Lower blepharoplasty is usually performed under local anesthesia in our office. Patients are awake and relaxed with eyes closed. Our facial plastic surgeon Anand D. Patel starts by making an incision just below the lash line. A strip of skin and muscle is removed just below the eyelid and any excessive lower eyelid fat is removed. The lower eyelid is then tightened to create a smooth contour from the lower eyelid to the cheek. The entire procedure takes about 1-3 hours.