The Gold Standard of Lower Eyelid Surgery + Midface Lift

Get It Done Right — Don’t Compromise on Your Lower Blepharoplasty!

By Dr. Yongwoo Kim, Board-Certified Plastic Surgeon at Returning Plastic Surgery

Introduction

Hello, I’m Dr. Yongwoo Kim, board-certified plastic surgeon.

Lower eyelid surgery is a must-have procedure in anti-aging surgery — especially popular among men. Because of high demand, it’s offered by nearly every plastic surgery clinic, even at non-specialist offices.

It may seem like a common and simple surgery, but true lower eyelid surgery requires a deep understanding of anatomy and orbital pressure dynamics. This is not a procedure to get just anywhere.

Lower Eyelid Fat Repositioning vs. Traditional Lower Blepharoplasty

People often confuse “fat repositioning” with lower eyelid surgery. While not strictly medical terms, the difference is this:

  • Fat repositioning (commonly called “undereye correction”) is performed through the conjunctiva (internal incision), with no skin removal.


  • Lower blepharoplasty is done through a skin incision and also addresses skin laxity.

Procedure

Improves Tear Trough

Fixes Fat Pouch

Tightens Skin

Fat Repositioning

✅

✅

❌

Lower Bleph

✅

✅

✅

Lower Blepharoplasty vs. Midface Lift

Midface lift is often confused with lower blepharoplasty. It’s a bit harder for patients to understand, so it’s less commonly recommended — but it can be very effective.

Here’s the difference:

  • Lower blepharoplasty: reduces bulging fat and smooths the tear trough by moving fat downward
  • Midface lift: lifts sagging cheek tissues (malar fat pad) upward, filling the hollow under the eyes from below
Marked cheek fat lifted on one side only — visibly higher than the untreated side.

Procedure

Tear Trough

Fat Pouch

Skin Sagging

Midface Sagging

Lower Blepharoplasty

✅

✅

✅

❌

+Midface Lift

✅

✅

✅

✅

Midface lift improves nasolabial folds and repositions cheek fat upward.

⚠️ Since midface lift is performed through the lower bleph incision, dissection and fixation are more difficult. Patients must avoid excessive facial movement (e.g., yawning, laughing) in the early healing phase for optimal results.

Goals of Lower Eyelid Surgery

Lower blepharoplasty has four main goals:

  1. Tear trough correction
  2. Removal/repositioning of fat pads
  3. Skin tightening
  4. Improvement of midface sagging (if combined with midface lift)


Do Dark Circles Disappear After Surgery?

“Dark circles” isn’t a true medical term — it usually refers to the shadowy appearance under the eyes.



Causes:

  • Tear trough depression → shadow
  • Pigmentation from thin skin or visible veins

Surgery can correct the hollow but not completely erase pigmentation. Lasers may help with pigment, but they’re not always effective — especially for thin skin.



✅ Even if pigmentation remains, reducing the tear trough improves shadows and makes dark circles easier to cover with makeup. That’s why lower bleph is still recommended for dark circle concerns.

Anatomy of the Lower Eyelid

[Image Source: https://www.veiaesthetics.com/lower-eyelid-blepharoplasty]

The lower lid contains:

  • Superficial layer: skin + orbicularis oculi muscle
  • Deep layer: bulging orbital fat

As discussed in our sunken eye blog, upper and lower orbital fat share internal pressure. Removing fat too aggressively reduces orbital pressure, which can:

  • Cause recurrence of bulging
  • Lead to sunken eyes later
Mechanism of Sunken Eye Correction After Orbital Fat Repositioning and Septal Reinforcement
Maintaining proper intraorbital pressure during lower blepharoplasty is essential to prevent sunken eyes.

➡️ To prevent this: Use septal reinforcement techniques and avoid excessive fat excision.

Core Surgical Principles:

  1. Reinforce septum to preserve orbital pressure
  2. Fully release the tear trough ligament
  3. Fill the released area with repositioned fat to prevent re-adhesion and recurrence

What About Aegyo-sal (Undereye Roll)?

Many fear losing their “aegyo-sal” (youthful under-eye roll) after lower bleph. But with proper technique, aegyo-sal can be preserved or even enhanced.

OOM Suspension (Upward Fixation)

The key is orbicularis oculi muscle suspension (OOM suspension):

  • Lifting and securing the muscle to the lateral canthus during closure
  • Improves skin support and prevents complications like ectropion
  • Final skin trimming is done after muscle suspension
Proper suspension can make the under-eye roll look fuller post-op.


With precise lower blepharoplasty, the under-eye roll (aegyo-sal) can actually become more prominent.


Final Thoughts



Lower blepharoplasty may seem common, but it’s far from simple. It requires precise anatomical knowledge, advanced technique, and careful post-op planning.

I hope this post helps you make an informed decision and receive the right kind of lower eyelid surgery.

Thank you for reading.
— Dr. Yongwoo Kim


📣 Special offer on lower blepharoplasty now available at Returning Plastic Surgery!
Book your consultation today!


 #LowerBlepharoplasty #MidfaceLift #TearTroughCorrection #EyeBagSurgery  

#KoreanPlasticSurgery #OrbitalFatRepositioning #AegyoSal #DrReturning  

#UnderEyeRejuvenation #FacialRejuvenation


💬+82 10 4836 1122
https://returningps.com/




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