Lower Eyelid Surgery: Scarless Eye Bag Removal by Dr Aicee Bernal

---

Lower blepharoplasty, or lower eyelid surgery, is a cosmetic procedure that removes fat under the eyes.

This delicate surgery restores a more refreshed, youthful look by targeting tired, sagging under-eye areas that creams or fillers can’t fix permanently.

• Those with persistent under-eye bags that don’t go away with sleep or skincare
• Individuals with puffy or swollen-looking lower eyelids
• People who feel they look tired, older, or stressed even when they’re not
• NOT for those with sunken under eyes

Before surgery:  Make sure blood pressure is controlled.  Medications that cause bleeding or easy bruisability like anticoagulants should be stopped 1-2 weeks prior to surgery.

Anesthesia: under local anesthesia or IV sedation in a hospital setting

Incision: the incision depends on the type of technique.  It is located near the lash line for Subciliary Lower Blepharoplasty and inside the eyelid for Transconjunctival Lower Blepharoplasty

Procedure Time: 2 hours

Types of Lower Blepharoplasty:

1. Subciliary Blepharoplasty (through the skin)

• Incision: a cut is made just below the lower lash line making the scar less visible
• Best for: young patients with elastic skin and those with thick muscles under the eye
• Contraindicated for: elderly patients with loose inelastic skin because they are prone to complications such as eyelid ectropion
• What it addresses: Removes excess fat, can release the tear trough and can remove excess orbicularis oculi muscle
• Advantages: Faster procedure, more exposure and easier for the surgeon
• Downside: Small external scar (usually well hidden), slightly higher risk of lower lid retraction/ectropion 

2. Transconjunctival Blepharoplasty (from inside the eyelid)

• Incision: a small incision is done  inside the eyelid (no visible scar)
• Best for: elderly patients with thin inelastic skin
• What it addresses: Removes excess eyelid fat
• Advantages: No external scar, lower risk of lid malposition
• Downside: thick orbicular oculi muscle cannot be removed, tear trough may be difficult to detach

• Post-op Course: Oral antibiotics and pain reliever are taken for a week.  Topical eye antibiotic or eyedrops are used for a week.  Expect swelling and bruising for 7-14 days or more.  Ice compress is advised to lessen swelling.
   
• Suture Removal:  done after a week for Subciliary Lower Blepharoplasty.  No sutures for Transconjunctival Lower Blepharoplasty

• Downtime: 7-14 days for swelling; most return to work in a week

• Scarring: Often hidden along lash line for Subciliary Lower Blepharoplasty.  No scars for Transconjunctival technique.
   
• Results: Visible within 3 months; Final results in 6-12 months

Q: What’s the difference between upper and lower blepharoplasty?
A: Upper blepharoplasty removes saggy upper eyelid skin, while lower blepharoplasty targets under-eye bags and puffiness.

Q: Will it remove dark circles?
A: If your dark circles are caused by fat bulging or shadowing, yes. If caused by pigmentation, additional treatments may be needed.

Q: Will fat be redistributed?

A:  The fat may be redistributed however this is usually not enough, a fat grafting procedure is best done together with lower blepharoplasty especially for those with flat cheeks or sunken undereye

Q: Is it painful?
A: Discomfort is usually mild. Most patients feel sore for 1–2 days but recover quickly.

Cost of Lower Blepharoplasty by Dr. Aicee Bernal is P55,000 (Subciliary Technique) to P70,000 (Transconjunctival Lower Blepharoplasty) if done in the clinic under local anesthesia, and this does not yet post-operative medications. 

If you prefer to be sedated, the procedure will be done in a hospital setting under the care of a board-certified anesthesiologist. Hospital cost will vary from P130,000–170,000 for uncomplicated cases, also excluding preoperative laboratories , clearance and post-op medications.

With years of surgical expertise, Dr. Aicee Bernal uses both external and scarless (transconjunctival) techniques to customize lower blepharoplasty based on each patient’s anatomy and goals.

Her refined, conservative approach ensures natural-looking results without overcorrecting — so you look like yourself, only more rested.

Say goodbye to tired-looking eyes with lower blepharoplasty by Dr. Aicee Bernal — for a smoother, more youthful under-eye area.