Lower Blepharoplasty in Brazil

Lower Blepharoplasty: eliminate bags and dark circles with naturalness and surgical precision.

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By Dr. Walter Zamarian Jr. · Updated: 02/18/2026

Lower Blepharoplasty in Brazil: the rejuvenation of the gaze begins with the lower eyelids

The lower eyelids are undoubtedly one of the areas that most reveal aging and fatigue. Under-eye bags that protrude beneath the eyes, thin and wrinkled skin, deep dark circles that no concealer can disguise -- these signs can appear early, sometimes before the age of thirty, and become more pronounced over time. Lower blepharoplasty -- commonly known as under-eye surgery or eye bag removal -- is the surgery that corrects these changes permanently, restoring a rested and rejuvenated appearance to the gaze. As a board-certified plastic surgeon in Brazil, I welcome patients from around the world at my clinic in Brazil.

With over twenty years of experience in plastic surgery and more than eight thousand surgeries performed, I have developed a deep understanding of eyelid anatomy. The area of the lower eyelids is one of the most delicate in the human body — the skin is the thinnest in the entire body, the muscles are extremely subtle, and the supporting structures are complex. Operating in this area requires millimeter-level precision, in-depth anatomical knowledge, and, above all, respect for the structures that protect your eyes.

On this page, I will explain in detail how I perform lower blepharoplasty, the different techniques I use depending on each case, what to expect from recovery, and how this surgery can transform not only your appearance but also your self-confidence. If you also wish to treat the upper eyelids, know that I often combine both procedures in the same surgical session.

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What Causes Bags and Dark Circles Under the Eyes

To understand lower blepharoplasty, it is essential to comprehend what happens to the area around the eyes over the years. The lower eyelid is not just a piece of skin — it is a complex system of layers that includes skin, orbicularis muscle, orbital septum, fat compartments, and the tarsal plate that provides support.

With aging, several changes occur simultaneously:

  • Weakening of the orbital septum: the septum is a fibrous membrane that keeps the orbital fat in place. When it weakens, the fat protrudes forward, forming under-eye bags.
  • Loss of volume in the mid-third: the cheek loses fat and descends, accentuating the transition between the eyelid and cheek and creating the so-called nasojugal groove, commonly known as dark circles.
  • Skin and muscle laxity: the eyelid skin, already naturally thin, loses elasticity and the orbicularis muscle elongates, creating wrinkles and an appearance of excess tissue.
  • Bone resorption: the very bone of the lower orbital rim remodels with age, enlarging the orbital cavity and allowing the fat to protrude even more.
  • Genetic factors: many people develop eyelid bags early due to family predisposition, regardless of age.

The combination of these factors explains why no cream, massage, or non-surgical procedure permanently resolves under-eye bags. Procedures such as facial fillers with hyaluronic acid can camouflage mild dark circles, but do not eliminate herniated under-eye bags or treat excess skin.

The Techniques I Use in Lower Blepharoplasty

There is no single technique that works for all patients. The choice of approach depends on a careful evaluation that I take very seriously during the consultation. Basically, I work with two main approaches and their variations:

Transcutaneous Lower Blepharoplasty (External Approach)

In the transcutaneous approach, I make a precisely measured incision just below the eyelashes of the lower eyelid, in the so-called subciliary line. This incision gives me complete access to all layers: skin, orbicularis muscle, orbital septum, and fat compartments. It is the technique I choose for patients who present significant excess skin, wrinkles, muscle laxity, and under-eye bags — that is, when there are multiple problems to be corrected simultaneously.

Through this approach, I can:

  • Remove or reposition herniated fat
  • Precisely remove excess skin
  • Tighten the orbicularis muscle when necessary
  • Perform canthopexy to reinforce the lateral support of the eyelid
  • Smooth the transition between the eyelid and cheek

The resulting scar is hidden in the natural fold just below the eyelashes and becomes practically invisible in a few weeks.

Transconjunctival Lower Blepharoplasty (Internal Approach)

In the transconjunctival approach, the incision is made on the inner surface of the eyelid, through the conjunctiva. There is no cut on the skin — therefore, there is no visible external scar. It is the ideal technique for younger patients who have under-eye bags but with good skin quality and no significant excess skin.

Through the transconjunctival route, I directly access the fat compartments and can remove or reposition them precisely. Since there is no manipulation of the skin and muscle, recovery tends to be faster and the risk of eyelid position alteration (ectropion) is lower.

The skin pinch Technique

In some cases, I combine the transconjunctival approach with the removal of a thin strip of skin just below the eyelashes — the so-called skin pinch technique. It is a refined technique that allows me to treat mild excess skin without needing to detach the entire eyelid as in the complete transcutaneous technique. The scar is minimal and the result is very natural.

Fat Repositioning vs. Removal

One of the most important evolutions in modern lower blepharoplasty has been the change in philosophy regarding orbital fat. In the past, the approach was simply to remove all herniated fat. The immediate result was good, but over time the eyes became hollow, with a skeletal and aged appearance.

Today, whenever possible, I prefer to reposition the fat instead of removing it. In practice, I mobilize the fat pads that protrude as bags and displace them downward, filling the nasojugal groove (dark circle). This way, I achieve two benefits in a single gesture: I eliminate the bag and correct the dark circle. The result is a smooth transition between the eyelid and cheek, without depressions or unwanted projections.

In selected cases, the combination of eyelid fat repositioning with fat grafting in the mid-third of the face produces an even more complete and natural-looking rejuvenation.

Canthopexy and Canthoplasty: Protecting Eyelid Position

One of the most important aspects of lower blepharoplasty — and often overlooked — is the evaluation and reinforcement of the lateral support of the eyelid. The outer corner of the eye (lateral canthus) is supported by the lateral canthal tendon. With age, this tendon can loosen, allowing the lower eyelid to descend and expose more of the sclera (the white part of the eye).

Canthopexy is a procedure that reinforces this tendon, keeping the eyelid in the correct position after surgery. It is a step that I consider fundamental in most of my lower blepharoplasties, especially in patients with pre-existing eyelid laxity or prominent eyes.

The difference between canthopexy and canthoplasty is subtle but important: in canthopexy, I reinforce the tendon without sectioning it; in canthoplasty, I section and reinsert the tendon in a new position. The choice depends on the degree of laxity found during surgery.

Why This Matters for Your Result

A lower blepharoplasty without attention to canthal support can result in ectropion — a condition in which the lower eyelid pulls away from the eyeball, exposing the conjunctiva. Besides being aesthetically undesirable, ectropion causes dry eye, tearing, and discomfort. It is a complication that can be avoided with proper technique, which is why I am so meticulous in this evaluation.

Patients who present ptosis (drooping of the upper eyelid) also deserve special attention, as the combined correction of upper and lower eyelids requires integrated planning to ensure symmetry and proper function.

Who is a Candidate for Lower Blepharoplasty

Lower blepharoplasty is recommended for men and women who present one or more of the following changes:

  • Under-eye bags beneath the lower eyelids, giving a permanently swollen appearance
  • Deep dark circles caused by an accentuated nasojugal groove
  • Excess skin with fine wrinkles on the lower eyelid
  • Muscle laxity that accentuates the aged appearance
  • Eyelid asymmetry that is aesthetically bothersome
  • Permanently tired appearance, even after a good night's sleep

Age is not the determining factor. I have patients in their twenties with significant hereditary under-eye bags and patients in their sixties with mild changes. What matters is the individual evaluation.

When Lower Blepharoplasty is Not Recommended

There are situations where I recommend caution or temporarily advise against surgery:

  • Active eye diseases (decompensated glaucoma, severe dry eye)
  • Uncontrolled thyroid diseases (can affect eye projection)
  • Unrealistic expectations about the outcome
  • Active smoking (must be discontinued at least two weeks before and after)
  • Use of anticoagulants that cannot be safely discontinued

During the consultation, I evaluate each of these factors individually. My priority is always the safety and best possible outcome for each patient.

The Consultation: Detailed Evaluation for an Accurate Result

The consultation for lower blepharoplasty is extremely detailed. I take time to examine not only the eyelids but the entire periocular region and the mid-third of the face, because these structures function as a unit.

What I Specifically Evaluate

  • Snap-back Test: I gently pull the lower eyelid down and assess the speed with which it returns to the normal position. This indicates eyelid tone and the need for canthopexy.
  • Eyelid Distraction Test: I assess how much the eyelid moves away from the eyeball when pulled. More than six millimeters indicates significant laxity.
  • Fat Evaluation: I identify which of the three fat compartments (nasal, central, and lateral) are herniated and to what degree.
  • Skin Quality: determines whether the approach will be transconjunctival or transcutaneous.
  • Eye Projection: prominent eyes require special care to avoid ectropion.
  • Nasojugal Groove: the depth of the dark circle indicates whether fat repositioning will be necessary.
  • Mid-third of the Face: I assess whether there is volume loss in the cheek that contributes to the aged appearance of the infraorbital region.

Pre-operative Exams

I request the following exams:

  • Complete blood count
  • PT/INR + aPTT
  • BUN/Creatinine
  • Fasting blood glucose
  • Urinalysis
  • EKG
  • Pre-operative cardiac clearance
  • Ophthalmological evaluation (when recommended)

Two weeks before surgery, I recommend discontinuing aspirin, anti-inflammatory medications, vitamin E, ginkgo biloba, high-dose omega-3, and any herbal supplements that may increase the risk of bleeding.

The surgery step by step

The isolated lower blepharoplasty lasts between one and two hours, depending on the chosen technique and any combined procedures. It can be performed under local anesthesia with sedation or general anesthesia, as planned.

Transcutaneous approach

After careful surgical marking, I make the subciliary incision — two millimeters below the lash line. I carefully dissect the orbicularis muscle, expose the orbital septum, and identify the three fat compartments: nasal (the most medial and often the most prominent), central, and lateral.

As planned, I reposition the herniated fat to fill the nasojugal groove or conservatively remove the excess. When necessary, I tighten the orbicularis muscle and perform canthopexy to ensure adequate lateral support. Finally, I redrape the skin without excessive tension and remove only the minimum necessary excess. The closure is performed with very fine absorbable sutures, with any non-absorbable stitches removed in five to seven days.

Transconjunctival approach

After everting (gently turning outward) the lower eyelid, I make the incision in the conjunctiva, directly accessing the fat compartments behind the orbital septum. I mobilize and reposition the fat as needed. There is no external suture — the conjunctiva heals spontaneously in a few days.

Frequently combined procedures

Lower blepharoplasty is rarely an isolated surgery. I frequently combine it with other procedures for a more balanced result:

  • Upper blepharoplasty: the most natural combination, treating upper and lower eyelids in the same surgical session.
  • Deep plane facelift: for complete facial rejuvenation, lower blepharoplasty complements the lifting of the mid and lower third.
  • Mini facelift: a less invasive option when facial sagging is moderate.
  • Fat grafting: to restore volume in the mid-third of the face and enhance the result of blepharoplasty.
  • Facial fillers: in some cases, I complement with hyaluronic acid in specific areas post-operatively.

Post-operative: what to expect from recovery

The recovery from lower blepharoplasty is faster than most people imagine, especially when I use the transconjunctival approach. Some important milestones:

First 48 hours

There will be swelling and possibly bruising in the eyelid and periorbital region. I recommend cold compresses in the first twenty-four hours, keeping the head elevated, and limiting activity. Pain is mild to moderate, easily controlled with OTC pain medication such as acetaminophen. Lubricating eye drops are essential to keep the eyes comfortable.

First week

Swelling peaks between the second and third day and begins to decrease progressively. Bruising, when present, usually resolves in seven to ten days. I remove the stitches from the transcutaneous approach between the fifth and seventh day. Avoid physical exertion, prolonged reading, and sun exposure.

Second week

Most patients are already presentable for social activities. Light residual swelling may persist but is easily disguised with sunglasses. Light makeup can be used after stitch removal and with your surgeon's approval.

First to third month

The result progressively refines. Residual edema gradually subsides, tissues settle, and the scar (in the transcutaneous approach) matures, becoming practically imperceptible. During this period, it is already possible to observe a result close to the final one.

Final result

Between three and six months, the result is complete. The rejuvenation of the gaze is long-lasting — the under-eye bags do not return, although the natural aging process continues. Most patients maintain the result for many years.

Risks and complications: transparency above all

Like any surgical procedure, lower blepharoplasty has risks. I am transparent about each of them during the consultation because I believe that a well-informed patient makes better decisions.

Possible complications

  • Ectropion: detachment of the lower eyelid from the eyeball. It is the most feared complication and the reason why I am so meticulous in pre-operative evaluation and in performing canthopexy when recommended. When it occurs, it is usually temporary and resolves spontaneously or with guided massages.
  • Hematoma: accumulation of blood in the operated area. Rare when hemostasis is meticulous during surgery and when the patient follows rest instructions and discontinues medications as directed.
  • Chemosis: edema of the conjunctiva that causes it to bulge between the eyelids. It resolves spontaneously in days to weeks with eye drops and local care.
  • Asymmetry: slight asymmetries are normal and usually balance out with the resolution of swelling. Significant asymmetries are rare with proper planning.
  • Temporary dry eye: may occur in the first weeks and is treated with lubricating eye drops.
  • Retrobulbar hematoma: an extremely rare but serious complication that requires immediate diagnosis and treatment. That is why I operate in a fully equipped operating room.

The best way to minimize risks is through a combination of refined surgical technique, careful pre-operative evaluation, and attentive post-operative follow-up. That is exactly what I offer my patients.

Lower blepharoplasty in the context of facial rejuvenation

It is essential to understand that the eyes do not age in isolation. The lower eyelid is part of an aesthetic unit that includes the upper eyelids, eyebrows, the mid-third of the face, and even the neck. When I plan a lower blepharoplasty, I always consider the face as a whole.

The importance of the eyelid-cheek transition

One of the hallmarks of aging is the deepening of the junction between the lower eyelid and the cheek. In youth, this transition is smooth and imperceptible. Over time, a step forms — the palpebromalar groove — which gives a tired appearance to the gaze.

The repositioning of fat in lower blepharoplasty is precisely the technique that restores this smooth transition. And when combined with fat grafting in the cheek or with a deep plane facelift, the result is a natural-looking rejuvenation of the entire face.

Lower blepharoplasty and complementary procedures

I often advise my patients on the importance of treating the face as a whole. A rejuvenated gaze on a face with significant sagging can create a noticeable imbalance. Similarly, a facelift without eyelid treatment can leave the result incomplete.

The decision to combine procedures or perform them in stages depends on various factors: age, degree of aging, health conditions, availability for recovery, and, of course, your personal goals. During the consultation, I develop a personalized plan that may include one or more procedures, always prioritizing safety and naturalness.

My experience and approach

I graduated from the State University of Londrina and had the privilege of being a student of Professor Ivo Pitanguy, the greatest name in Brazilian plastic surgery. With him, I learned not only surgical techniques but a philosophy of respect for the patient and an unrelenting pursuit of excellence.

Over more than twenty years of practice, I have performed over eight thousand plastic surgeries. I am a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). Blepharoplasty — both upper and lower — is one of the procedures I perform most frequently, often combined with deep plane facelift and fat grafting.

My approach to lower blepharoplasty is conservative and individualized. Conservative because I respect the tissues, preserve fat when possible, and never over-remove skin. Individualized because there is no one-size-fits-all approach — each pair of eyes deserves its own surgical plan.

Why trust me

I do not promise impossible results. I promise honesty in evaluation, meticulous technique in surgery, and dedicated follow-up in recovery. If during the consultation I realize that lower blepharoplasty is not the best path for you, or that another procedure would bring a more satisfactory result, I will say that clearly. My commitment is to your best result, not to performing a surgery.

Frequently Asked Questions about Lower Blepharoplasty

Does lower blepharoplasty eliminate dark circles?

It depends on the type of dark circle. Dark circles caused by a deep nasojugal groove (depression between the eyelid and the cheek) are significantly improved with fat repositioning. Dark-colored circles, caused by hyperpigmentation or vascular transparency, are not corrected by surgery and require specific dermatological treatments. During the consultation, I identify the cause of your dark circles and recommend the best treatment.

What is the difference between transcutaneous and transconjunctival lower blepharoplasty?

The transconjunctival is performed from inside the eyelid, without an external scar, ideal for those with under-eye bags without excess skin. The transcutaneous is done through an incision just below the eyelashes, allowing for the treatment of bags, excess skin, and muscle laxity simultaneously. The choice depends on the individual evaluation during the consultation.

Is the surgery painful?

Lower blepharoplasty is a procedure with minimal pain. Most of my patients report mild discomfort, easily controlled with OTC pain medication. Swelling and a feeling of heaviness in the eyelids in the first few days are more bothersome than the pain itself.

Can the under-eye bags return?

The fat that is removed or repositioned does not return. However, the aging process continues, and over many years, new changes may arise. The vast majority of patients maintain the results for ten years or more.

Can I have lower and upper blepharoplasty at the same time?

Yes, and this is a very common combination in my practice. Treating both eyelids in the same surgical session offers a more balanced result and avoids two separate recoveries. The complete blepharoplasty (upper and lower) is one of the procedures that most transforms the gaze.

How long does recovery take?

The majority of patients are socially presentable in seven to ten days. Light physical activities can be resumed in two weeks and intense exercises in one month. The final result settles between three and six months.

Can lower blepharoplasty be done along with a facelift?

Yes, and this combination is highly recommended. The deep plane facelift rejuvenates the middle and lower third of the face and the neck, while lower blepharoplasty takes care of the gaze. Together, they provide a complete and natural-looking rejuvenation. The mini facelift can also be combined when the laxity is moderate.

Is there a risk of having a droopy gaze or turned eyelid?

Ectropion (eyelid turned outward) is the complication that most concerns patients. With proper pre-operative evaluation — including tests for eyelid laxity — and performing canthopexy when recommended, this risk is very low. That is why choosing an experienced blepharoplasty surgeon is so important.

Can men have lower blepharoplasty?

Absolutely. Lower blepharoplasty is one of the most sought-after procedures by men who want a more rested and less aged appearance. The technique is adapted to respect masculine characteristics: thicker skin, lower positioned eyebrows, and incisions placed to maintain a naturally masculine appearance.

What is the cost of lower blepharoplasty in Brazil?

The cost of lower blepharoplasty in Brazil varies according to the technique used (transcutaneous or transconjunctival), combined procedures such as fat grafting, and the type of anesthesia. Brazil is recognized worldwide for the quality of its cosmetic surgery, and the cost is significantly lower than in the United States or Europe. I openly discuss all costs during the consultation after defining your individualized surgical plan. International patients can contact our clinic for assistance with travel planning.

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Dr. Walter Zamarian Jr.

Plastic Surgeon in Brazil

Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil

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