Lower eyelid surgery
Toronto

Lower eyelid surgery (lower blepharoplasty) addresses the structural changes beneath the eye that produce bags, hollows, and a perpetually fatigued appearance. At EyeFACE, the preferred technique is fat transposition, which repositions herniated fat into the tear trough rather than simply removing it, which can leave the eye looking hollow and worse than before.

Under-eye bags are caused by weakening of the orbital septum, the thin membrane that holds periorbital fat in place. This allows fat pockets to move forward. This is largely genetic and can appear as early as the 20s. Simultaneously, volume loss in the upper cheek deepens the tear trough, creating a shadow that accentuates the bag above it. The bag and the hollow are two sides of the same anatomical problem.

Fat transposition moves herniated fat over the orbital rim into the tear trough, aiming to reduce the bag and soften the hollow in one procedure. Hollowing after earlier surgery can often be improved with fat grafting or by moving fat, depending on the cause.

The transconjunctival approach accesses lower eyelid fat through the inside surface of the eyelid (the conjunctiva), with an incision inside the eyelid. It provides direct access to the three orbital fat compartments for transposition with minimal disruption to the eyelid's supporting structures. It is ideal for patients with good skin elasticity.

Good candidates are healthy adults bothered by persistent under-eye bags that have not responded to rest, products, or fillers. Ideal candidates have visible fat herniation, good-to-moderate skin elasticity, no active eye disease, and realistic expectations. If significant skin laxity or eyelid malposition is present, Dr. Gill may recommend combining techniques. This is determined at consultation: no standard protocol fits every face.

With the transconjunctival technique, the incision is inside the eyelid, so there is usually no scar on the skin. If a skin pinch is needed to address skin laxity, a fine incision is placed just below the lash line where it usually heals well and becomes hard to see.

Most patients have swelling and bruising for 10–14 days. Most patients feel comfortable in social situations at about 2 weeks. Most patients return to desk work within 5–7 days. Exercise resumes progressively from weeks 3–6. Final results, including the settling of deep swelling, emerge over 3–6 months as the transposed fat settles into its natural contour.

Cosmetic lower eyelid surgery is not covered by OHIP. However, lower eyelid malposition (ectropion or entropion) that causes corneal exposure, chronic irritation, or visual impairment may qualify for OHIP coverage. Dr. Gill will assess and document clinical eligibility at consultation.

Lower eyelid surgery from $13,000 + HST. Your written quote lists what is included and when payment is due. Financing through Beautifi is available, subject to approval.

At EyeFACE, procedures are performed at YASC, an out-of-hospital surgical facility accredited by the College of Physicians and Surgeons of Ontario (CPSO). Anaesthesia ranges from local anaesthetic with or without oral sedation, to moderate or deep sedation given through an intravenous (IV) line, to general anaesthesia with or without a breathing tube. It is chosen for your comfort and safety, based on your health and the length of surgery.

Yes. Lower blepharoplasty is commonly combined with upper blepharoplasty (four-eyelid blepharoplasty), endoscopic midface lift, fat transfer, or advanced skin treatments. Combining procedures under a single anaesthetic is often more efficient and cost-effective. Dr. Gill will advise on what is appropriate and safe for your goals.

Lower eyelid surgery is a complex procedure that needs careful planning. Oculoplastic surgeons complete dedicated fellowship training in eyelid and periorbital anatomy. Dr. Gill completed a two-year American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) fellowship in ophthalmic plastic, orbital and reconstructive surgery. He has performed thousands of procedures.