The eyelids frame the eyes — and the eyes are the single most expressive feature of the human face. Drooping upper eyelids can make patients look perpetually tired, lazy, or older than they are. Puffy lower-lid bags and dark circles can produce an exhausted appearance that no amount of rest seems to fix. The skin of the eyelid is the thinnest skin anywhere on the body, which makes it particularly prone to stretching, sagging, and showing the changes of aging years before other facial regions. Upper and lower blepharoplasty — the surgical correction of these specific eyelid concerns — restores firmer eyelids, sharper eye contours, and the rested, refreshed appearance that defines beautiful, youthful eyes. At Los Angeles Plastic Surgery, Dr. John Anastasatos performs intricate upper and lower blepharoplasty at his Beverly Hills practice with the foundational anatomic training and aesthetic precision this delicate region demands.

Dr. Anastasatos performs blepharoplasty surgery with academic credentials directly relevant to eyelid surgical excellence. Dr. Anastasatos completed his plastic surgery training under Dr. Luis Vasconez at the University of Alabama at Birmingham — one of history’s foremost plastic surgeons and the inventor of the endoscopic brow lift — providing the foundational training in deep facial anatomy that distinguishes excellent blepharoplasty work from average results. He has presented at Cedars-Sinai Medical Center Grand Rounds on advanced surgical techniques — teaching credentials at one of the leading medical institutions in Southern California. With over two decades of facial surgical expertise in Beverly Hills since 2007, he is board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Why Eyelid Skin Ages Faster Than Other Skin

The skin of the eyelids is the thinnest on the body — meaningfully thinner than facial skin, which is itself thinner than most body skin. This delicate skin is exposed to constant physical stress: thousands of blink cycles per day, eye-rubbing, makeup application and removal, and significant UV exposure relative to its thickness. Combined with normal aging, genetic predisposition to thin skin, and the loss of underlying fat compartments that occurs with age, the eyelid region tends to show aging changes years before other facial regions develop similar concerns.

The result is a constellation of changes that often appear together: drooping upper lid skin that can fold over the lash line, puffy lower-lid bags from herniation of orbital fat, dark circles produced by visible blood vessels through translucent skin, hooding that obscures the natural eyelid contour, and crepey texture that no skincare product can resolve. Blepharoplasty addresses all of these surgical concerns at once.

Upper Eyelid Blepharoplasty

Upper eyelid blepharoplasty removes the folds of excess sagging skin from the upper lid through an incision strategically placed in the upper eyelid crease — a location that effectively hides the resulting scar within the natural anatomic line. Beyond simply removing excess skin, the procedure can also create or refine the upper eyelid crease itself, producing a beautiful, defined fold appropriate to the patient’s anatomy.

Healing time for upper blepharoplasty is just a few days, and recovery is virtually painless for most patients. Most of the swelling resolves over approximately two weeks. Most patients are surprised by how minimal the recovery experience is for a procedure that produces such substantial visible change.

Lower Eyelid Blepharoplasty

Lower eyelid surgery is more technically complex than upper blepharoplasty, with four specific surgical goals working together to produce a refined, youthful lower lid:

• Remove and tighten excess saggy lower-lid skin — addressing the loose, draped appearance that produces a tired look
• Address the orbicularis muscle — the muscle of the lower eyelid that becomes lax with age. Tightening this muscle supports the lid in a youthful position. In some patients the muscle becomes hypertrophic and thickened, producing what is called a festoon. Festoons can be corrected with lower eyelid surgery.
• Remove or reposition excess eyelid fat — addressing the puffy lower-lid bags caused by herniation of orbital fat through weakened tissue
• Address dark circles — through specific surgical techniques targeting the visible blood vessels that produce the dark color

The combination of upper and lower eyelid surgery typically produces better results than either procedure alone for patients with concerns in both regions. In many cases, Dr. Anastasatos performs upper and lower blepharoplasty together with endoscopic brow lift — the combination producing dramatic upper-face rejuvenation in a single recovery period.

The procedure can be performed under local anesthesia, local with sedation, or general anesthesia depending on patient choice and the extent of the procedure.

Addressing Dark Circles and Puffy Eyes

Two of the most common concerns that motivate patients to pursue blepharoplasty are dark circles and lower-lid puffiness — both of which can persist regardless of how well-rested the patient is. Both concerns have a common anatomic basis: the very thin skin of the lower eyelid, which allows the underlying blood vessels to be visible at the surface.

When blepharoplasty is performed, these blood vessels can be specifically minimized through targeted surgical technique. In addition to reducing excess skin and fat, some of the visible blood vessels can be detached from the eyelid skin to reduce dark circles or puffiness — producing a result that addresses both the structural and the vascular components of these concerns.

Medical Considerations Before Surgery

Several medical conditions can make blepharoplasty riskier and warrant careful evaluation before surgery is planned:

• Thyroid problems including hypothyroidism and Graves’ disease
• Dry eye disease or insufficient tear production
• High blood pressure or other circulatory disorders
• Cardiovascular disease
• Diabetes
• Detached retina or glaucoma history

Patients with any of these conditions should consult their ophthalmologist before pursuing blepharoplasty. Dr. Anastasatos’s consultation evaluates each patient’s specific medical situation and coordinates with the patient’s ophthalmologist when appropriate.

Frequently Asked Questions About Blepharoplasty

What’s the difference between upper and lower blepharoplasty?

Upper blepharoplasty addresses excess upper-lid skin and creates or refines the upper eyelid crease. Lower blepharoplasty is more technically complex, addressing skin, muscle, fat, and dark circles in the lower eyelid region. Many patients pursue both together for comprehensive eye rejuvenation.

How long does recovery take?

Most patients feel comfortable returning to private daily activities within 7-10 days. Visible bruising and swelling resolve over approximately 2 weeks. Final settling of the result continues over 3-6 months as residual swelling fully resolves.

Will the scars be visible?

Upper blepharoplasty incisions are placed in the natural upper eyelid crease and become nearly invisible once healed. Lower blepharoplasty incisions are typically placed just below the lash line or inside the lower eyelid (transconjunctival approach), both of which heal to nearly invisible scars.

Can blepharoplasty correct dark circles?

For dark circles caused by visible blood vessels through thin eyelid skin, yes — through specific surgical technique that detaches some of these blood vessels. For dark circles caused by other factors (pigmentation, allergic shiners), additional non-surgical approaches may be needed.

Will I need general anesthesia?

Not necessarily. Many patients have blepharoplasty performed under local anesthesia or local with sedation, without general anesthesia. The choice depends on the extent of the procedure and patient preference.

How long do the results last?

Upper blepharoplasty results typically last 10-15 years or longer. Lower blepharoplasty results are generally permanent — the orbital fat does not regrow once removed. Natural aging continues, but the corrected anatomy does not return to its pre-surgical state.

Why Choose Dr. Anastasatos for Blepharoplasty

• Trained Directly by Dr. Luis Vasconez at UAB: Foundational training under one of history’s foremost plastic surgeons in the deep facial anatomy that excellent blepharoplasty requires.
• Cedars-Sinai Medical Center Grand Rounds Presenter: Teaching credentials at one of the leading medical institutions in Southern California.
• Two Decades of Beverly Hills Practice: Sustained experience in eyelid surgery since 2007.
• Board-Certified, FACS, ASPS, and ASAPS: Certification by the American Board of Plastic Surgery and full membership in the specialty’s most respected peer societies.
• Combined Upper, Lower, and Brow Lift Capability: Comprehensive upper-face rejuvenation in a single coordinated procedure when appropriate.
• Anesthesia Flexibility: Local, local-with-sedation, or general anesthesia options matched to patient preference.
• Festoon and Dark-Circle Correction: Specific surgical attention to the muscle hypertrophy and vascular concerns that other surgeons may not address.
• Top 10 International Recognition: Named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Schedule Your Blepharoplasty Consultation in Beverly Hills

If drooping upper lids, puffy under-eye bags, dark circles, or hooded eye contours have begun making you appear older or more tired than you feel, blepharoplasty can produce dramatic, long-lasting refreshment with a recovery dramatically shorter than most patients expect. Dr. Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation evaluating your specific eyelid anatomy and outlining the appropriate surgical approach. Contact us at Los Angeles Plastic Surgery to schedule your blepharoplasty consultation with Dr. Anastasatos.