Rejuvenating Your Eyes: The Modern Approach to Lower Eyelid Surgery

As we age, one of the first areas to show noticeable changes is around the eyes. You may begin to see “bags,” dark circles, sagging skin, or a tired appearance — even if you feel full of energy. While many people believe these changes are simply due to loose skin, the real cause is often volume loss in the lower eyelid area. Over time, we naturally lose fat, bone, and muscle under the eyes, creating hollows, grooves, and shadows that make us look older than we feel.

What Causes Bags and Dark Circles?

  • Bags are typically caused by fat pushing forward above the cheek area, combined with hollowing below.
  • Grooves and hollows develop because the skin is tethered by a tight ligament under the eye, creating a visible dip.
  • Dark circles can result from shadows cast by these structural changes, or from increased skin pigmentation.
  • Loose, sagging skin (known as dermatochalasis, or malar festoons when extending to the cheek) can further add to a tired, aged look.

A New Era in Lower Eyelid Surgery

Modern lower eyelid surgery, or blepharoplasty, does far more than simply remove excess skin. Our comprehensive approach is designed to:

  • Restore lost volume
  • Smooth out grooves and hollow areas
  • Gently tighten and refresh the skin
  • Minimize dark circles and shadows

The goal is to create a natural, youthful look — not a pulled, tight, or unnatural appearance. In most cases, there is enough of the patient’s own fat in the under-eye “bags” to reposition and fill the hollow areas below. This technique, known as fat transposition blepharoplasty, helps smooth the eyelid-cheek junction for a refreshed, seamless contour. It can be performed either from inside the eyelid (no visible scar) or through a fine external incision.

Figure 2. Repositioning of fat (A & B)

Tailoring the Technique to You

  • Younger patients often benefit from an internal (transconjunctival) approach, which avoids any external incision.
  • Middle-aged and older patients may require an external (transcutaneous) approach to also address skin laxity.

In cases where orbital fat is limited — especially in patients who have had previous eyelid surgery — we may recommend fat transfer from another part of the body to restore youthful volume and achieve a smooth, natural result.

Protecting Your Eye Shape

When surgery is performed through the skin, there is a slightly higher risk of the lower eyelid pulling downward (a condition called ectropion). To prevent this, we often perform a lateral canthopexy or canthoplasty. These small, supportive procedures reinforce the outer corner of the eye, preserving its natural shape and preventing complications.

Why Choose Modern Blepharoplasty?

By focusing on both volume restoration and gentle skin tightening, modern lower eyelid surgery achieves results that are:

  • Natural
  • Youthful
  • Long-lasting

Each procedure is customized to your unique anatomy and cosmetic goals, ensuring that you look refreshed, energized, and beautifully natural — never overdone.

At ELZA, your care is led by Dr. Dion Paridaens, PhD, MD, our Consultant in Oculoplastic Surgery with over 25 years of experience in the field.

Dr. Paridaens is internationally recognized for his expertise and has co-authored the chapter on lower blepharoplasty in the current textbook of the European Society of Ophthalmic Plastic & Reconstructive Surgery (ESOPRS).

He warmly invites you for a personal consultation to explore the most advanced, tailored options in modern eyelid rejuvenation — and to help you achieve natural, lasting results with confidence.

Dr. Dion Paridaens, PhD, MD

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