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Turn Back Time on Your Body’s Most Tell-Tale Asset (PLUS: Why a Good Night’s Sleep Isn’t Always “Refreshing”)
by: Dr. Bunkis

Q: My eyes are looking old. Can you tell me what’s involved with an eye lid tuck?

-John N., San Clemente, CA

A: It would be difficult for me to tell you specifics without seeing you in person, but I can give you some generalities about such procedures, which we call upper and lower eyelid blepharoplasties.

A blepharoplasty procedure is designed to remove excess skin or bagginess around the eyes to give the eyes a more youthful appearance. As people age some develop lower eye lid "bags" or "dark circles" and excess upper lid skin which drapes down over the lashes. These signs of aging can be reversed by a plastic surgeon by removing excess skin or repositioning the lower lid fat. Wrinkles around the eyes which are etched into the skin cannot be removed by a blepharoplasty procedure alone, without the addition of a skin wrinkle treatment such as a laser resurfacing or a chemical peel. Likewise, a brow lift is frequently recommended to complete the rejuvenation of the eye area. Frequently such rejuvenation procedures are combined with tightening of the neck skin or elevation of the brows to give the face a more youthful harmony.

Your goal as a patient is to make sure that all of your questions are answered and that you fully understand the procedure and it’s consequences before you decide to go ahead with such surgery. Your surgeon should explain the procedure to you, give you detailed hand outs about the procedure, show you photographic examples of his/her work, and preferably either show you a staff member who has had the procedure or have a patient who has had a similar procedure contact you so you can get a patient’s insight into having the procedure done. Do some research online. Visit your surgeon as many times as necessary to have all your questions answered. Understand the alternatives as well. For example, if a patient has a low eyebrow, just removing excess upper eyelid skin will not change the distance from the eyelashes to the eyebrows and a brow lift may be recommended to give a more open eye look. Sometimes a laser resurfacing will be desired to remove excess wrinkles.

You should visit your surgeon as many times as you wish to have all of your concerns addressed. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed and that you accept the risks by signing the informed consent forms.

The operation is performed using local anesthetics with intravenous sedation, or under a light general anesthetic, to make you comfortable throughout the procedure. The anesthesiologist will administer the medications and monitor you to ensure your safety and comfort.

For an upper lid blepahroplasty, the incisions are placed in the normal skin folds of the upper lids. For lower lid procedures, the incisions are placed just beneath the eyelashes or, if fat has to be addressed but there is no skin excess, a hidden incision can be used just inside the lower eyelid. Excess skin is removed and the bulges caused by hereditary fat pockets are corrected by repositioning the fat or removing the excess. The incisions are closed with very fine sutures that will be removed approximately five days later. Within weeks, the incision will be very difficult to see. The approximate operating time for upper and lower eyelid blepharoplasties is two hours.

There is very little pain associated with a blepharoplasty and most patients do not require pain medication. What will limit your activities in the immediate post operative period is the presence of significant bruising and swelling. Our post operative instructions ask the patient to avoid much in the way of physical activity for the first two days, to sit and rest with your head elevated, and to apply ice packs to your eyes continuously except when getting up to eat or go to the bathroom. Ice does not help after the first 48 hours and the patient is free to do whatever they are comfortable doing. For example, most patients can walk as many miles as they wish, but in the first week, running would be uncomfortable. By the end of the first or second week, all bruising should be gone and the patient should have resumed normal activity.

As the years go, the skin will continue to thin and wrinkle but the fatty excesses that were removed do not grow back. We expect your eyes to look better than they would have without the procedure for the rest of your life.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at to learn more about our practice and eyelid surgery in particular. Here are a few before and after photos to give you an example of what can be achieved with such surgery.

 (Actual patient of Dr. Bunkis) 51-year-old female before and two years after a lower eyelid blepharoplasty

(Actual patient of Dr. Bunkis) 71-year-old before and after an upper eyelid blepaharoplasty

949.888.970 | 30212 Tomas Ste. 275, Rancho Santa Margarita, CA 92688 | 

As Medical Director of Orange County Plastic Surgery, Juris Bunkis, M.D., F. A.C.S. brings 30 years of surgical expertise to our communities. Dr. Bunkis is a Harvard trained, Board Certified Plastic Surgeon and Member of numerous prestigious organizations including the American Society of Aesthetic Plastic Surgeons, The International Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgeons and the California Society of Plastic Surgeons. Dr. Bunkis, a former faculty member at the University of California, San Francisco, has published more than 40 scientific publications, abstracts and book reviews, and 17 book chapters in plastic surgery text books. For questions or advice, please contact Dr. Bunkis directly at

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