Lower Eyelid Bulges

Patients often come into my office wondering what is going on with their lower eyelids. They notice bulges in the lower lids that were not there a few years ago. Often they will even notice the prominence of the bulge changes depending on the time of day, dietary  intake, and use of certain medication. I have even had patients approach me worried this was a bad tumor. While this could be a tumor, the majority of the lower lid bulges I see are from fat. Yes the bad word that most of hate to hear, fat.

Lower Eyelid Fat

The bulges of the lower eyelids is fat from around the eye pushing forward. The eye is naturally surrounded by fat, which is there to help cushion the eye. As we age the tissue that holds the fat back behind the lids gets weaker and the fat starts to move forward causing the bulges. The fat can swell and shrink some through out the day depending on the position of the body, the salt intake, and multiple other small factors. While the fat bulging is not dangerous to the eye, it is often seen as an unappealing appearance by patients.

Lower Eyelid Surgery

There are some over the counter and prescription medications to help the lower lid bulging, but their effect is usually very limited. The most effective treatment is to surgically remove the fat, a lower lid blepharoplasty. Unlike an upper lid blepharoplasty where skin is removed, the lower lid blepharoplasty removes mostly fat and little if any skin. The fat is removed by going through the back side of the eyelid so usually no scar is created on the skin. There fat is carefully removed by cutting and cauterizing it. Care must be taken to avoid a muscle that moves the eye, and to control bleeding so there is no damage to the optic nerve. Once adequate removal of fat is preformed the inner eyelid tissue, the conjunctiva, is closed with a few sutures and the patient is then sent home. I rarely remove skin because when the fat is removed more skin is needed to keep the lid in position then when there is a bugle.

After the surgery the patient is sent home to use ice packs on the lids and relax. Usually the lids are black and blue for about 2 weeks and then can have minimal swelling for a month or more.

The surgery can be done with the patient awake in a twilight sleep or under general anesthesia.

Who Pays for Lower Lid Surgery

Lower lid surgery is a cosmetic surgery which means it is not covered by insurance. I often combine the cosmetic surgery with another insurance covered procedure, like a lid tightening procedure or upper eyelid surgery. When this is done we can often do the lower lid procedure at a lower cost to the patient.

If you are interested in learning more about eyelid surgery upper or lower call Dr. Abrams at 941-921-5335 to schedule an appointment.


Jody Abrams, MD

Oculoplastics and Neuro-ophthalmology

Sarasota Retina Institute 

Sarasota Florida 

Jody Abrams, MD, FACS
Sarasota Retina Institute
Sarasota, Florida 34239