Lower Eyelid Surgery (Lower Blepharoplasty)




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    Upper and lower eyelid blepharoplasty

    Upper and lower eyelid blepharoplasty


    This is a female patient in her 60’s who wanted to improve the tired look and puffiness in the upper and lower eyelids. We did an upper and lower blepharoplasty (eyelid surgery) to remove excess skin and bags and to tighten the eyelid muscles. We also restored the eyelid shape and brighteness with a lateral “scarless” brow lift and a eye corner lift, or canthopexy.

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    Lower Eyelid Surgery in Atlanta, GA with Dr. Miotto

    The eyes can show a great deal of emotion, which may be the reason that upon meeting someone new or carrying on a conversation people tend to focus on the other person’s eyes. Since the skin surrounding the eyes is extremely thin, it is also very delicate. For this reason, these areas are frequently the first places to show the signs of aging. Signs of aging can include loose skin, wrinkles, fat deposits and creases.

    At ME Plastic Surgery in Atlanta, Dr. Gabriele Miotto performs lower eyelid surgery (aka a lower blepharoplasty), to address the signs of aging in the skin beneath the eyes. If the signs of aging are apparent in the upper eyelids, patients can have an upper blepharoplasty (aka upper eyelid surgery) or a combination procedure in which Dr. Miotto performs eyelid surgery on the patient’s upper and lower eyelids during the same surgical session.

    Dr. Gabriele Miotto is an internationally recognized and highly experienced plastic surgeon who is dedicated to helping her patients attain the refreshed, more youthful appearance they desire.

    Which Issues Can Lower Eyelid Surgery in Atlanta Address?

    A lower blepharoplasty is the perfect solution for the signs of aging that frequently develop in the lower eyelid as well as in the area directly beneath the eye.

    During Lower eyelid surgery Dr. Miotto can address:

    • lower eyelids that droop.
    • fatty deposits that make the lower eyelids appear puffy.
    • circles beneath the eyes.
    • fine wrinkles.
    • any excess skin that is affecting the appearance of the lower eyelid.

    Entropion Repair

    Entropion is the term used to refer to a condition in which the lower eyelid turns inward. Entropion can develop as part of the aging process and due to inner scarring of the lower eyelid resulting from repeated infections. Most people who need entropion repair are 60 years of age or older.

    Once the lower eyelid turns inward towards the eye, the skin and eyelashes usually begin to rub up against the patient’s eye. Besides causing pain, this rubbing can cause extreme irritation, resulting in a reddened eye. Additionally, this constant irritation can make the eye water. If left untreated, the cornea may become infected. Should a corneal infection result, the individual’s eyesight could be permanently affected because the cornea accounts for about 2/3 of the eye’s total optical power.

    Ectropion Repair

    If the lower eyelid droops and then turns outward, the individual has a condition referred to as ectropion. This condition can be caused by a skin disease, age, trauma, an eyelid burn or a tumor. Ectropion can cause the eyes to become dry or watery. In addition, people with ectropion may have eyes that are sensitive to wind and to light.

    With lower eyelid surgery in Atlanta, Dr. Miotto can return the patient’s eyelid to the correct position, helping to reduce the painful, irritating issues associated with these conditions. Furthermore, once the procedure is complete, the eyelid can provide protection for the patient’s eye.

    Who Should Consider Lower Eyelid Surgery in Atlanta?

    Individuals who may want to consider having a lower blepharoplasty are those with sagging, loose skin or puffiness beneath their eyes. With a lower blepharoplasty, these unwanted effects are addressed, leaving the patient with eyes that appear more youthful.

    The best candidate for lower eyelid surgery is an individual who:

    • is a nonsmoker or is willing to stop smoking for at least 4 weeks before and 4 weeks after their procedure.
    • does not have any serious eye condition.
    • is healthy without any medical conditions that impair healing.
    • has realistic goals.
    • is in good general health.
    • has a positive outlook.
    • has facial muscles and tissue that are healthy.

    Although a lower blepharoplasty can enhance an individual’s appearance, patients must realize its limitations. A lower blepharoplasty concentrates on the lower eyelid area; therefore, it is unable to change the entire appearance or structure of the face.

    What If a Patient Needs Upper and Lower Eyelid Surgery in Atlanta?

    If aging skin has resulted in sagging upper eyelids and bags beneath the eyes, a combination upper and lower blepharoplasty can address the issues causing these problems to provide the patient with rejuvenated, refreshed and more youthful-looking eyes. At ME Plastic Surgery in Atlanta, while performing upper eyelid surgery Dr. Miotto removes the excess skin that is weighing down the upper lid and causing it to sag. With lower eyelid surgery, she can address the bags beneath the eyes as well as any lower eyelid irregularities (e.g., ectropion or entropion).

    After a combination blepharoplasty procedure, the puffiness, fine lines and sagging eyelids are no longer present. The patient has a more youthful, rejuvenated appearance. Furthermore, after upper eyelid surgery patients whose upper eyelids were low enough to negatively affect their vision now have eyelids that open all the way; thus, improving the patient’s field of vision.

    What Causes the Changes in the Eyelids and Skin Around the Eyes?


    An individual may inherit traits that increase his or her likelihood of developing excess skin and fat deposits in the eyelids.


    Eyelid skin is extremely thin and, as time passes, it stretches. When upper eyelid skin stretches too much, the individual’s upper eyelid may begin to sag. When the skin on the lower eyelid stretches, the individual may develop bags beneath the eyes.

    Weakened Eyelid Muscles in the Upper Eyelid

    The upper eyelid may fall because the muscles holding it up have weakened. During an upper blepharoplasty, Dr. Gabriele Miotto can address the weak muscles, eliminating the reason for the falling eyelids.

    An Initial Consultation for Lower Eyelid Surgery in Atlanta

    The first step towards more youthful-looking eyes is scheduling an initial consultation for a lower blepharoplasty with Dr. Miotto at ME Plastic Surgery. During this consultation, individuals need to be prepared to talk about their medical history, current medication, vitamin and herbal supplement use, as well as any chronic medical conditions (e.g., diabetes, hypertension, glaucoma, etc.) they have. Patients who have allergies to certain medications or to latex products should provide details about these allergies during their initial consultation.

    Dr. Gabriele Miotto also asks the patient what he or she would like to accomplish with a lower blepharoplasty. Patients are always encouraged to be candid with their surgeon because this is the only way that Dr. Miotto can work towards providing a patient with his or her desired result.

    After reviewing the patient’s medical information, answering the patient’s questions and finding out what the patient’s motivation for lower eyelid surgery is, Dr. Gabriele Miotto examines the patient’s eyes.

    The Eye Examination at ME Plastic Surgery for a Lower Blepharoplasty

    The surgeon needs to determine what is causing the patient to experience the issues that lower eyelid surgery addresses; therefore, patients should expect their eyes to be examined. This examination may include measurements and checking tear production.

    Procedure Recommendations

    Once the examination is complete, Dr. Miotto will recommend the treatments and procedures that she believes will provide the patient with the results that he or she desires.

    If the patient is interested in any of the procedures or treatments recommended by Dr. Miotto, she will answer any questions the patient has and provide information about these services. Should the patient decide to move forward with any of the recommended procedures, Dr. Gabriele Miotto may begin preparing for these additional procedures. This preparation may include taking more measurements and photographs of the areas the patient is having addressed. Dr. Miotto uses this information as she creates the patient’s custom-designed surgical treatment plan.

    Can Any Other Procedures Be Performed During a Lower Blepharoplasty?

    Yes, there are other procedures that Dr. Gabriele Miotto can perform at the same time she performs the patient’s lower eyelid surgery or combination upper and lower blepharoplasty.

    These other procedures include:

    • A lateral or endoscopic brow lift.
    • Autologous fat grafting to fill in hollowing under the eyes and other areas of the face that appear to be sunken in. Once the fat is harvested, the strong fat cells are removed and strategically injected into these hollowed areas.
    • Skin resurfacing with a chemical peel or a laser treatment.
    • A facelift.
    • A neck lift.

    Preparing for Lower Eyelid Surgery in Atlanta

    Prior to surgery, there are a few things that Dr. Miotto asks her patients to do:

    • It is vital that patients who smoke cigarettes or use any other product that contains nicotine (e.g., chewing tobacco, nicotine gum, etc.) discontinue using these items or smoking at least 4 weeks before surgery and 4 weeks after. Continuing to use products that contain nicotine can lead to complications during the healing process because nicotine causes the blood vessels to narrow which negatively affects the body’s ability to heal itself. Slowed healing can result in the development of an infection, open wounds and even skin necrosis (i.e., death of the skin tissue). Furthermore, smoking cigarettes hasten the development of the wrinkles and lines in the face that are associated with aging.
    • 10 days before surgery patients need to stop taking Vitamin E.
    • 7 to 10 days before surgery patients should stop taking medications that are known to increase bleeding, including blood thinners (e.g., Warfarin, etc.) and aspirin. Patients who are taking prescription medication or aspirin because it has been recommended by their physician must receive approval from their prescribing physician or Dr. Gabriele Miotto before discontinuing these medications.
    • Since alcohol is known to increase inflammation, patients must avoid consuming alcohol for at least 7 days before their lower eyelid surgery in Atlanta.
    • 5 days before surgery patients must not take naproxen sodium (e.g., Aleve, etc.) and ibuprofen (e.g., Motrin IB, Advil, etc.).
    • Patients who need to take medication for pain within the 5-day timeframe leading up to surgery can safely take acetaminophen (i.e., Tylenol).
    • If applicable, be sure to have any preliminary testing done no later than a week before surgery (e.g., blood work, etc.).
    • Since a lower blepharoplasty is an outpatient procedure, patients need to ask someone to drive them to and from surgery. In addition, Dr. Gabriele Miotto requires that an adult remain with her eyelid surgery patients for at least 24 hours following surgery.

    10 days before their surgery, patients need to refrain from taking the herbal supplements listed below:

    • Valerian.
    • St. John’s Wort.
    • Saw Palmetto.
    • Licorice.
    • Kava-Kava.
    • Goldenseal.
    • Ginkgo Biloba.
    • Garlic.
    • Fish Oils.
    • Feverfew.
    • Ephedra/Phentermine (weight-loss drug).
    • Echinacea.

    Before their lower eyelid surgery in Atlanta, Dr. Gabriele Miotto requests that her patients take:

    • About 14 days before a laser treatment or a chemical peel Dr. Gabriele Miotto instructs her patients to begin using two products, tretinoin and hydroquinone. These products help the face heal quicker after chemical peels and laser treatments. Both hydroquinone and tretinoin are available at our Spa.

    On the Day of Lower Eyelid Surgery in Atlanta: What Patients Can Expect

    Dr. Miotto has a couple different lower eyelid surgery methods to choose from, the transconjunctival method or the lash-line method. While creating the patient’s personalized surgical treatment plan, Dr. Gabriele Miotto determines which of these lower blepharoplasty methods will serve the patient better.

    Safety is Our Main Concern

    ME Plastic Surgery’s main concern is always patient safety, which is why we do not permit our patients to use any of the for-hire driving services (e.g., a taxi, an Uber, etc.) that are available following procedures requiring sedation. Therefore, on the day of their procedure, patients must arrive at least 15 minutes before their scheduled procedure with a licensed driver. The licensed driver must be present with the patient when he or she arrives, otherwise, the procedure will need to be rescheduled until such a time when the patient can bring a licensed driver to the surgery center.


    As the patient prepares for surgery in the pre-op area, Dr. Gabriele Miotto will visit the patient. She will create several markings around the patient’s eyes, which she uses as a guide while performing the lower eyelid surgery in Atlanta. Dr. Miotto wants her patients to feel as comfortable as possible before their procedure, which is why she encourages her patients to ask any last-minute questions they have at this time.

    Anesthesia Options for a Lower Blepharoplasty in Atlanta

    Anesthesia options include IV sedation or local anesthesia with oral sedation.

    Lower Eyelid Surgery in Atlanta: Surgical Techniques

    The procedure Dr. Miotto chooses depends on the issues she is addressing for the patient.

    The Lash-Line Incision Lower Blepharoplasty Method

    1. This technique involves the creation of an incision along the patient’s eyelash margin. Through this incision, Dr. Gabriele Miotto removes excess fat and any extra skin that is causing the eyelid to droop.
    2. She closes the lash-line incision using very fine sutures.
    3. Although she creates the lash-line incision outside the eye its visibility fades quickly.

    After a lower blepharoplasty using a lash-line incision is complete, the patient enjoys a smoother transition from his or her lower eyelids to the cheeks.

    The Transconjunctival Lower Eyelid Surgery Method

    1. This eyelid surgery method involves the creation of an incision inside the lower eyelid. Using this incision, Dr. Gabriele Miotto removes the excess fat that is present in the lower eyelid.
    2. Since the incision used during this procedure is created inside the lower eyelid, sutures are not required.

    Lower Eyelid Surgery in Atlanta and a Canthopexy

    A canthopexy is a procedure that can be performed during the same surgical session as the lower blepharoplasty.

    The canthopexy procedure addresses the outer corner of the eye and is designed to provide the lower eyelid with additional support to prevent it from drooping.

    After this combination procedure, very fine sutures are placed. These sutures are visible, but they will be removed within a week’s time.

    A Sinking-In or Hollowing Beneath the Eyes Can Be Addressed with Autologous Fat

    If the area beneath the eyes appears sunken-in or hollow, Dr. Gabriele Miotto can harvest the patient’s own fat to use as a filler. After she fills these areas, the patient’s eyes will look more youthful.

    Autologous Fat Grafting

    During this procedure, Dr. Miotto harvests fat from an area of the body where excess fat has accumulated. Common areas used for fat harvesting include the hips, abdomen and thighs.

    The fat being used for injection is harvested via liposuction.

    After harvesting the fat, Dr. Gabriele Miotto prepares it for injection. During this preparation process, the stronger fat cells are separated from the weaker ones. Dr. Miotto uses the stronger cells for injection.

    She strategically injects the fat cells into the hollowed areas to provide the patient with even, natural-looking volume.

    It is likely that some of the injected cells will die, however, many of the fat cells will survive. The cells that survive remain within the areas where Dr. Gabriele Miotto injected them, indefinitely.

    What Patients Can Expect Directly Following Lower Eyelid Surgery in Atlanta

    Directly following surgery, the patient’s eyes need to remain moist. For this reason, while in recovery, the patient’s eyes will have lubricating ointment in them. In addition, the patient’s eyes are covered with cold compresses. These compresses help reduce inflammation, which decreases bruising.

    The patient remains in the recovery room being monitored for some time. Once the patient is awake and Dr. Miotto is happy with how well the patient is progressing, he or she is released to the driver that arrived with the patient. Before the patient leaves, ME Plastic Surgery’s Patient Care Coordinator schedules his or her first post-surgical appointment. This appointment is scheduled for the following day and patients are not permitted to drive for a full 24 hours after their eyelid surgery; therefore, patients will need a driver for this follow-up appointment.

    Recovery After Lower Eyelid Surgery in Atlanta

    Dry eyes following eyelid surgery are common. This side effect typically lasts approximately 2 weeks. Should this continue past the 2-week mark, patients need to contact the office at (404) 850-5851 to discuss this issue with our team.

    Patients taking narcotic pain medication after their blepharoplasty must have transportation until they have completed taking this type of medication.

    Sluggishness is expected and usually lasts for a few days after a lower blepharoplasty.

    Bruising and swelling are common. These side effects generally resolve within two-week’s time.

    Temporary side effects following a lower blepharoplasty in Atlanta can include:

    • Watery eyes.
    • Double vision.
    • Sensitivity to light.
    • Dry eyes.
    • Blurry vision.
    • Numb, puffy-looking eyelids.
    • Discomfort or pain.
    • Bruising and inflammation (similar to a black eye).

    Generally, these side-effects subside within 10 to 14 days. Nonetheless, visible incisions can take several months to fade. As any incision heals, avoiding sun exposure is imperative to ensure that the incision does not darken and fades well.

    Restrictions and Self-Care Following Lower Eyelid Surgery in Atlanta


    If stitches were placed, Dr. Miotto removes them within 7 days of surgery.

    Patients must avoid any type of strenuous activity (including intercourse) for the initial 2 weeks after surgery.

    It can take from 6 to 8 weeks to fully recover from lower eyelid surgery in Atlanta.

    Caring for the eyes after lower eyelid surgery:

    Ice packs help reduce inflammation and should be used for the initial 48 hours after eyelid surgery. Use ice packs wrapped in a towel on the eyes in 10-minute intervals every hour on the night of surgery. The next day, use the ice packs wrapped in towels in 10-minute intervals every six hours.

    Use the prescribed ointments or eye drops to gently clean the eyelids. If the patient received lubricating eye drops, these drops may be used for up to two weeks.

    Wear dark sunglasses.

    It is important for the patient to elevate his or her head with two or three pillows while sleeping.

    Patients need to avoid:

    • Smoking, using products that contain nicotine or being around second-hand smoke.
    • Heavy lifting, straining and swimming for at least a week.
    • Rubbing their eyes.
    • Wearing contacts for at least 14 days.
    • Using medications like aspirin, naproxen and ibuprofen for approximately a week. Unless the patient is taking a prescribed pain medication, acetaminophen (Tylenol) can be used to control pain.

    When to Seek Medical Attention

    The patient needs to seek medical attention right away if he or she is experiencing:

    • Chest pain.
    • • Bleeding.
    • Vision problems.
    • Shortness of breath.
    • The development of new eye pain that is severe.
    • An irregular heart rate.

    Lower Blepharoplasty Results

    The results from lower eyelid surgery in Atlanta can continue to improve for 6 months.

    After lower eyelid surgery, Dr. Gabriele Miotto’s patients have eyes that appear more youthful and refreshed. The results achieved during a lower blepharoplasty can last 10 years, sometimes longer.

    Potential Lower Blepharoplasty Complications

    Every complication is troubling, however, there are some complications that are considered more concerning than others. Knowing the potential risks and complications before any procedure is important.

    Possible complications following a lower blepharoplasty include:

    • Excess bleeding.
    • Infection.
    • Dry eyes.
    • Visible scarring.


    More serious potential complications following blepharoplasty procedures are rare, however, they must also be acknowledged:

    • The patient is unable to fully close his or her eyes.
    • Changes in the skin color of the eyelid.
    • Inconsistencies in the skin of the eyelid (e.g., it folds out or folds in).
    • A lower lid that is pulled down.
    • Loss of vision.
    • The need for a follow-up procedure/surgery.
    • The general risks associated with any surgical procedure.

    If a patient experiences a complication listed above, he or she needs to contact the surgeon’s office right away.

    How Much Does It Cost to Have Lower Eyelid Surgery in Atlanta?

    Everyone is unique and since all surgical plans at ME Plastic Surgery are designed to meet the needs of a particular patient, the only way to determine how much an individual’s surgery costs is with an initial consultation.

    Be Sure to Choose an Experienced Plastic Surgeon

    If you are thinking about having a lower blepharoplasty, or any other procedure, make sure to choose a plastic surgeon who has experience performing the procedure or procedures you are considering.

    Choosing an experienced plastic surgeon like Dr. Gabriele Miotto greatly reduces the likelihood of a complication following a cosmetic treatment or plastic surgery procedure in Atlanta.

    Dr. Gabriele Miotto performs upper and lower eyelid surgery for people who reside in, or around Atlanta. She is an internationally recognized plastic surgeon who has more than two decades of experience performing cosmetic treatments and plastic surgery procedures. Dr. Miotto enjoys helping her patients with achieving their aesthetic goals.

    If you are considering plastic surgery or a cosmetic treatment and you reside in or are visiting the Atlanta area, schedule an appointment with Dr. Gabriele Miotto at ME Plastic Surgery today. Call (404) 850-5851 to make your appointment. ME Plastic Surgery is located at 3200 Downwood Circle, Northwest, Suite 640 in Atlanta.



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