# Lower Blepharoplasty in Brazil Rested-looking eyes start with understanding what causes under-eye bags and dark circles. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20lower%20blepharoplasty%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Explore At a glance ## Lower blepharoplasty in Londrina, Brazil: at a glance ### What is lower blepharoplasty? Lower blepharoplasty is surgery of the lower eyelid to treat bulging fat and excess skin; when there is a deep under-eye hollow, the plan may include fat grafting, such as nanofat. Whether it is right for you depends on your skin, the bags, the hollow, and how well the eyelid is supported. It does not correct pigmentation, visible blood vessels, or swelling that comes and goes. - Technique: a transconjunctival approach, from the inside, when there is no skin to remove; the pinch technique when there is excess skin. - Anesthesia: total intravenous anesthesia; without a facelift, you can go home the same day. - Recovery: most people look presentable within 10 to 14 days; the tissues keep settling for months. - Scar: inside the eyelid with the transconjunctival approach; with the pinch technique, slightly below the lashes rather than right at the lash line, to help prevent ectropion. - Risks: eyelid retraction, ectropion, dry eye, and asymmetry; published series report retraction rates between 1.2% and 15%. - Results: long-lasting, not guaranteed; follow-up visits for one year. By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · CRM-PR 17.388 · [RQE 15.688](https://www.walterzamarianjr.com/us/credentials/) Tired-looking eyes ## When the mirror shows a tiredness you don’t feel Sometimes you’ve slept well, you feel full of energy, and people still tell you that you look tired. The area under the eyes can contribute to that impression: a bag casts a shadow, a hollow sharpens the transition to the cheek, and creased skin changes the texture. The first step is to identify which of these features are present on your face. I’m not trying to give you different eyes. I want to understand what bothers you and plan an improvement that respects your expression. That’s why a lower blepharoplasty consultation doesn’t start with choosing an incision. It starts with you showing me what you would like to change and with me examining how your eyelid works. I also distinguish a structural change from swelling that comes and goes, from pigmentation, and from other conditions that need their own evaluation. Photos help the conversation, but lighting and angle can hide or exaggerate dark circles. An in-person exam is still important to decide what really needs treatment. Planning ## Three questions guide my plan ### Is there excess skin? I look at how much skin is left over, how elastic it is, and where the edge of the eyelid sits. If removing skin is indicated, the amount must still allow the eyelid to protect the eye. ### Is there bulging fat? I assess the bulges that protrude under the eyes. When they need to be reduced, I choose the approach and how much to treat, without hollowing out the area indiscriminately. ### Are there deep under-eye hollows? A hollow can remain visible even after the bags are treated. In that case, I consider whether fat grafting could soften the transition between the eyelid and the cheek. These questions frame the decision, but they don’t replace an assessment of eyelid support. One person may have little excess skin and still need attention to the position of the eyelid. Another may have obvious bags with no need to remove any skin. I avoid applying the same set of steps to everyone. Skin ## Lower blepharoplasty: removing skin in measured amounts When there is excess skin, I use the pinch technique in suitable cases. The name refers to gauging the skin by pinching it before anything is removed. This step helps gauge the excess and avoid removing too much. The goal is not an artificially tight look, but to redrape the skin without pulling the eyelid down. When I remove skin with the pinch technique, I place the incision slightly below the lash line rather than right at it, to help prevent ectropion. An incision below the lashes is an [approach described by the ASPS](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/procedure). In that position, the scar tends to blend with the thin skin of the eyelid, but it is still a scar and goes through a period of maturation. Scleral show is the term for increased exposure of the white of the eye below the iris. Ectropion, on the other hand, is when the edge of the eyelid turns outward. They are different problems, and both can affect how the eye looks and how comfortable it feels. Careful planning of skin removal is part of prevention, but no single maneuver eliminates these risks. Kim and Bucky’s study of pinch blepharoplasty included 71 patients, many of whom had combined procedures. There were cases of temporary scleral show. It is a useful reference on the approach, but it does not prove that the pinch technique rules out complications. [See the publication](https://pubmed.ncbi.nlm.nih.gov/18434828/). If you’ve had eyelid surgery before, I need to take into account the skin that was already removed and the internal scarring. In some cases, the right decision is to remove very little skin or none at all. Preserving eye function takes priority over trying to erase every line. ### What bothers you most about the area around your eyes? Bring your concerns to the consultation. I want to show you which changes are present and talk about a plan that respects the way your eyes look. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20lower%20blepharoplasty%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) Bags ## Under-eye bags: reducing the excess without creating a hollow A bag is a bulge that stands out; a deep under-eye hollow is a depression. They can sit side by side and create a pronounced shadow. If I only remove fat without assessing the hollow next to it, I may not address your main concern, or I may make the area look sunken. The bags can be treated from inside the eyelid, through the transconjunctival approach, or through an external incision. When I use the pinch technique, I also consider reaching the bags through the same incision used to treat the skin. The choice depends on the full set of changes and on your individual plan. In the literature, the fat in the bags may be partly removed or repositioned into the hollow just below, [as the American Academy of Ophthalmology describes](https://www.aao.org/eye-health/tips-prevention/bags-under-eyes). In my practice, I remove the excess fat and, for deep under-eye hollows, use nanofat. I repositioned fat in the past, but the results I got were not as good, so I stopped doing it. That is my own experience, not a judgment of surgeons who reposition fat; I explain below why I favor nanofat. I don’t consider the inside approach better by definition, nor the external one inappropriate. [Transconjunctival blepharoplasty](https://www.walterzamarianjr.com/us/face/transconjunctival-blepharoplasty/) is especially useful when there are bags but no excess skin to remove. If other structures need treatment, combined procedures may be necessary. At the consultation, I explain which incisions you will have in your case. Dark circles ## Why I prefer nanofat for deep under-eye hollows The skin of the lower eyelid is thin, and small irregularities in contour can show. In my practice, I prefer to use nanofat for certain deep under-eye hollows because I see it settle more smoothly in this area. I have noticed an improvement in contour after surgery, and I take that experience into account when planning the graft. My concern with microfat in this area is that it may leave a more noticeable irregularity, even when placed deep. This is my own clinical preference, based on what I observe in the patients I follow. It doesn’t mean every microfat injection causes irregularities, or that nanofat is the best choice for everyone. It’s important to keep this experience separate from the scientific evidence. In the original paper by Tonnard and colleagues, the processed nanofat contained no viable adipocytes in the analysis performed, and the clinical focus was on improving skin quality. That study does not prove a lasting structural filling of under-eye hollows or superiority over microfat. [Original research on nanofat](https://pubmed.ncbi.nlm.nih.gov/23783059/). That’s why I explain what I aim to improve, which limits I recognize, and how we will monitor your progress. In the first few weeks, the appearance is still influenced by swelling. I don’t use that period to promise permanent volume retention. You can also read how I plan [facial fat grafting](https://www.walterzamarianjr.com/us/face/fat-grafting/). Limits ## Not every dark circle calls for the same answer ### Shadow from a bag It may lessen once the volume causing it is treated. That doesn’t mean every change in color will go away with it. ### Hollow under the eye It may call for a volume-based approach. The depth, the skin, and the rest of the face influence the choice. ### Pigmentation and visible vessels They are not corrected simply by removing skin or bags. They may need a separate evaluation and a different kind of treatment. ### Swelling that varies It needs to be distinguished from fat. Surgery shouldn’t be chosen based only on how you look on a given day or in one photo. Making this distinction protects your expectations. It’s possible to improve an important part of the area and still have some pigmentation or expression lines remain. Before surgery, I want you to know what is part of the plan and what is not being promised. Testimonial ## Rosana shares her blepharoplasty experience Hearing from someone who has been through surgery can help you organize your questions about care, recovery, and the decision itself. In this video (in Portuguese), Rosana shares her experience with blepharoplasty. The story is hers; which steps would be right for you depends on your consultation. As you watch, think about what you’d like to clarify with me: which change bothers you most, how you plan to organize your recovery, and what concerns you would still like to talk through. These points are also part of the planning. Rosana Her experience with eyelid surgery, in her own words (in Portuguese). Consultation ## What I need to know before recommending surgery - How your eyes are today. Let me know about dry eye, irritation, contact lens use, any eye treatments, and any difficulty closing your eyes. - What has already been done in the area. Surgery, fillers, and other treatments can change the tissues. Bring dates and any records you have. - How the eyelid is supported. I examine its position, firmness, asymmetries, skin, and relationship to the cheek, as well as the bags you see in the mirror. - What you hope to change. I compare your expectations with what treatment can offer, including scars, limits, and the possibility of other approaches. Tell me about all the medications and supplements you take. Don’t stop blood thinners or other treatments on your own. Tests, the anesthesia evaluation, and any input from other physicians are arranged according to your health and the extent of the procedure. Combined procedures ## When the eyes and the face are part of the same plan Lower blepharoplasty can be combined with upper eyelid surgery, a [brow lift](https://www.walterzamarianjr.com/us/face/brow-lift/), and a deep plane facelift when indicated. That doesn’t make any of these combinations mandatory. A low brow, for example, shouldn’t automatically be mistaken for excess eyelid skin. When we plan more than one area, I explain how that changes the surgery and the follow-up. I also take the surface of the eye into account. A retrospective series of 892 cases published by Prischmann and colleagues found an association between certain surgical combinations and dry eye symptoms or chemosis. The data justify careful planning; they are not an individual prediction. [Study on eye symptoms](https://pubmed.ncbi.nlm.nih.gov/23329270/). Surgery ## Anesthesia, operating time, and discharge I operate in a hospital, under total intravenous anesthesia (TIVA), the same anesthesia I use for almost all my surgeries. When lower blepharoplasty is done without a facelift, you can go home the same day if you wish: since I schedule these cases for the afternoon, discharge is at around 10 p.m. When it is combined with a facelift, it follows the facelift’s hospital stay. In my hands, eyelid surgery takes about 1 hour on average: around 45 minutes when I operate on two eyelids and around 1 hour 15 minutes when I operate on all four. Adding the pinch technique, fat grafting, the upper eyelids, or the brow increases that time, and I give you an estimate after the exam. The [main blepharoplasty page](https://www.walterzamarianjr.com/us/face/blepharoplasty/) covers what applies to both the upper and lower eyelids. Recovery ## Recovery: I monitor your eyes as they heal, not just their appearance in photos Swelling, bruising, and temporary differences between the two sides can occur. Eye comfort also needs to be monitored: a gritty feeling, dryness, or tearing should be reported. A photo sent by message can help, but it doesn’t replace an exam when there is doubt about how you are healing. You will receive instructions on hygiene, medication, protection, and returning to activities based on what was operated on. Light exercise is allowed at 1 month; any physical activity, including contact sports, at 2 months. If the transconjunctival approach is used, my protocol includes two weeks without contact lenses. Clearance also takes healing and symptoms into account. Have glasses ready for that period. For reference, the ASPS states that most people look presentable 10 to 14 days after eyelid surgery and that final healing can take a few months. [Results according to the ASPS](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/results). On the lower eyelid, swelling in the under-eye area may take longer to settle when fat grafting is done, so I don’t judge the contour during the first few weeks. For the first few days, I recommend cold compresses and sleeping with your head elevated. Avoid choosing your surgery date just by counting the days until an event. The time it takes to feel comfortable in social settings varies, and the tissues keep settling after the initial improvement. When blepharoplasty is done with a facelift, the aftercare for the combined surgery takes precedence. Our [patient journey](https://www.walterzamarianjr.com/us/patient-journey/) explains how follow-up visits are organized (they continue for one year) and the support my team provides. Risks ## Safety and warning signs that shouldn’t wait Risks include bleeding, infection, asymmetry, unfavorable scarring, changes in eyelid position, dry eye, and the need for revision. Serious vision problems are rare, but they are part of the conversation about safety. The [ASPS outlines these risks](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/safety) for patients. A change in eyelid position is the most characteristic risk of lower blepharoplasty, and the reported rate varies with the technique. In a series of 111 patients published by McGraw and Adamson, 15% had some degree of lower eyelid retraction, three needed another operation, and none had frank ectropion. [Study on postblepharoplasty ectropion](https://pubmed.ncbi.nlm.nih.gov/1892615/). In a series of 164 patients operated on through the transconjunctival approach alone, retraction occurred in 1.2%. [Study on the transconjunctival approach](https://pubmed.ncbi.nlm.nih.gov/23645352/). These are series from specific practices, using different techniques, and they don’t predict individual risk. In Prischmann’s series, pre-existing eyelid laxity and scleral show before surgery were associated with chemosis and dry eye. It’s one more reason to examine eyelid support before deciding how much skin to remove. When the eyelid is lax, I can perform a canthopexy or a canthoplasty, but I only recommend them when strictly necessary, because of the risks: an asymmetric position of the outer corner of the eye, a narrower eye opening with canthoplasty, and extrusion of the fixation sutures. Severe or worsening pain, reduced vision, and rapid swelling, especially on one side, require urgent evaluation. Don’t wait for your next follow-up visit or rely only on a WhatsApp reply. We will explain how to reach the team and where to get care. Talking about these points doesn’t diminish the importance of the result you want. It lets you decide with full information and take a more active part in your recovery. My commitment is to plan carefully and follow your progress, including when something needs extra care. Pricing ## Results, alternatives, and cost The ASPS describes the results of eyelid surgery as long-lasting, with the caveat that aging continues. On the lower eyelid, this applies to the treatment of the bags and the skin; how a fat graft behaves over time varies, and I don’t promise permanent volume retention. Not every dark circle calls for surgery. Fillers, laser treatment, and peels are among the [treatments listed by the American Academy of Ophthalmology](https://www.aao.org/eye-health/tips-prevention/bags-under-eyes) for this area, each with its own indications and limits, and they are not equivalent to removing bags or skin. When pigmentation is the main issue, I may tell you that surgery is not the first step. The cost depends on what will be treated: the approach, skin removal, grafting, combined procedures, operating time, and the hospital facilities. I only see private-pay patients. I explain how the quote is put together on the [pricing](https://www.walterzamarianjr.com/us/pricing/) page, and the fee is given after the evaluation. Questions ## Your questions deserve a careful answer. Does lower blepharoplasty get rid of all dark circles? No. It can treat skin and bags, and hollows can be grafted when indicated. Pigmentation, blood vessels, and other causes of discoloration don’t necessarily go away with surgery. Do I need skin removed if I have bags? Not necessarily. If there isn’t excess skin, I may consider the transconjunctival approach to treat the bags from the inside. The decision also depends on how the eyelid is supported and where it sits. Does the pinch technique prevent the lower eyelid from being pulled down? It helps gauge how much skin to remove, and I place the incision slightly below the lashes rather than right at the lash line, to help prevent ectropion. But that doesn’t eliminate every risk of a change in the eyelid. Support, healing, previous surgery, and the extent of treatment also matter. Why does Dr. Walter prefer nanofat for some under-eye hollows? In my practice, I see it settle smoothly in this thin skin, and I take that experience into account when planning. I don’t present this preference as proven scientific superiority over other forms of fat grafting. Can I have surgery again if I’ve already had blepharoplasty? We can look into it, but scarring and the amount of skin available change the plan. In some cases, I don’t remove any more skin. I need to examine what is causing your current concern. Does the online consultation settle every detail? The video call allows for a preliminary evaluation and a conversation about your expectations. The plan needs to be confirmed in person, with an exam of the skin, eyelid support, and eye health. How long is recovery after lower blepharoplasty? In the literature, most people look presentable 10 to 14 days after surgery, and final settling takes months. Fat grafting and combined procedures can prolong swelling. I set your time off work at the follow-up visits; light exercise is allowed at 1 month, and any physical activity at 2 months. What is the difference between the transconjunctival approach and an incision below the lashes? The transconjunctival approach reaches the bags from inside the eyelid, without cutting the skin, and is used when there is no skin to remove. An incision slightly below the lashes allows skin to be removed. The choice depends on the exam. You don’t need to arrive knowing which technique to choose. Let’s start with what you feel when you look in the mirror and what you would like to understand better. [Explore my options](https://wa.me/16402248116?text=Hi%21%20I%20came%20from%20the%20lower%20blepharoplasty%20page%20and%20would%20like%20to%20know%20if%20it%20is%20right%20for%20me.) References ## References and authorship By [Dr. Walter Zamarian Jr.](https://www.walterzamarianjr.com/us/walter-zamarian/) · CRM-PR 17.388 · [RQE 15.688](https://www.walterzamarianjr.com/us/credentials/) References reviewed on October 3, 2026. The sources below support the general information on this page. When I describe how I care for patients, I am referring to my team’s routine; the instructions for your surgery will be individual. - [Kim EM, Bucky LP. Power of the pinch: pinch lower lid blepharoplasty. Annals of Plastic Surgery, 2008. DOI: 10.1097/SAP.0b013e318172f60e.](https://pubmed.ncbi.nlm.nih.gov/18434828/) - [Tonnard P, Verpaele A, Peeters G, et al. Nanofat grafting: basic research and clinical applications. Plastic and Reconstructive Surgery, 2013. DOI: 10.1097/PRS.0b013e31829fe1b0.](https://pubmed.ncbi.nlm.nih.gov/23783059/) - [Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plastic Surgery, 2013. DOI: 10.1001/2013.jamafacial.1.](https://pubmed.ncbi.nlm.nih.gov/23329270/) - [American Society of Plastic Surgeons. Eyelid Surgery Risks and Safety.](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/safety) - [ASPS. Eyelid Surgery Procedure Steps.](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/procedure) - [ASPS. Eyelid Surgery Results.](https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/results) - [American Academy of Ophthalmology (AAO). How to Get Rid of Bags Under the Eyes.](https://www.aao.org/eye-health/tips-prevention/bags-under-eyes) - [McGraw BL, Adamson PA. Postblepharoplasty ectropion. Prevention and management. Archives of Otolaryngology–Head & Neck Surgery, 1991.](https://pubmed.ncbi.nlm.nih.gov/1892615/) - [Kashkouli MB, Pakdel F, Kiavash V, et al. Transconjunctival lower blepharoplasty: a 2-sided assessment of results and subjects' satisfaction. Ophthalmic Plastic and Reconstructive Surgery, 2013.](https://pubmed.ncbi.nlm.nih.gov/23645352/) ### Keep exploring - [Blepharoplasty →](https://www.walterzamarianjr.com/us/face/blepharoplasty/) - [Transconjunctival blepharoplasty →](https://www.walterzamarianjr.com/us/face/transconjunctival-blepharoplasty/) - [Fat grafting →](https://www.walterzamarianjr.com/us/face/fat-grafting/) [← All facial procedures](https://www.walterzamarianjr.com/us/face/)