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In my practice, about half of my patients who do the upper eyelids do the lower lids so that there's good balance and harmony between the two areas. So removing the tissue from the upper lids often brightens the lid and brightens the eye itself. Removing the bag or smoothing the lower lid really compliments that. Some people made an analogy to a car. You want to wash the top and the bottom of a car, it's a pretty good analogy. You want to make things look harmonious like they balance together and certainly the periorbital complex or the upper and lower lids should look like they match and belong together. So when we do the upper lids, the lower lids are often partnered with that. It takes about 20 minutes to do an average lower lid tuck. The upper and lower lids take a little over half an hour. Healing time is really about 2 weeks and I really love the results.

How are the lower lids repaired? The beauty of the lower lids is often there's no skin incision. I make little incision inside the conjunctiva of the lid so the incision is hidden inside the lid without having any sutures on the skin of the lid. So, as it has been said before in surgery, there's no incision... like no incision. So the incision is made inside the lid that is hidden or invisible. I then recontour the fat, remove some redundant fat which is the bag, which becomes more prevalent with age and sometimes I'll even add fat back to areas if need to, so sort of level out the creases and the valleys and recontour the lid. The lower lids then will be draped and because the skin often has damage on it, I will then paint a light laser on the skin to tighten the skin. That is a beautiful job of tightening collagen and connective tissue reducing fine lines and wrinkles and really rejuvenating that whole periorbital area.

Why Upper and Lower Eyelid Surgery Is "Like Washing a Car"

If you're in the neighborhood, might as well treat the lower lids, too, says Dr. John Fezza.