Lower Eyelid Surgery (Lower Blepharoplasty)

Lower eyelid surgery at MUDr. Kloud's Hradec Králové clinic removes or repositions the herniated fat pads that create persistent under-eye bags, and can address lower lid skin laxity, through either a transconjunctival incision (inside the lower lid, leaving no visible external scar) or a subciliary incision just below the lower lashes. Performed under local anaesthesia as an ambulatory procedure, lower blepharoplasty is often combined with upper eyelid surgery in the same session for a comprehensive lid correction. When lower lid laxity is present — a factor assessed at pre-operative consultation — canthopexy or canthoplasty may be added to support the lower lid margin.

Lower blepharoplasty targets the structural changes that produce under-eye bags: the herniation of orbital fat through a weakened orbital septum, which creates the characteristic persistent puffiness below the eye that is unrelated to sleep quality or fluid retention. Unlike temporary swelling, under-eye bags caused by fat herniation cannot be resolved through skincare or lifestyle measures — they require surgical repositioning or removal of the fat compartments. MUDr. Kloud selects the surgical approach based on the anatomy present at consultation. The transconjunctival approach (incision on the inner surface of the lower lid) is used when the primary concern is fat repositioning or removal without significant lower lid skin excess — the technique leaves no visible external scar and has a lower risk of lower lid distortion in patients with good skin tone. The subciliary approach (incision just below the lower lash line) is used when both fat and excess lower lid skin require correction, providing access to the full lower lid anatomy through a single incision that heals to a fine line concealed in the natural lid shadow. For patients with pre-existing lower lid laxity — assessed by the snap-back and pinch tests at consultation — canthopexy (tightening the lateral canthal tendon through an internal stitch) or canthoplasty (reconstruction of the lateral canthal angle) is added to prevent the ectropion (outward turning of the lower lid) that can complicate lower blepharoplasty in susceptible patients. This assessment and any planned lateral canthal support are discussed before surgery. The procedure takes approximately 45 to 60 minutes under local anaesthesia. Post-operative care parallels upper blepharoplasty: chilled compresses for the first 48 hours, elevated head position during sleep, suture removal at day seven to nine, and avoidance of eye makeup for two weeks. Bruising is typically more prominent after lower blepharoplasty than upper; most resolves within ten to fourteen days. Final results — the disappearance of residual swelling and the final contour of the lower lid — emerge over four to six weeks. Lower blepharoplasty is frequently combined with upper blepharoplasty in the same session, addressing both lids simultaneously under a single block of local anaesthesia. This avoids a second procedure visit and consolidates the recovery period. Both procedures together deliver a comprehensive refresh of the periorbital area without the need for general anaesthesia or hospital admission.