Lower eyelid

Having bags under your eyes is often referred to as being the main reason for looking tired. Bags are caused by a weakening of a connective tissue layer in the lower half of the eye socket. The slack connective tissue allows the fat to bulge out over the rim of the eye socket, creating a swelling or a bag.

The function of the lower eyelid

Where the upper eyelid mostly blinks, the function of the lower eyelid mainly depends on the tension in its muscle. Maintaining the correct tension arc is therefore essential for both form and function. This is why I use a muscle-sparing technique, which is least invasive and combines the most natural results possible with the shortest recovery time.

The goal

It is important to realize that, form a certain age, it is not normal to have a lower eyelid without any folds or wrinkles. Every movement of the muscle (which is essential for the function of a lower eyelid) by definition leads to wrinkling over time. The operation is therefore aimed at correcting the bags as much as possible, removing any skin surplus and evening the eyelid out in a natural way, not so much at removing all wrinkles. Usually this is achieved by making a smooth the transition from the lower eyelid skin to the cheek, with as little level difference as possible. The goal is to optimize your face so you look good for your age, not to pull it so much that you look "tight".

In general, you can say that the purpose of a lower eyelid correction is to optimize your natural appearance by reducing the excess skin in the lower eyelids, evening out any bags under the eyes and at the same time improving and respecting the tension arc of its muscle, thereby reducing functional as well as aesthetic complaints someone may experience.

The method

Which technique suits you best is very personal. Each lower eyelid is different, often even one side is different from the other. An accurate preoperative analysis is therefore very important. It often happens that I have to do something different on the left compared to the right. It is thus only logical that the healing and the results may differ slightly per side.

The different parts of a lower eyelid correction determine how the operation is performed. Skin reduction and muscle strengthening can be performed under local anesthetic. As soon as a correction of the bags under the eyes is required, the operation will have to take place under sedation. Sometimes people prefer this anyway for reasons of comfort.

Logically, lower eyelid corrections often take place in combination with a correction of the upper eyelids. After all, it is the same area and has been subject to the same degree of wear. Typically the procedure is performed on an outpatient basis.

Most people experience slightly more discomfort from a lower eyelid correction than from an upper eyelid correction. This is mainly due to the difference in function between these eyelids. Where the upper eyelid is very mobile - blinking more than 15,000 times a day - and therefore is very flexible, the function of the lower eyelid is mainly static. The tension arch of the muscle in the lower eyelid is so important for exactly this reason, which is why the muscle is strengthened during the procedure with a few tiny and solvable sutures. It will feel a bit tight in the first few weeks, but that feeling gradually disappears over time.

A correction of the bags under the eyes or the skin surplus of the lower eyelids greatly contributes to obtaining a fresher and more youthful appearance.

All steps of a lower eyelid correction

All phases of an eyelid correction are explained below in more detail. My recommendation would be that you read this information carefully and contact us if any questions arise. I wish you a good recovery!

The preparation

  • You should not take medication that makes your blood thinner, this increases the risk of bleeding. Therefore, non-steroidal anti-inflammatory drugs such as aspirin, Brufen, Ibuprofen and Nurofen should be stopped two weeks before surgery, up until two weeks after the procedure.
  • Ask us in advance if you have any doubts about the safety of your current medication regarding the operation.
  • If you smoke, it is strongly recommended that you quit two weeks before to at least a week after the surgery. Smoking restricts blood flow, which may prevent proper wound healing.
  • Make sure someone is able to pick you up after your surgery, because you can't drive home (also you’re not insured) if you’ve just undergone surgery.
  • We advise you to shop for your groceries in advance, so that you don’t have to do this immediately after the operation.
  • We also advise you to arrange for some help at home for the first few days after surgery.
  • Make sure you get the prescription eye drops and gel at home before your surgery date.

The lower eyelid correction

  • Please come to the surgery without makeup or contact lenses in.
  • On the day of the operation, I’ll see you right before the operation and I will briefly go through the procedure with you again.
  • I’ll make some markings on your eyelids and will take pictures to record the preoperative status.
  • The operation will be performed in a fully equipped operating room, adhering to the strictest medical rules and guidelines.
  • The operation is generally be performed under sedation anesthesia, which is always well tolerated. You’ll receive your medication through an IV drip, which means that you will be asleep during the procedure.
  • An incision is made just below the lashes of the lower eyelids, following the natural curve of your eyelids. This incision then continues to the side next to the eyelid. If correction of the bags under the eyes is also necessary, a separate incision is made on the inside of the eyelid. It will be invisible from the outside and you will notice that you won’t be bothered by it.
  • The operation takes between the 30 and 45 minutes.
  • A dissolvable suture will be used to close the incision. A few small stitches are also placed under the skin in the muscle to optimize the tension arc. You may experience a slight stretching feeling in the first weeks after the procedure.
  • Skin-colored plasters are used across the width of the lower eyelid to support the muscle and to prevent swelling. They should sit there for 1 week and stay dry.

After the procedure

  • After the operation you will be taken to our recovery room. Your eyelids will be cooled there to prevent the swelling as much as possible.
  • Once the local anaesthetic has worn off (after 2-4 hours), you may experience some discomfort for a few hours. Paracetamol (2x500mg) is usually sufficient.
  • In the beginning it slowly swells and (sometimes) some bruises develop. Regular cooling of your eyelids will help keep this swelling to a minimum. The swelling increases for the first three days before it subsides. Cooling therefore mostly makes sense during the first 3 days.
  • In the beginning your eyes can sometimes feel a bit dry. If you notice this, it is wise to assist your eyes with the help of some eye drops (or ointment before going to sleep). You will receive eye drops and eye ointment on prescription before the operation and must therefore be brought home beforehand.
  • Avoid bending or lifting heavy things in the first few days. During this period perhaps it could be pleasant to sleep with an extra pillow so that your head is slightly higher, then the swelling will decrease faster.
  • You’ll notice that you can do many things in your daily life, you are simply limited by the swelling. For example, your eyes are often a bit tired and you will have to adjust your pace accordingly. If you don’t do this, the process will be more troubling than is necessary.
  • We’ll make an appointment for a week after the operation. We’ll check up on the wound and the patches and the stitches of the eyelids. From this moment onwards using make-up is possible again.
  • By this time the swelling and bruising, if any, have usually returned to an acceptable level that allows social activities to resume. Sometimes, however, these side effects take longer to disappear completely. We therefore recommend that you do not plan really important social activities in the first 3 weeks after the procedure.
  • We also recommend that you avoid any heavy physical activities in the first 2 weeks.
  • You will notice a varying feeling of tightness in your forehead and upper eyelid, which often lasts for several weeks, but then slowly disappears. Massaging the scars with a silicone gel especially made for scars, such as Dermatrix, can relieve this feeling.
  • The scar will be slightly red compared to the surrounding area. This will last for approximately 4-5 months. This is mostly visible at the side of the eyelids. You can use makeup to camouflage this.
  • A scar usually takes a year to fully settle and heal. During this period it is vulnerable to damage from UV light, such as from sunlight or sunbeds. We recommend that you protect the scars from the sun by covering them or applying a sunscreen (factor 50).
  • Most people only need one lower eyelid correction. Realize that after the procedure, the aging process will continue as normal and that slack structures will give even after strengthening. In the rare case that people come for a second time, there is always a minimum time span of 15 years.

Does this appeal to you?

If you want to know more about this and in particular want more information about what this could imply for you, please contact me to make an appointment.

To summarize

Duration of the procedure
30 to 45 minutes
(How long) Will the scars be visible?
The scars are somewhat swollen in the first two weeks. The part under the lashes fades fairly quickly, but the part on the side of the eye socket will remain slightly red for 4-5 months. Ultimately, scars fade so much that they appear as normal skin and then usually are no longer visible.
When can I resume with my social life?
After 1-2 weeks, although the scars will still be visible.
It is normal to experience some tightness in the first month.
Back to normal daily activities
1 week
Return to normal sports activity
Within 2 to 4 weeks, depending on the type and intensity of the activity. Particularly bending down can still be troubling.
Disclaimer: Surgical intervention and the healing process are subject to many (individual) variables and therefore cannot be fully predicted. This information is only intended to help you better understand the process. No rights can be derived from it. Keep in mind that reality may be different in your case. If in doubt, please contact Dr. van der Meulen.