Lower Blepharoplasty
The goal is contour, not just correction
The lower eyelid is one of the most expressive and defining features of the face. When fat herniates forward beneath the eye, it creates the appearance of puffiness, fatigue, and aging that is often disproportionate to how a person actually feels. The goal of lower blepharoplasty is not simply to remove what has become prominent, but to restore a smooth, continuous contour from the lower eyelid through to the cheek.
In most cases, this means addressing both the herniated fat and the valley of transition at the orbital cheek junction, the hollow that often sits just below the bulge and accentuates it. Fat grafting to this area, using autologous fat harvested from the abdomen or thighs, restores volume precisely where it has been lost and blends the eyelid into the cheek naturally.
"The lower eyelid and cheek are one aesthetic unit. Treating them as such produces results that look like you, only more rested."
The approach here is transconjunctival, meaning the incision is placed on the inside surface of the eyelid. There is no external scar. The fat is accessed, reduced or redistributed, and the orbital cheek complex is augmented with grafted fat in the same operation. When skin laxity is present, laser resurfacing, skin excision, lid tightening, or a cheek lift can be incorporated for the right candidate.
Extensively trained around the orbit
Lower blepharoplasty sits at the intersection of cosmetic refinement and precise anatomical surgery. The orbit demands both.
American Board of Otolaryngology – Head & Neck Surgery
American Board of Facial Plastic & Reconstructive Surgery
Extensive experience with cosmetic eyelid surgery, orbital trauma including fractures and lacerations, and endoscopic orbital decompressions. Operating around the orbit is not new territory here.
A high volume of lower blepharoplasty cases, with and without fat grafting, across a wide range of anatomies and presentations, including revision cases and patients with prior treatments.
Is lower blepharoplasty right for you?
Candidacy depends on anatomy, history, and goals. These are the factors considered most carefully.
Herniated lower lid fat
The most common indication. Fat that has prolapsed forward beneath the eye creates persistent puffiness that does not respond to rest or skincare. This is a structural problem and responds well to surgery.
Tear trough hollowing
A groove or shadow at the junction of the lower eyelid and cheek, often present alongside fat herniation or independently. Fat grafting to this area restores volume and blends the transition between eyelid and cheek.
Skin laxity
Mild to moderate skin laxity in the lower eyelid can be addressed with laser resurfacing at the time of surgery. More significant laxity may require skin excision, lid tightening, or incorporation of a cheek lift.
Filler history
Prior filler in the tear trough or cheeks requires careful evaluation. The lymphatics of the lower eyelid are extremely delicate, and filler in this area, even if placed some time ago, can affect surgical results or create new problems. Dissolution is typically performed by Dr. Hashemi personally before proceeding.
A careful history before anything else
A detailed ocular history is obtained at every consultation. Prior eye surgery, dry eye symptoms, contact lens use, and any history of retinal or optic nerve conditions are all relevant to surgical planning and risk assessment. Vision is not taken lightly in any context, and around the eye it demands particular care.
The anatomy of the lower eyelid and cheek is assessed in detail, including the quality and distribution of herniated fat, the depth of the tear trough, the degree of skin laxity, and the position and tone of the lower lid itself. If filler is present or suspected, this is discussed and a plan for dissolution is made before a surgical date is set.
Goals are reviewed honestly. Lower blepharoplasty produces reliable, meaningful improvement in the right candidate. What it can and cannot achieve will be stated clearly.
Complexity is where your surgeon's skills show
The orbit is unforgiving anatomy. The structures that govern vision, lid position, and tear production are all in close proximity to the surgical field. A transconjunctival approach, when performed correctly, avoids the risks associated with external incisions, but it still requires precise dissection in a confined, delicate space.
Beyond the technical demands of the approach itself, lower blepharoplasty frequently involves decisions that cannot be fully anticipated before the operation begins. The exact distribution and character of herniated fat, the degree of septal laxity, and the quality of the orbital cheek junction are all assessed and addressed in real time. Fat grafting adds another layer of judgment: how much volume, where precisely, and in what plane.
"Operating around the eye requires the same precision you would want applied to any irreplaceable structure."
The experience brought to this surgery extends well beyond cosmetic blepharoplasty alone. Orbital trauma, including fractures, lacerations, and endoscopic orbital decompressions, demands the same anatomical fluency at higher stakes. That background informs every cosmetic case performed here and is part of what makes this practice well suited for patients whose anatomy is complex, whose prior treatments complicate the picture, or who simply want a surgeon with a deep and tested understanding of the structures involved.
Filler history and the lower eyelid
The lymphatics of the lower eyelid are among the most delicate in the face. Hyaluronic acid filler placed in the tear trough or cheek, even months or years prior, can persist in ways that are not clinically apparent and can compromise the surgical result or create new problems when the tissue is disturbed during surgery.
For this reason, any history of filler in or around the lower eyelid is taken seriously. Even if you believe the filler has dissolved on its own, or if it was placed some time ago, a thorough examination is performed. If residual filler is identified or suspected, dissolution is performed personally by Dr. Hashemi before a surgical date is set. This is not a precaution that is delegated or skipped.
This applies to filler placed in the tear trough directly, as well as volumizing filler placed in the cheeks, which can migrate or exert effects on the lower lid over time. The lower eyelid is not a forgiving area for assumptions about what has or has not resolved.
Please disclose all prior filler treatments at consultation, including treatments that were performed elsewhere or that you believe are no longer present. This information directly affects the safety and timing of your surgery.
Before your surgery
Once a surgical plan is agreed upon, the pathway to the procedure is organized and well-supported.
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Medical optimization
Lower blepharoplasty is a low physiologic stress procedure; routine pre-operative testing is not always required and depends on individual health status. Any specific requirements will be reviewed in advance. A detailed ocular history is obtained at or before consultation to identify any conditions relevant to surgical planning or anesthesia.
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Medications & supplements
Aspirin, ibuprofen, fish oil, vitamin E, and turmeric must be paused one week before surgery. Prescriptions will be sent to your pharmacy one week before your surgery date. All medications should be filled and on hand before surgery day.
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Ancillary considerations
Take care of routine monthly appointments, haircuts, dental cleanings, and similar tasks in the weeks before surgery. This is also a good time to coordinate any personal or professional obligations so your recovery period is low in stress and free of demands.
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Arranging support
A trusted adult must drive you home and stay the first night. Having someone available for the first few days is helpful, particularly for cold compress management and general comfort. After that, most patients are quite independent. Private nursing support is available and can be arranged through the practice if preferred.
What to expect when you arrive
Lower blepharoplasty with fat grafting is performed under general anesthesia in an accredited surgical facility. Nothing to eat after midnight; small sips of water only for approved medications. Wear comfortable, loose clothing and avoid makeup, lotions, and jewelry.
Arrival & preparation
Arrive approximately one hour before surgery for check-in, nursing assessment, IV placement, and anesthesia consultation. Anyone may drive you to the surgery center; however, a designated adult must be present to take you home, as the center cannot discharge you to a rideshare or taxi.
The procedure
The transconjunctival incision is made on the inner surface of the lower eyelid, providing direct access to the herniated fat without any external incision or visible scar. Fat is reduced or, when appropriate, transposed to fill the adjacent hollowing. Autologous fat harvested from the abdomen is then grafted to the tear trough and orbital cheek complex to restore volume and smooth the lid-to-cheek transition. When indicated, laser resurfacing or additional contouring procedures are performed in the same session.
Who is in the room
Throughout the entire procedure, the surgical team consists of a board-certified anesthesiologist dedicated solely to monitoring and managing your anesthesia and safety, a circulating nurse present at all times, and a scrub technician assisting directly with instruments. Before surgery begins, the anesthesiologist and nursing staff will each introduce themselves and speak with you personally, so you know exactly who is caring for you during your surgery.
Discharge
Most patients spend one to two hours in recovery before discharge the same day. That evening, Dr. Hashemi will personally reach out to check in. Patients are given a direct cell number and stay in close communication throughout the recovery period. Photos may be sent by text at any time, and stopping by the office during the first week is always welcome.
Engaged care, directly from the surgeon
Recovery is not a period of uncertainty. Patients have direct access to Dr. Hashemi throughout the healing process.
Evening of surgery
Dr. Hashemi personally reaches out the evening after surgery to check in, review how you are feeling, and address any questions before the first night.
Direct access throughout
All surgery patients have direct after-hours access to Dr. Hashemi. Photos may be sent by text at any time. Stopping by the office during the first week to have anything checked is always an option.
Follow-up visits
The first post-operative visit is at one week. All follow-up visits are conducted personally by Dr. Hashemi, ensuring continuity from first consultation through final result.
A lighter recovery than most expect
Lower blepharoplasty has a notably gentle recovery compared to other facial procedures. Most patients feel physically well within the first few days. The primary limitation is appearance, not function.
Swelling & bruising
Bruising and swelling are expected and typically peak around days three to five before gradually improving. Swelling is often most noticeable in the morning and improves through the day. By one week, most patients have yellowish discoloration and scattered bruising. By two weeks, the skin is mostly clear. By three weeks, most people look fully presentable and it is not obvious that surgery was done.
Cold therapy & positioning
Elevate the head on two to three pillows for the first two weeks. Apply a cool compress gently to the eyes and cheeks for 10 to 15 minutes every two to four hours while awake during the first three days. No direct ice on skin.
Eye care
Apply erythromycin antibiotic ointment to the eyelash line three times daily. Use Maxitrol antibiotic drops as directed. For dryness or irritation, use preservative-free artificial tears. Avoid rubbing or touching the eyes for at least two weeks. No makeup or creams near the eyes for at least two weeks.
Donor site care
The abdominal donor site will have small stitches where fat was harvested. Expect some bruising, firmness, and tenderness for one to two weeks. Apply antibiotic ointment twice daily. The area may feel firm or lumpy for several weeks as swelling resolves. Gentle massage may begin after two weeks if tenderness has subsided.
What you will be prescribed
All prescriptions will be sent to your pharmacy one week before surgery. Fill everything in advance so it is on hand when you arrive home.
- Tylenol: 650mg every 4 hours as needed (max 4,000mg/day). Most patients do well with Tylenol and Celebrex alone.
- Celebrex: once morning and evening. Do not combine with ibuprofen or aspirin.
- Oxycodone: available if needed for stronger pain. Do not drive or make legal decisions while taking it. Use Miralax or Colace to prevent constipation.
- Erythromycin ointment: applied to eyelash line 3 times daily for 10 days after surgery.
- Maxitrol drops: 2 drops in each eye 3 times daily for 10 days after surgery.
- Doxycycline: oral antibiotic, complete the full course as prescribed.
- Mupirocin ointment: applied to abdominal donor site twice daily for 2 weeks.
- Refresh Plus: preservative-free artificial tears for dryness or irritation, as needed.
- Any sudden change in vision
- Severe or increasing pain not controlled by medication
- Significant swelling on one side only
- Fever above 101.5°F
- Foul drainage or signs of infection
- Excessive bleeding from the donor site
- Shortness of breath or chest pain, call 911
Office: 650-313-2338
All surgery patients have direct after-hours access to Dr. Hashemi.
Returning to normal life
Lower lid blepharoplasty carries one of the lighter activity restriction timelines of any facial procedure. Most patients feel physically ready to return to their routines within days. The recovery is primarily about protecting the surgical result during early healing, not managing significant discomfort.
Days one through seven: Light walking is fine from day one. Avoid strenuous activity, bending, heavy lifting, swimming, and hot tubs. Do not drive until vision is clear and narcotic medications have been discontinued.
Week three: Light activity resumes. Keep heart rate generally below 110 bpm.
Week four: Full activity may resume if recovery is progressing well.
Lower eyelid stretch: Beginning after the first week visit, gently stretch the lower eyelids upward and outward two to three times daily for two weeks. Light stretching only, no circular or forceful massage.
No ibuprofen, Motrin, Advil, or aspirin while on Celebrex. After Celebrex is complete, ibuprofen may be used as needed.
The result reveals itself gradually
The visible recovery from lower blepharoplasty moves quickly relative to other facial procedures. The deeper healing, particularly the maturation of grafted fat and the final settling of contour, continues over several months.
Most patients feel physically well. Bruising and swelling present but improving.
Fully presentable. Surgery not obviously apparent. Light activity resumes.
Grafted fat settling. Contour refining. Most of the result is visible.
Final result. Grafted volume stable. Lid-cheek contour at its best.
Although most visible recovery occurs within a few weeks, healing continues to refine over four to six months. These are subtle, gradual changes that contribute to the final contour and are not noticeable day to day.
Your eyes. Your identity. Your result.
The lower eyelid is one of the first places fatigue and aging become visible in the face, and one of the most meaningful areas to address. Done well, the result is simply a more rested, more refreshed version of you.
For those considering lower blepharoplasty in Palo Alto or the Silicon Valley area, a consultation is the right first step.
Schedule a Consultation