As with other areas of the face and neck, the eyelids may exhibit wrinkles and bulges due to either hereditary factors or the aging process.


The eyes are the focal point of visual contact in our society and are often the first to show signs of looking tired or aging. Most patients who need facelift surgery should carefully examine their eyelids, since correction of sagging or baggy eyelids at the time of the facelift may add to the overall improvement in appearance. Pouches at the inner part of the upper eyelid and along the lower eyelid resulting in dark circles are generally due to accumulations of fat. The excess fat and skin are removed during the blepharoplasty procedure.


The upper eyelid surgery is usually done at the same time as the lower lid surgery. Each procedure can be done separately or in conjunction with a facelift or other surgery. Often, there is no need for an external decision on the lower eyelid to “take the bags” out. A technique called transconjunctival blepharoplasty can now be performed “from the inside” in order to achieve the desired result. This surgery is also completed under the “twilight” anesthesia I have described in the introductory sections of this booklet.

After Surgery

As a rule, the operation is associated with minor disability. Normally, patients are able to return to routine living within a few days with the aid of make-up and sunglasses. Within a few weeks, the thread-thin scars blend in so well with the surrounding skin that they become perceptible only upon very close scrutiny. A few months after surgery, I frequently recommend a chemical peel to further tighten the skin and improve the fine wrinkling. Occasionally, I will recommend a chemical peel at the same time that I am removing the bulges from the lower eyelids.

If I believe that your case is not a purely cosmetic one, I may recommend that you see an ophthalmologist or optometrist (eye specialists) who can document the deficit in the visual field which results from an extreme overhand of upper eyelid tissues and/or your sagging eyebrows. At this point, a portion of your surgery may be covered by insurance. This generally requires pre-authorization of insurance benefits. Medicare will not pre-authorize benefits.

Please advise me of any history of eye disease or visual problems, so these problems can be fully evaluated. Filling out the eye information sheet as thoroughly as possible is extremely important. I do recommend that you have a complete eye examination prior to your eyelid surgery, particularly if you have not had one in the preceding twelve months. Please request your physician to send a report to my office.

Often, excess skin hanging from the upper eyelid may be due, in part, to the sagging of the eyebrow itself. During our consultation, I may advise you to have an elevation or lift at the same time as the blepharoplasty procedure.


  • Past President of the American Academy of Facial Plastic and Reconstructive Surgery
  • 30+ Years of Experience
  • Facial Plastic Surgery Specialist
  • High Expertise
  • Individualized Care