Sagging, bagging, or puffy skin on the eyelids or the lower eye area can often be corrected with a relatively simple procedure known as blepharoplasty. This surgical technique literally removes excess skin and fat, or tightens lax muscles to improve the appearance around the eyes. Statistically, it is the most popular surgical cosmetic corrective procedure performed (Source: www.facial-plastic-surgery.org). As successful as this procedure can be, it is important to realize that this type of surgery does have limitations. For the most part, blepharoplasty will only remove wrinkles that are physically cut away, it cannot change or impact "crow's feet," lift the eyebrow, or alter skin discolorations such as natural discoloration under the eye. Those concerns can potentially be corrected by chemical or laser resurfacing treatments in tandem with a forehead lift. Though blepharoplasty can be performed as a single procedure, physicians often recommend a combination of treatments to achieve the best, most dramatic results (Sources: Plastic and Reconstructive Surgery, April 2004, pages 1242-1250; Annals of Plastic Surgery, March 2004, pages 234-239; Archives of Facial Plastic Surgery, May-June 2004, pages 150-154; and Ophthalmic Plastic and Reconstructive Surgery, January 2004, pages 1-9).

Incisions for blepharoplasty follow the natural contour lines in both upper and lower lids, and if the goal of creating thin surgical scars is met, these incisions are barely visible and blend into the eyelids' natural lines and folds. How you scar depends on both the skill of the surgeon and your own genetic propensity for scarring. To eliminate some types of bagging under the eye, a technique called transconjunctival blepharoplasty is used. This removes excess fat by making the incision on the inside of the lower eyelid, leaving no visible scar.

A talented surgeon can avoid some of the typical risks or complications such as creating a scar above the fold of the upper eyelid, overpulling the skin, or removing too much of the fat pad areas which creates a sunken, drawn appearance. Other risks include decreased sensation in the eyelid area, dryness, burning, stinging, or gritty sensations in the eyes, asymmetrical appearance of the eyes, whiteheads where the sutures were placed, and difficulty closing the eyes (Sources: Plastic and Reconstructive Surgery, April 2004, pages 1459-1468; www.plasticsurgery.com; and Facial Plastic Surgery, March 1999, 173–229.)

While blepharoplasty can do away with drooping eyelids, some physicians may recommend performing only an endoscopic forehead lift as a less invasive alternative to lift the eye area and improve the appearance of the forehead. This can produce more desirable results, without risking complications around the eye area or causing potentially obvious scarring.