Lower Blepharoplasty + Midface Lift — Severe Under-Eye Hollowing

Before (top), after (bottom). Significant under-eye hollowing and dark circles driven by midface descent, not just lower-lid fat — skin-only or fat-only surgery would not have fixed this. A transcutaneous subciliary lower blepharoplasty was combined with an extended subperiosteal midface lift and buccal fat suspension to lift the descended cheek tissue back into position and smooth the lid-cheek junction.

This case needed structural lifting, not resurfacing. The subciliary (through-skin) approach gives direct access to release the midface at the subperiosteal plane — below the muscle, on the bone — so the cheek pad can be repositioned and suspended higher, re-draping the skin over it rather than pulling skin alone. Buccal fat suspension adds support to hold the lift. This combination is reserved for real midface descent, not routine under-eye bags — most lower-lid cases do not need it. Dr. Khaled Ghalwash, Alexandria.