What lower blepharoplasty involves, and why people choose it

Lower blepharoplasty, the medical name for surgery on the lower eyelids, is a cosmetic procedure on the skin, muscle and fat beneath the eyes, usually by a consultant plastic surgeon. Most people choose it for cosmetic reasons: to reduce under-eye bags, smooth sagging skin and restore a more youthful appearance. It differs from upper eyelid surgery, or upper blepharoplasty, which lifts drooping eyelids and hooded skin on the upper eyelids; that operation reshapes the upper eyelids, while this one focuses on the lower eyelids.

According to the NHS, the surgeon makes an incision just below the lash line or inside the lower lid. They then carry out the removal of excess fat from the eye socket, sometimes take a small amount of skin, and support the muscle and tendon of the eyelids. An incision inside the lid leaves no external scar.

In the UK, blepharoplasty surgery typically costs £2,000 to £6,000, and most patients pay privately. Eyelid surgery rose 13% in 2024 to become the third most common cosmetic surgery in the country, according to the BAAPS audit.

What is lower eyelid retraction?

Lower eyelid retraction is a condition in which the lower eyelid is pulled downward or away from the eye, disrupting its normal position. Rather than sitting snugly against the eyeball, the eyelid drops below the lower edge of the iris, exposing an area of the white part of the eye known as the sclera - a visible sign referred to as scleral show.

In a healthy eye, the lower lid should rest at or just below the coloured part of the eye. When eyelid retraction pulls the lid away from this natural position, the change in eye shape can be noticeable and distressing. Beyond the cosmetic impact, the altered position of the lower lid can affect the eye's ability to close fully, which in turn leads to functional problems including dry eyes, excessive tearing, blurred vision, and in more serious cases, corneal irritation and exposure keratitis.

Eyelid retraction varies in severity. For some, it is a mild cosmetic change. For others, the degree of retraction is significant enough to affect vision, daily comfort, and quality of life.

The risks and complications of lower blepharoplasty

As with any cosmetic procedure, this surgical procedure carries risk. Many outcomes of the surgery are recognised complications, not signs of a negligent blepharoplasty. If you think something has gone wrong with your eyelids, notify your treating surgeon or clinic first.

Normal recovery: what to expect

The common side effects below are expected and usually settle within several weeks as your eyelids heal:

• Swelling and bruising around both eyelids
• General discomfort or tightness
• Dry, gritty or itchy eyes
• Watery eyes
• Temporary blurred vision

The NHS lists these as ordinary after-effects of the procedure.

Red flags that need attention

Other complications are more serious and may suggest care has fallen below standard, especially where the surgeon removed too much skin from the lower eyelids and weakened the muscle that holds the lid in place. Look out for:

• Ectropion, where the lower lid pulls down and turns outward
• Lower lid retraction, or visible white below the iris
• Difficulty closing the eye fully
• Marked asymmetry, or asymmetrical looking eyes
• Vision problems that persist, including impaired vision

One 2025 systematic review reported ectropion after lower blepharoplasty at rates from 0% to 11.3%, and lid retraction in around 15% of patients, with excess skin excision and lid laxity as key risk factors In short,.If your lower lid feels loose or turns outward, this is a recognised risk that happens to a meaningful minority of patients - it doesn't automatically mean negligence, but it's worth having checked.

When to seek medical attention

Some symptoms need prompt clinical review, not reassurance. Contact your treating clinic urgently, or call NHS 111, if you notice:

• An eye that will not close, which risks corneal exposure
• Sudden loss of vision, or vision that quickly worsens
• Severe or increasing pain
• Signs of infection, such as spreading redness or discharge

Acting quickly protects your health. It also protects any future position, because symptoms reported early are recorded in your medical records, which can later become evidence. Keep dated photographs of your eyelids, and note any additional treatment advised. If pain or other complications continue after your procedure, ask your medical team to see you again.

When to seek legal advice about lower eyelid surgery negligence

Not every poor result after lower eyelid surgery is negligent, as all surgery carries recognised risks. However, surgeons must meet their duty of care before, during and after treatment.

They are expected to:

• Before surgery: assess your suitability, explain the material risks, realistic outcomes and reasonable alternatives, and obtain informed consent.
• During surgery: use an appropriate technique, maintain proper hygiene and operate to the expected professional standard.
• After surgery: provide clear aftercare, monitor your recovery and act promptly if complications develop.

Following Montgomery v Lanarkshire Health Board [2015], a surgeon must make sure you understand any material risks that could affect your decision to proceed. For lower eyelid surgery, these may include ectropion, dry eye, visible scarring or the need for revision surgery. A signed consent form alone does not prove informed consent if these risks were not properly explained.

The standard of surgical care is assessed using legal principles established by the Bolam and Bolitho tests. In broad terms, a surgeon may not be negligent if their approach is supported by a responsible body of medical opinion and that opinion is logical. However, removing more skin or tissue than the eyelid can safely tolerate may indicate that the surgery fell below the expected standard.

To make a medical negligence claim, it must usually be shown that:

• Your care fell below the expected standard, known as a breach of duty.
• That breach directly caused your injury, known as causation.

Most claims must be started within three years under the Limitation Act 1980. This period may run from the date you knew, or should reasonably have known, that your treatment may have caused your injury rather than the date of surgery itself.

A specialist solicitor can review your medical records, photographs and treatment history to assess whether you may be entitled to compensation. Many lower eyelid surgery claims are resolved through negotiation without the need for a court hearing.

For example, our client Sandra received £35,000 following a claim involving facelift, eyelid and breast surgery, including a failure to obtain proper consent and disfiguring eyelid scarring.

For a sense of what your compensation claim may be worth, see our eyelid surgery compensation page, which explains general and special damages. You can also read about lower eyelid retraction after blepharoplasty and how a negligent blepharoplasty can lead to claiming compensation.