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I think the rest of my face looks very good but my eyes are starting to look tired. What can be done to improve them?

Christina K. Newport Beach, CA

It would not be possible to specifically answer your question without seeing a photo of your eyes or seeing you in person, but we can discuss some generalities regarding eyelids and aging. As we age, skin loosens, wrinkles may appear, lash lines may sag, and bags may develop on the lower lids. Blepharoplasty or eyelid surgery is a surgical procedure designed to rejuvenate the eye area by removing or repositioning excess skin or fat and by reinforcing surrounding tendons. A droopy upper lid lash line may be elevated at the same sitting if necessary. Blepharoplasty procedures address both functional and cosmetic concerns. There procedures are generally divided into upper eyelid procedures and lower eyelid procedures – and some patients require attention at both sites and will be candidates for upper and lower eyelid surgery, or a “quad blepharoplasty”. These operations are designed to remove excess skin and bagginess, or to rearrange the fatty deposits, to give the eyes a more youthful appearance. It must be understood that most of the wrinkles around the eyes are etched into the skin and cannot be removed by a blepharoplasty procedure alone, without the addition of a skin wrinkle treatment like resurfacing with a chemical peel or lasers, or a Plasma Pen® type of procedure.

Lower lid bags are completely a congenital feature – one cannot get lower lid bags unless your mom or dad had the same issue! Lower eyelid fat is not under dietary control – if you gain or lose weight, the size of your lower lid bags do not change. These lower eyelid fatty deposits may become noticeable at an early age – we have had teenage patients who have requested removal of lower eyelid bags. In a younger patient, without a skin excess, lower lid bags are removed through a transconjunctival incision (inside the eyelid, leaving no external incisions). In older patients with a skin excess, an external incision is utilized, which allows us to remove the skin excess at the same time, and these incisions usually heal extremely well and are not visible after the wounds have healed.

The blepharoplasty procedure is designed to improve your appearance as much as possible at the present time. One must accept the judgment of your plastic surgeon and realize that she/he will remove or reposition as much of the excess or drooping tissue as he feels can be safely taken done in order to obtain the optimal result for each patient. Another important factor in youthful appearing eyes is brow position. Brows sag with age – sagging of the brows causes the upper eyelids to appear fuller. When removing excess upper eyelid skin, the distance from the eyebrows to the lash line does not change! Removing this extra skin will take the weight of the skin off the eyelashes, but a wide open upper eyelid space will not occur without raising the eyebrows.

If a patient presents with droopy brows, it may be impossible to obtain a significant improvement of upper eyelid appearance without first raising the brows. The blepharoplasty procedure by itself (without a brow lift) does not improve droopy eyebrows. In fact, removing excess upper eyelid skin in someone with low brows may cause the brows to drop even further. Generally speaking, female patients look better with eyebrows in an elevated, more youthful position, but care must be taken not to overdo a brow lift on a male because males, as a rule, do not have high eye brows, even in youth – raising brows aggressively in a male results in a Kenny Rogers type of look! Your surgeon may discuss a forehead lift with you if he feels that a significant portion of your problem is caused by a low brow position.

Please join us for our next complimentary virtual seminar on April 1st on YouTube. The topic will be eyelid rejuvenation. Please call our offices if you are not on our mailing list and would like an invitation to the seminar – those in our data bases will receive an invitation to the event on EventBrite.

Note that the excess upper eyelid skin has been removed but the distance from the eyelashes to brows has not changed – the only way to “open the eyes more” would be to add a brow lift to the procedure.

Note that the lower eyelid incision under the lashes is barely perceptible. The fatty excess has been removed but note that the surface wrinkles remain.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.

If you would like to contact Dr. Ekstrom or Dr. Bunkis,

For CA, please call 949-888-9700 or visit our websites at:

Or for MA location, call 508-755-4825 or visit

You can respond in the comment section below or write to me at or Dr. Ekstrom at

Thanks for staying in touch and for your feedback!

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