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.
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, the planning page below is a good place to start.
Learn More about Planning & Recoveryfor Lower Blepharoplasty→