The eyes play an essential role in your facial aesthetics. Over time, changes occur to the bone, skin, muscles, and connective tissues. The bone of the eye socket recedes, and the soft tissues lose elasticity. As a result, you can experience sagging in your upper lids, bags under your eyes, and drooping eyebrows, making you look older and more tired than you feel.

But these problems are not reserved for the old. While more commonly an age-related problem, young people, for genetic reasons can have eyelid concerns. More commonly, tear-troughs are a genetic issue. Young people can have bags and dark circles because of the genetic shape of their bone. Less commonly, young people can have extremely full upper eyelids. Often times, full upper eyelids on a young person don’t need any treatment until the skin loses elasticity with age, but personal preference for a less full upper eyelid is a consideration for some people.

Dr. Apo in Austin, TX, offers surgery to restore facial harmony and youthfulness to the eyes. The official name for surgery on the eyelids (either upper or lower) is blepharoplasty. Lower blepharoplasty may include the use of tear trough implants. Blepharoplasty procedures can correct tired, puffy-looking eyes. However, each approaches the restoration differently.


Blepharoplasty, or eyelid surgery, removes excess skin from the eyelids. While excess skin around the eyes can affect your facial aesthetics, it can also interfere with your vision, especially your peripheral vision in the upper and outer areas of your visual field.

Upper eyelid blepharoplasty typically involves removal of redundant skin. Lower blepharoplasty generally does not include removal of skin but rather re-shaping of the tissues. Excess skin is usually not an issue in the lower eyelid and “pulling tight” a lower eyelid to smooth things would in fact not pull the skin tight but rather pull your eyelid down, a serious complication. Therefore, it is generally preferred to not remove skin from the lower lids.


Patients who seek blepharoplasty are generally middle-aged or older. Upper eyelid surgery is well tolerated and can be performed even on people with other complicating health factors. Lower eyelid surgery is generally reserved for people who otherwise are in descent health. The best candidates for eyelid surgery have some of the following concerns:

  • Sagging skin that causes drooping in the upper eyelid
  • Puffiness from puffy fat deposits in the upper eyelid
  • Bags under the eyes or lower eyelid drooping
  • Excess skin that partially blocks peripheral vision

All patients undergoing this procedure should have realistic expectations and goals for the outcome.


Upper blepharoplasty surgeries take about 30 minutes. It’s an outpatient procedure, and patients can choose whether they prefer local or general anesthesia. Lower eyelid surgery takes a bit longer depending on the exact nature of your surgery.

During upper blepharoplasty surgery, we make an incision using a radiofrequency (RF) cutting device to create a shallow cut through the eyelid. The RF device seals the microscopic vessels to reduce bruising and bleeding. We place the incisions in the eyelids’ natural folds to minimize the visibility of the incision during healing.

After placing the incision, we remove excess skin that causes drooping or heaviness in the eyelids. Fat and muscle in the upper eyelid are addressed per that patient’s needs, generally it is best to preserve fat and muscle so as to avoid a hallow eyelid, however in some individuals this is not a risk. The results reveal naturally more alert and youthful-looking eyes.

We can simultaneously perform blepharoplasty and other procedures, such as a brow lift, facelift, or skin resurfacing, for patients seeking a more complete transformation.


Typically, patients experience little discomfort during their eyelid surgery recovery. You can return home on the day of surgery. The day after your procedure, you can resume mostly sedentary activities such as driving or working a desk job.

You can begin resuming exercise a week after your blepharoplasty and restore your full activity level within two to three weeks. In addition, postsurgical swelling fades in the two weeks following the procedure. Upper eyelid surgery will have less restrictions than lower eyelid surgery.

After blepharoplasty, patients report increased self-confidence, a more alert and youthful expression, and an overall improvement in their facial aesthetics.


Tear trough implants correct shape problems of the lower eyelids, targeting the space that forms a groove between the eyes and the cheek. This groove is referred to as a tear-trough. An ideal lower eyelid blends seamlessly into the cheek. The tear-trough groove causes an unsightly dark circle under the eye that no amount of makeup can fix.

Formerly, surgery to correct the bags and shadow that it casts involved removal of the lower eyelid fat. While being a successful way to get rid of the bag, the lower eyelid afterwards appears long, drawn, and hollow.

Tear trough implants take the opposite approach to improve the shape under the eye. Instead of reducing the bags, the procedure adds volume to smooth the space between the lower eyelid and upper cheek. In addition, the fat is repositioned, blending it into the cheek.


The best candidates for tear trough implants are in good enough health to tolerate being sedated. Patients with dark circles under their eyes, large fat pockets in their lower eyelids, or a hollow, sunken appearance between their eyes and cheeks see the most benefits from the procedure.


Tear trough implants are an outpatient procedure performed in our accredited surgery center attached to our main office. We place the implants through the eyelid’s underside; there is no visible scarring and no extended recovery time. Patients often combine tear trough implants with upper eyelid surgery or a facelift.


Most patients experience mild discomfort in the upper cheeks after undergoing a tear trough implant procedure. They will also experience some bruising and swelling, which subsides in about two weeks.

During the first two weeks following your implant placement, you can engage in everyday activities but should avoid strenuous exercise. Tear trough implants are reversible in rare cases where patients are unhappy with their results.

Patients who receive tear trough implants report a high satisfaction rate and enjoy long-term results that align well with their natural bone structure. The implants are expected to last the rest of your life without need for maintenance. The implants are made of silastic, a hard, rubber-like material. Silastic is a common material used in humans for more than 50 years. In addition to facial implants, the bag of a breast implant is often made of silastic (regardless of what material is inside the implant) as is the insulation on any electric implant such as a pacemaker.


First impressions start with your eyes. When time causes your eyes to become droopy, asymmetrical, or hollow, you may naturally appear tired, angry, and grumpy. Eye restoration procedures like blepharoplasty or tear trough implants can restore your open, friendly appearance.

Trusting a doctor to operate on your eyes requires working with the best. Dr. Apostolakis is a board-certified plastic surgeon who has performed thousands of eye procedures with exceptional results. When you’re ready to rejuvenate your eyes, start by scheduling your consultation with Dr. Apo. Call or book your appointment online today.