Lowering the Lower Eyelid Procedure

What is the Lowering the Lower Eyelid (LLL) procedure?

The Lowering the Lower Eyelid (LLL) procedure, also known as lower eyelid shortening, is a cosmetic surgical procedure designed to increase the vertical opening of the eyes and adjust the shape of the lower eyelid for a more open appearance.

This is an elective cosmetic procedure and is not medically necessary. It is performed to alter the appearance of the eyes rather than to treat a health condition.

Who might consider this procedure?

Some people choose to undergo this procedure to achieve larger, oval-shaped eyes. It may be considered in individuals with certain features, such as:

Up-slanting eye openings, including:

A positive canthal tilt of less than 2 mm
A steep upward slope of the outer third of the lower eyelid margin
A high-positioned lower lid margin partially covering the lower portion of the cornea

It is important to note that individual suitability for this surgery can only be determined following a comprehensive, face-to-face consultation with a qualified surgeon.

How is the procedure performed?

The LLL procedure may be performed using one of the following surgical techniques:

Trans-conjunctival static shortening of the lower eyelid retractors, or
Trans-conjunctival approach combined with sub-ciliary skin excision.

At Restore Cosmetic Surgery, Dr. Xu most often performs the procedure using the trans-conjunctival approach, which avoids visible skin incisions on the lower eyelid.

The procedure typically takes 1–2 hours.
It can be performed under local anaesthesia (LA) or local anaesthesia with sedation.

Dr Xu will discuss the most appropriate technique for you during your consultation.

Recovery and aftercare

Mild swelling, bruising, and discomfort are common after surgery.
Recovery time varies, but most people can return to light daily activities within 1–2 weeks.
Following post-operative instructions, such as avoiding strenuous activity, using prescribed medications, and attending follow-up appointments, is essential for proper healing.
Full results may take several weeks to months to become apparent.

Possible outcomes

For some patients, the LLL procedure may be effective in enhancing the vertical opening of the eyes as either a standalone treatment or in combination with other procedures, such as levator aponeurotic surgery.

However, it is important to understand that:

Results vary between individuals, depending on factors such as healing response, anatomy, and surgical technique.
No specific aesthetic outcome can be guaranteed.

Risks and potential complications

Like all surgical procedures, the LLL procedure carries certain risks, including but not limited to:

Conjunctival swelling and inflammation
Malposition of the lower eyelid, such as drooping or uneven positioning
Temporary double vision (diplopia)
Eyelid inversion (entropion), where the eyelid turns inward toward the eye
Asymmetry between the eyes
Under-correction or overcorrection, which may require revision surgery
Infection, bleeding, or delayed wound healing

Dr Xu will discuss these risks in detail during your consultation to help you make an informed decision.

Important considerations

This is a cosmetic and elective procedure, meaning it is undertaken for aesthetic reasons and is not required for medical health.
Under the Medical Board of Australia guidelines, there is a mandatory cooling-off period of at least 7 days before cosmetic surgery can proceed for adults.
Patients under the age of 18 must undergo a psychological assessment before being considered for cosmetic surgical procedures.
A face-to-face consultation is essential to discuss your goals, expectations, risks, and suitability.