Lower blepharoplasty in Turkey

Lower blepharoplasty in Turkey: what it treats

Lower blepharoplasty is surgery on the lower eyelids to remove bags under the eyes, smooth the step between the lid and the cheek and, where needed, tighten loose skin. It is a different operation from upper-lid surgery: the lower lid has to stay supported against the eye, so the surgeon removes very little skin and works mainly on the fat behind it. For the full guide to eyelid surgery — all types, prices, the trip and how to choose a surgeon — see blepharoplasty in Turkey. This page covers only the lower lids.

Lower eyelid surgery in Turkey starts at €1,260 at the hospitals on this page, which show their own prices and the surgeons who perform it.

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What causes bags under the eyes?

Each lower lid holds three small pads of fat that cushion the eye. With age — and earlier in some families — the thin membrane holding them back (the orbital septum) weakens and the fat bulges forward, while the cheek beneath loses volume. The result is a bag with a groove under it, the tear trough, which casts a shadow and makes the face look tired even after sleep.

Not every dark circle is a bag. Pigmentation, thin skin showing the vessels underneath, fluid that comes and goes with salt, allergies or sleep, and festoons (swelling lower down on the cheek) do not respond well to surgery. A surgeon should tell you which of these you have before offering an operation; under-eye bag removal surgery helps only when the cause is fat that is actually bulging.

A simple test many surgeons use: look up while keeping your head level. If the bags become fuller, they are likely to be fat; if the puffiness is worse in the morning and better by evening, fluid plays a larger part. Photos taken from the front and at an angle in daylight help the surgeon judge this before you travel.

Who is a good candidate for lower eyelid surgery?

You may be suitable if bags under the eyes are visible in most photos and at all times of day, you are in good general health, do not smoke or can stop for several weeks, and have realistic expectations: the aim is a smoother, rested lower lid, not a different eye shape. Lower-lid fat bags are often inherited, so patients in their twenties and thirties are sometimes good candidates for the inside approach, while patients over fifty more often need some skin tightening as well.

The surgeon also checks how firm your lower lid is — gently pulling it away from the eye and watching how fast it snaps back. A lax lid is not a reason to refuse surgery, but it changes the plan, usually towards lid support and less skin removal. Tell the surgeon about dry eyes, thyroid eye disease, previous laser eye surgery, allergies that make the lids swell, and any blood thinners. If your main concern is a hollow groove rather than a bag, a filler or fat transfer may be the better first step.

Transconjunctival or skin approach?

Transconjunctival blepharoplasty goes in through the pink lining inside the lid, so nothing shows outside. The skin approach is used when there is real excess skin to remove. Some surgeons combine an inside approach for the fat with a tiny "skin pinch" just under the lashes.

Fat removal or fat repositioning

Older techniques simply removed the bulging fat. Removing too much can leave the eye hollow and the lid sunken a few years later, which is hard to correct. Many surgeons today prefer fat repositioning: the fat is released and moved down over the bony rim to fill the tear trough, so the bag and the groove are treated together. Others combine modest fat removal with fat transfer to the trough. Ask which approach your surgeon recommends for your lids and why.

When lower-lid surgery is combined with the upper lids, a brow lift or a facelift, the surgeon plans the lid and cheek together, because lifting the midface also changes how the lower lid sits. Combining saves a second trip, but swelling lasts longer and the stay is a few days longer.

Lower blepharoplasty or tear trough filler?

A hyaluronic acid filler in the tear trough can soften the groove when the bag is small. It does not remove bulging fat, and filler placed under a real bag can make the area look puffier. Filler lasts roughly 9–18 months under the eyes and can cause lumps or a bluish tint if placed too superficially. Surgery is a one-off operation with long-lasting results, but with more downtime and surgical risk. Botox under the eyes treats fine lines, not bags.

How much is lower blepharoplasty in Turkey?

At the hospitals on this page lower eyelid surgery starts at €1,260. The other figures are approximate private totals and vary between clinics.

The lower blepharoplasty cost rises with general anaesthesia, fat repositioning, lid support and combined upper-lid surgery; four-lid surgery is priced on the main eyelid page. Package contents (transfers, check-ups, stitch removal) and payment are the same as for other eyelid operations.

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The operation and your stay

Lower-lid surgery usually takes one to two hours, more often under general anaesthesia or deep sedation than upper-lid surgery. Most patients go back to the hotel the same day or after one night. Plan about 7 days in Turkey: stitches, if any, come out around day 5–7, and the surgeon checks lid position and eye closure before you fly. Transfers and appointments are arranged as described in how it works.

On the day, the surgeon marks the bags with you sitting upright, because fat pads look different lying down. With the inside approach the lining is often left to heal without stitches; with a skin incision fine stitches are placed under the lashes. You leave with cold packs, eye ointment and instructions to avoid bending, lifting and hot showers for the first days. A companion is useful for the first night, as the eyes may be too swollen for comfortable reading or walking around a new city.

Lower blepharoplasty recovery

• Days 1–3: swelling and bruising peak; the eyes may water or feel gritty. Cold compresses, ointment and sleeping with the head raised.
• Week 1: bruising often spreads down onto the cheeks before it fades. Short spells of reading and screens are fine.
• Weeks 2–3: most people are back at desk work and in public with light make-up.
• Weeks 4–6: exercise and swimming again.
• Months 3–6: lower-lid swelling settles more slowly than upper-lid swelling; the result is judged after about six months.

Some surgeons ask you to massage the lower lid upwards for a few weeks to help it stay in position. Tips for the flight home are in flying after surgery.

How long do results last? Fat that has been removed or repositioned does not bulge forward again in the same way, so the result of lower-lid surgery is usually long-lasting, often ten years or more. The skin and cheek continue to age, and some patients later choose filler or a small skin tightening, but a second full operation is uncommon.

Risks specific to lower-lid surgery

• Lower-lid malposition: the lid can sit lower and show white below the iris (scleral show), or in more severe cases turn outwards (ectropion). It is the main reason lower-lid surgery needs an experienced surgeon; the risk is higher with skin removal and an already lax lid, and lower with the inside approach and lid support. Mild cases often improve with massage; others need revision surgery.
• Hollowness after too much fat removal.
• Persistent swelling or chemosis (swelling of the eye's surface), usually temporary.
• Dry eyes, asymmetry or remaining bags, sometimes needing a small correction.
• Bleeding behind the eye — rare (a review in Ophthalmic Plastic and Reconstructive Surgery, 2004, estimated about 1 in 2,000 eyelid operations) but urgent: sudden severe pain, a hard eye or reduced vision need immediate help.

The NHS and BAAPS patient information on eyelid surgery lists the same risks.

Questions to ask your surgeon

Ask whether your bags are fat, fluid or skin; whether the inside or skin approach is planned and why; whether fat will be removed or repositioned; whether lid support is needed; and to see lower-lid before and after photos at least six months after surgery. Choosing a surgeon and hospital in general is covered on the main eyelid surgery page and in how to choose a safe surgeon in Turkey. Upper lids are covered in the upper eyelid surgery guide.

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Hospitals with Plastic & Aesthetic Surgery in Turkey

Academic Hospital

Üsküdar, Istanbul

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Lokman Hekim Istanbul Hospital

Pendik, Istanbul

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