Lower Eyelid Surgery


Skin looseness, drooping of facial fat pads (malar cheek fat pad), and muscle slackening constitute the major changes that occur in the aging lower eyelid and face. Triple board-certified plastic surgeon Dr. Gordon Sasaki can correct these issues with lower eyelid surgery performed at his Pasadena plastic surgery practice serving the Los Angeles area.

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Addressing Under-Eye Bags

Rejuvenation of lower eyelid fat protrusions, skin folds and lid laxity may be accomplished by the following 2 different approaches to the lower lid:

  • Transconjunctival (inside the lid) approach permits fat removal and relocation, but not the removal lax skin.
  • Infraciliary (outside the lid) approach permits removal and/or transposition of fat. This technique allows removal of excess skin because of the incision beneath the lash line. Surgical correction of lower lid laxity (determined by measurements, symptoms of dryness of eyes, and scleral show/lateral lid bowing) is more easily addressed by the infraciliary approach because the exposed orbicularis muscle may be tightened at the outside corner of the lower lid (lateral orbiculopexy).

Does Lower Eyelid Surgery Reduce Under-Eye Wrinkles?

Crepey skin on the primary lower lid frequently accompanies visible skin laxity, fat bulging, and lid laxity. Although skin separation from the underlying orbicularis oculi muscle may precede the removal of a conservative strip of excess skin, this maneuver does not ensure improvement of this troublesome finding. Since crepey skin is a result of progressive thinning from aging/sun damage and the attachments of the underlying orbicularis muscle, excision of damaged crepey skin will not resolve this aesthetic concern. The following treatments can help address these signs of aging in the face:

  • Fractional laser resurfacing
  • Intermediate chemical peels combined with BOTOX® Cosmetic
  • Ultherapy® tissue tightening

Dr. Gordon H. Sasaki

Triple Board-Certified Plastic Surgeon
Few plastic surgeons can match Dr. Sasaki's combination of expertise, compassion, and experience. He's a distinguished educator and a renowned innovator whose work and research have influenced a generation of plastic surgeons. Dr. Sasaki will work with you to make the improvements you desire.

Meet Dr. Sasaki

Full Facial Rejuvenation

You may be self-conscious about your lower eyelid bulges and skin folds, deepening crescent-shaped hollowness at the lid-cheek junction, swelling on your lateral cheek (malar bag), irregularity from your tear-trough downward, fullness of the nasolabial fold along with deepening of the nasolabial line, jowliness above and below your jawline, and downward fold at the corner of your mouth (marionette fold). These interdependent transformations are determined not only by your genetic background but also by your age and lifestyle.

For the majority of aging patients, a more complete facial rejuvenation is optimally achieved by blending the lower lid to the facial procedure. Based on your findings and goals, Dr. Sasaki will explain his reasoning for redistributing your lower lid fat downward to fill in the hollow at the lid-cheek junction, simultaneously elevating the large triangulated cheek fat pad upward to meet the lower lid fat and produce a smoother, fuller, a more youthful appearance in both areas. The doctor may also suggest fat grafting to your lower lid-cheek hollow for optimal results. To obtain a desired natural and longer-lasting rejuvenation in mature patients, however, a facelift procedure oftentimes requires not only fat repositioning, but also tightening of a deeper layer (submuscular aponeurotic system) whose laxity contributes to the formation of jowls and marionette folds, and a gentle skin adjustment. In younger patients who do not yet exhibit skin laxity, Dr. Sasaki may suggest an endoscopic facelift through small incisions to elevate the drooping facial structures without skin removal.

Your Lower Eyelid Surgery Procedure

A well-designed lower lid blepharoplasty is performed either through an incision within the lid or through the skin immediately below the lash line. Dr. Sasaki uses both approaches to expose the fat bulges. The doctor will then determine the amount of fat removal or fat relocation to smooth out the lower lid region for an optimal outcome. A transconjunctival approach is used when there is no need to remove skin. An infraciliary approach permits an opportunity to remove excess skin and to tighten the underlying muscle for lid support.

Lower lid blepharoplasties may take about an hour to perform and may be done safely under local anesthesia in our office surgical suite. You may shower and get the incisions wet the day after surgery. Medicated eye drops will be prescribed to reduce irritation and infection. Skin sutures will be removed ten days after surgery. If a transconjunctival blepharoplasty is performed, the single absorbable suture inside the lower lid is not removed.

Dr. Sasaki’s Research

In addition to creating excellent lower eyelid surgery results for his patients from Glendale, Arcadia, and throughout the Los Angeles area, Dr. Sasaki devotes his time to researching the procedure and furthering its development within aesthetic medicine. As an author of multiple textbook chapters and peer-reviewed papers published in medical journals, Dr. Sasaki demonstrates an ongoing effort to expand the medical field’s understanding of eyelid surgery and share his discoveries with his fellow surgeons. Learn more about Dr. Sasaki’s contributions.

Are you ready to discover all the ways Sasaki Advanced Aesthetic Medical Center in Pasadena can enhance your appearance and confidence? Request a consultation using our online form or call (626) 219-2357 for an appointment.

Sasaki Advanced Aesthetic Medical Center
800 S. Fairmount Ave., Suite 319
Pasadena, CA 91105
Phone: 626-412-0271
Fax: 626-796-1678
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