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 — repositioning 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 — allowing fat pockets to herniate 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 repositions the herniated fat over the orbital rim into the tear trough depression, simultaneously eliminating the bag and filling the hollow beneath it — one procedure, two problems solved. Simple fat removal discards this volume permanently, which can leave patients looking skeletal or create a persistent dark shadow in the tear trough, an outcome that is very difficult to reverse.

The transconjunctival approach accesses lower eyelid fat through the inside surface of the eyelid (the conjunctiva), leaving no visible external scar. 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, there is no visible external scar — the incision is entirely inside the eyelid. If a skin pinch is needed to address skin laxity, a fine incision is placed just below the lash line where it heals imperceptibly within the natural skin crease.

Most patients have swelling and bruising for 10–14 days. Presentable for social situations occurs around 2 weeks. Most patients return to desk work within 5–7 days. Exercise resumes progressively from weeks 3–6. Final results — including full resolution 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.

Fees are personalised based on technique, anatomy, and whether procedures are combined. A complete itemised quote is provided following consultation. Financing through Beautifi is available. We do not publish package pricing online — your consultation is the right place to discuss costs.

At EyeFACE, procedures are typically performed under RN-administered sedation (twilight anaesthesia) at our CPSO-inspected Level 3 Out-of-Hospital Premises — not general anaesthetic. This reduces risk, recovery time, and cost compared to hospital-based 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.

The lower eyelid is one of the most technically demanding zones in facial surgery — a millimetre of malposition affects eyelid function, and overcorrection of fat can be very difficult to revise. Oculofacial plastic surgeons complete dedicated fellowship training in eyelid and periorbital anatomy that goes beyond standard plastic surgery or ENT training. Dr. Gill is ASOPRS fellowship-trained — the gold standard in this subspecialty — with over 10,000 eyelid procedures performed.