The eyes are the window to the soul and all that. But what does it mean if those eyes are droopy, saggy, lined, and crêpey yet the soul is still robust?
Believe me, I see you.
There’s a reason blepharoplasty—also known as an eye lift—is now in such high demand. It was the second most popular cosmetic surgery performed in 2022, according to the American Academy of Facial Plastic and Reconstructive Surgery. On TikTok, #blepharoplasty has 412 million views, and #browlift, its sister surgery, more than half a billion. According to recent reports from two market-research firms, the global blepharoplasty market is expected to almost double by the end of this decade.
The numbers align with a new survey, funded by Allergan, that named dark circles and under-eye bags as the top appearance-related concerns among men and women.
Doctors attribute this boom to the universality of eye issues. It’s no longer just old ladies getting their eyes done. It’s men, too, and even people in their 20s who inherited under-eye bags or hooded lids.
Dr. Oren Tepper, a board-certified plastic-and-reconstructive surgeon in New York City, says he operated on a number of twentysomethings in recent weeks, including a certain model you may have heard of who’d long been bothered by her bags. When the issues are uncomplicated by aging, surgery tends to be straightforward, and the results discreet.
When young people seek surgery from Dr. Catherine Chang, a board-certified plastic-and-reconstructive surgeon in Beverly Hills, “They’ll say, ‘When I’m putting on my eyeliner, I can’t wing it anymore, because I now have this hooding around my outer eye,’” she says. “They’ve tried Botox to lift the corners of the eyebrows, but it’s not enough.”
Surgeons are also treating more and more men, who often come to them complaining of looking tired. When Dr. Robert Schwarcz, a board-certified oculoplastic surgeon in New York City, started his practice 18 years ago, only about five percent of his patients were men. Today, it’s 30 percent.
“For a lot of men, eyelid surgery is their introduction to the world of plastic surgery,” Dr. Tepper says. Part of its appeal is its relative simplicity and speed of recovery.
An upper blepharoplasty focuses on trimming away excess skin and, occasionally, tightening lax muscles or adjusting fat pads close to the nose. This is usually a half-hour procedure in the surgeon’s office, with numbing shots rather than stronger anesthesia. Recovery can take as little as one week, and scars blend into the creases of the lids. Dr. Chang says her high-profile patients are back on-camera within eight days of upper-lid surgery.
“It’s the simplest thing you can do that’s going to have the biggest impact on your overall appearance,” says Dr. Flora Levin, a board-certified oculoplastic surgeon in Westport, Connecticut. She doesn’t mean to sound cavalier: it’s still surgery—on a highly unforgiving feature.
The best surgeons have learned from the mistakes of their predecessors, who routinely removed too much tissue, skeletonizing the lids and unintentionally aging their patients. Modern techniques prioritize volume. If a fat pad is protruding on the upper or lower lids, doctors will re-purpose it to inflate nearby concavities. If there’s too little fat on the upper lid, the surgeon may source fat from the belly, process it, and inject it under the brows. A few drops of injectable filler can also do the trick.
Lower-eyelid surgery requires more time and finesse, including an operating room and anesthesia. During the procedure, surgeons rearrange the fat pads under the eyes to flatten bulges and fill hollows, entering from inside the lower lids to avoid visible scars. They may inject a small amount of fat, especially in lean patients, to blur the boundaries between the lower lids and the cheeks or temples. If the area is wrinkled or crêpey, the doctor will use a CO2 laser or chemical peel to smooth the skin.
To create the most natural result, doctors assess the upper and lower lids together, along with the forehead and eyebrows. “It’s hard to untie the brow and the upper eyelids,” Dr. Tepper notes. As the brow drops with age, it weighs down the top lids, causing excess skin to collect in their creases and obscuring the area of the lid that overlies the eyeball.
This is why surgeons often recommend a brow lift to accompany the lid lift. In many cases, “I’m doing a brow lift so that your blepharoplasty looks better,” explains Dr. Levin. “I cannot take away the hooding at the outer portion of your eyelid without also lifting your eyebrow.”
Many people worry that a brow lift will create the look of permanent surprise. “About 50 percent [of my patients] are deathly afraid of it,” says Dr. Levin.
The stigma isn’t unfounded. In the past, attempting to raise a fallen forehead meant lifting it fully through an ear-to-ear incision across the top of the head—a maneuver that often hiked the middle of the brow, giving the face that startled expression. This “coronal” approach has largely been replaced by the lateral or temporal brow lift, which targets the tails of the brows, usually through two small slits in the hairline. Instead of reimagining the position of the brows, it merely restores it—and the recovery is far more manageable.
“I don’t even know the last time I did a coronal,” says Dr. Chang. “Maybe 10 years ago? It’s pretty rare.” She adds that brows are strongly linked to individual identity. In some cases, moving them, even to a technically better spot, can create an unfamiliar, or otherwise undesirable, look.
Every surgery comes with risks. With the eye area, asymmetry, bleeding, infection, muscle injury, eyelid distortion and malfunction, scarring, and numbness are all possibilities.
This might explain why many people prefer Botox and other wrinkle-relaxing neuromodulators over eye surgery. A few injections of Botox near the lower lash line and at the outer corners of the eyes can minimize smile-induced wrinkles. But the doctor needs to go easy on the crow’s feet to prevent a dead-eyed grin, says Dr. Dan Belkin, a board-certified dermatologist in New York City. Injected strategically, Botox and the like can also “reposition the brow slightly,” he adds. A touch of filler at the temples can give a little lift to the tail of the brows.
There’s a lot of buzz about radio-frequency micro-needling to boost collagen production and help firm the skin slightly over several sessions. Morpheus8 has been getting the most attention lately, perhaps because of its energetic marketing and cinematic name. It also has the reputation of being uncommonly painful. One makeup-artist friend described the experience as feeling as if he “gave birth through my nostrils.” It requires minimal recovery time but, according to several doctors who spoke to me off the record, also delivers only modest results.
One competitor to Morpheus8 is the EndyMed Intensif, which is Dr. Belkin’s preferred tool for eyelids. It has a smooth-plated tip that re-surfaces the skin and a traditional needle-studded handpiece that goes deeper to stimulate collagen production. Another alternative, the Sylfirm X employs shorter needles than most, making it ideal for the thin eyelids, says Dr. Stella Desyatnikova, a board-certified facial plastic surgeon in Seattle. She frequently uses it after dissolving old under-eye filler to help shrink skin that’s been stretched by excessive injections.
Unsurprisingly, many surgeons view these tools not as substitutes for the knife, but as a means of delaying it, if used early when the skin is still relatively taut. If you’re past that point, their influence may be subtle, notes Dr. Belkin.
But even then, doctors may suggest skipping the scalpel. “I have patients who are very open to surgery, who really have no hesitancy,” says Dr. Belkin. “And sometimes I’ll pull them back and say, ‘Your eyes are really cute—yeah, there’s a little wrinkling, but it’s pretty. You can look really beautiful without effacing every line.”
Oh, Dr. Belkin, you charmer! Tell me what I want to hear.
Jolene Edgar is a writer who frequently contributes to Town & Country, Allure, and Harper’s Bazaar