"Traditionally, eyelid surgery removes excess skin and/or fat around your eyes. Except in rare circumstance, I believe this approach is misguided."
"While it may smooth the skin around your eyes, it does NOT make you look younger."
Youthful, attractive upper eyes are smooth, with a slight fullness just below your brow. The lower lids are smooth, possibly with a small ridge (of important muscle) just below your lower eyelashes.
As you get older, your eyelid skin looses elasticity similar to an aging rubber band. Contrary to popular belief, bags that develop around your eyes are not excess fat. Instead of developing new fat, you have lost volume (fat) around your eyes. Your “bag” of fat actually works as padding, protecting your eye during blunt trauma.
The restoration of your eyes will address three concerns: volume, texture, and/or skin excess. In general, upper eyelid treatment is more direct. Lower eyelid treatment is often part of an overall facial rejuvenation.
Skin excess: In my experience, removing lower eyelid skin is almost never required. In fact, removing skin from your lower eyelid is likely to change the shape of your eye.
I have found that tucking rather than removing upper eyelid skin helps to both eliminate excess skin, as well as replacing lost eye volume. With your eyes closed, your redundant skin is marked. The surface of your skin excess is vaporized, and then tucked beneath the incision.
Texture: Just as a rubber band looses its elasticity over time, your skin becomes loose over time. If you have little skin excess, or if your eyelid skin is “crêpe,” resurfacing rejuvenates your skin.
Resurfacing tightens your eyelid skin by creating a highly controlled burn. As the injury heals, your skin becomes smoother. Although you will experience some redness, this can be camouflaged by make-up.
Volume: (See Volume Restoration) Commonly, restoring volume is used for lower eyelid treatment. Lower eye area volume has a major impact on your overall appearance. Fat grafting is the most common technique for adding volume.
Fat grafting uses your own tissue. Collected using a form of liposuction, your fat is processed, and then injected using small, blunt probes through small puncture incisions in your cheek.
Fat grafts are permanent, though it takes a full year to know your final result. In general, you would expect fat grafts to be more effective in a person who is not excessively overweight.