over time.
Is lower blepharoplasty painful?
Discomfort is usually mild and controlled with prescribed pain relief.
Can it be combined with upper eyelid surgery?
Yes. Upper and lower blepharoplasty are often done together.
Do you see patients outside Johannesburg?
Yes. Patients from across South Africa are seen at the single practice in Fourways.
How much does lower blepharoplasty cost?
The published range is R41,000 to R45,000. A written quote follows your consultation.
How long is recovery after lower eyelid surgery?
Swelling and bruising usually settle within about two weeks, and many patients return to desk work within five to seven days. The contour continues to refine over six to eight weeks.
Is lower bleph surgery done under general anaesthetic?
Lower-lid surgery is usually done in theatre. The anaesthetic plan is agreed at consultation and reviewed by the anaesthetist before the day.
Will lower blepharoplasty remove dark circles?
It treats bulging fat and hollows, which cast shadows. Pigment in the skin itself is not removed by surgery, and other treatments may be discussed for that.
Speak to Dr Deon Weyers About Lower Eyelid Surgery
Dr Deon Weyers is a board-certified plastic and reconstructive surgeon, registered with the Health Professions Council of South Africa and a member of APRASSA. Every consultation, procedure and follow-up is with him personally, at the practice’s single location at Life Fourways Hospital in Johannesburg.
Call 011 875 1694
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