Lower Blepharoplasty
Under-eye bags are one of the most common and noticeable signs of facial aging — and one of the most difficult to address non-surgically. They are caused by the forward herniation of fat pads that normally cushion the eye, combined in many patients with thinning of the overlying skin. Fillers can temporarily mask the shadow, but they do not remove the bulge. Lower blepharoplasty — often part of a lower eyelid lift — addresses the problem directly. Patients travel from across North Jersey and the NYC area to Dr. Rafizadeh's Morristown office for this procedure.
Dr. Rafizadeh performs lower blepharoplasty using the approach best matched to each patient's anatomy: transconjunctival (incision hidden inside the eyelid) for patients with good skin tone, or a subciliary (external) approach for patients who also require skin tightening. Both techniques are performed under local anesthesia with sedation.
“The lower lid is a more technically demanding operation than the upper lid. The key decisions — how much fat to remove vs. reposition, whether to tighten skin, how to avoid ectropion — require judgment that comes from experience. There is no formula.”
— Dr. Farhad Rafizadeh MD FACS
Transconjunctival vs. Subciliary Approach
The choice of technique depends primarily on how much excess skin is present and the quality of lower lid tone.
| Feature | Transconjunctival | Subciliary (External) |
|---|---|---|
| Incision location | Inside lower eyelid — no external scar | Just below the lash line |
| Skin removal | No — skin tightened with laser or chemical peel if needed | Yes — allows direct skin excision |
| Fat treatment | Removal or repositioning into tear trough | Removal or repositioning |
| Best for | Good skin tone, primary fat prolapse | Excess skin + fat prolapse, looser lids |
| Scar | None visible | Hidden below lash line, fades within months |
| Ectropion risk | Lower | Slightly higher — requires precise technique |
Fat Removal vs. Fat Repositioning
Traditional lower blepharoplasty simply removed the herniated fat pads. The modern approach recognizes that the tear trough hollow — the dark groove just below the bag — is often worsened when fat is simply excised, leaving a hollow appearance. Fat repositioning moves the prolapsed fat down over the bony orbital rim and into the tear trough hollow, simultaneously eliminating the bag and filling the groove beneath it. Dr. Rafizadeh selects the approach based on each patient's anatomy: patients with pure fat excess may benefit from conservative removal; patients with both bags and hollowness are better served by repositioning, sometimes augmented with fat grafting. When the lower-lid puffiness is actually a festoon or malar bag, a standard lower blepharoplasty alone will not correct it — an accurate diagnosis at consultation is essential.
Lower Lid Tone and Ectropion Prevention
One of the most feared complications of lower blepharoplasty is ectropion — outward turning of the lower eyelid caused by removing too much skin or by a lower lid with insufficient tone to withstand the contraction of healing. Dr. Rafizadeh evaluates lower lid tone with the snap test and distraction test at every consultation. In patients with lax lower lids, he may add a canthopexy or canthoplasty to tighten and support the lid and prevent this complication.
Combining Lower Blepharoplasty with Other Procedures
Lower blepharoplasty is frequently combined with upper eyelid surgery (upper blepharoplasty) at the same session. It is also commonly performed alongside a facelift, brow lift, and fat grafting for comprehensive facial rejuvenation. Combining procedures reduces overall recovery time compared to staging them separately.
Recovery Timeline
Days 1–3: Swelling and bruising under the eyes. Cold compresses and head elevation help minimize both. Most patients are comfortable at home.
Days 7–10: Most bruising resolves; swelling continues to reduce. Patients typically return to desk work around day 10.
Week 2: Presentable with minimal makeup. Social activities resume.
Months 1–3: Progressive refinement and fading of any external incision. Final result fully apparent by 3 months.
Cost of Lower Blepharoplasty in New Jersey
Lower blepharoplasty in New Jersey typically ranges from $4,500–$7,500 all-inclusive. If fat repositioning or fat grafting is added for tear trough hollowness, the fee is higher. Combining upper and lower blepharoplasty at the same session is more cost-efficient than separate procedures. An exact quote is provided at consultation once technique and extent of surgery are determined. Financing through Prosper Healthcare Lending is available.