October 15, 2026 | Blepharoplasty, Facial Procedures, Plastic Surgery News
Nobody walks into my office and asks to look different.
“I think the most common reason patients come in is because people are telling them that they look tired, when they’re actually feeling just fine and feel like they have energy. A lot of them feel younger than their actual age, but the eyelids are not helping them send this message out. They look in the mirror and they look at photos, and they can identify the areas that they don’t like.”
The American Academy of Facial Plastic and Reconstructive Surgery just counted that conversation. In its annual member survey, reported by Alison Werner in Plastic Surgery Practice on September 24, 66 percent of facial plastic surgeons say more patients want eyelid procedures to look less tired. Blepharoplasty stays in the top three facial operations, with rhinoplasty and facelift. More of the people asking are men.
Rested, Not Transformed
The AAFPRS president, Anthony Brissett, describes patients who want to look refreshed, not changed. Same here, and it is the reason the oldest patients stopped being the most hesitant.
“I think patients are becoming a lot more willing to undergo facial procedures, including facelifts, because the results now are actually natural and do not change their overall appearance. So they still have a self identity after these procedures and they’re recognizable; they’re just looking ten to fifteen years younger.”
“I think it’s true. It’s restoration. It’s getting back to a younger self, or repairing some of the damage done by weight loss.”
Keep, Move, Restore, Remove
The survey piece describes a shift away from routinely cutting out skin, muscle and fat, toward deciding what stays, what gets repositioned, what gets restored, and what comes out. Skin, muscle, fat, brow, cheek, midface, bone. All of it ages at once.
“For example, patients who come in for under-eye bags really are not aware that it may take multiple procedures to create a nice contour underneath the eyes. Many think it is just a blepharoplasty, but I use the blepharoplasty approach to remove the fat bags, I use fat injections into the tear trough, and I use Morpheus8 microneedling with radiofrequency to tighten the skin. Sometimes I even use AccuTite to tighten the skin, avoiding an incision that can give you a visible scar, or even an ectropion.”
“I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight.”
“The technique that I use doesn’t reposition the fat. I prefer to excise the excess fat from the lower eyelid medial, middle, and lateral compartments. What I do instead is fat graft above the orbital rim and place the fat exactly where I want it, so that it doesn’t migrate.”
“The tear trough is a very common area that we inject. My preference is the patient’s own fat, as it gives us a lasting result. It is done in the operating room, and I use cannulas to inject right above the inferior orbital rim. It softens the tear trough and gives us long-lasting results.”
“It seems to be the first part of the face that patients notice as they age, especially the upper eyelid skin, which can hang and even rest on the eyelashes, giving the patient the impression of being tired and even making makeup hard to put on.”
When the Lid Is Really the Brow
“A hooded upper eyelid is when the fold extends laterally underneath the brow and the lateral eye, and usually needs an extended incision from the blepharoplasty. A lot of times the hooding is due to the brow being low and the excess skin folding in the lateral lid. We can perform a brow lift with brow shaping through two small incisions behind the hairline on either side. This technique also reduces the amount of upper eyelid skin, and thus the upper eyelid skin resection is much shorter, and the scar therefore is shorter and doesn’t extend laterally. This also removes the heavy look from the eye and gives us a nice reshaping of the brow, usually up and lateral, which looks more youthful. It’s usually combined with some fat grafting above the orbital rim as well.”
“There are three objective findings that will let us know whether a brow lift or temporal lift is indicated. The first is that the patient is usually forcefully raising their brows, and you can see the wrinkles in the lateral forehead as the patient raises the brows so they can see better. The second finding is if the brow sits right on top of the orbital rim, that is the bone right above the eye. In females, the brow should be one or two centimeters above the rim. If it’s right on the rim, then it means there is ptosis, and it can be improved with a brow lift, brow reshaping, or temporal lift. The last test is actually moving the brow with our finger up and out. If the lateral eye hooding resolves, then a brow shaping or endoscopic lift is indicated.”
When Adding Is Not Enough
I have moved away from filler under the eyes, and the survey’s “restore rather than remove” theme should not be read as “fill instead of operate.”
“Fat is one of the procedures we perform when treating the periorbital area, and just adding volume to the tear trough can hide the under-eye bags for a while. But as they keep progressing, it comes to a point where adding volume is not going to help, and we actually need to remove those herniated fat pads.”
“Festoons are frustrating because they are very difficult to remove completely. They are a combination of edema or swelling in the area, skin retraction from the facial ligaments, and loose skin. We can usually improve them, and in some cases remove them, using Morpheus8 microneedling with radiofrequency, and it often takes more than one treatment to repair this area. Sometimes it just has to be done surgically with a midface lift.”
Men
“Number three is eyelid surgery. I see it more and more frequently, especially the upper eyelids, but oftentimes upper and lower eyelids and the tear trough deformity.”
“When we do facelifts, we do not like to raise the brow as much. In men, it should pretty much line up with the superior orbital rim.”
“Upper blepharoplasty in men is shorter than in women, and I usually don’t chase the lateral hooding unless the patient specifically asks for it. The reason is that most men don’t use makeup, and hiding that lateral extension can be difficult. If there is lateral hooding in men, I strongly advise an endoscopic brow lift and brow shaping to raise the brow and address the lateral eye hooding. This keeps the incision short, so that when the patient opens his eyes, the scar hides in the natural eyelid fold.”
“In lower blepharoplasty, I almost never excise the excess skin. I perform the incision transconjunctival, which means through the inside of the eyelid, so there is no visible scar. The skin tightening is achieved with laser, Morpheus8, or AccuTite, and I almost always graft fat and nanofat into the tear trough and above the orbital rim.”
“So instead of saying that I am talking somebody out of it, I am explaining the best approach for the problem and how to reach their expectations.”
The Recovery Nobody Notices
“The recovery for eyelid surgery is actually quite easy. In my experience with patients, we usually don’t have any pain, but there will be swelling, and there could be bruising around the eyes. If there’s bruising, it can take one to two weeks for the bruising to go down. The upper lid does have a visible scar, which heals quite quickly, and the sutures are absorbable. The lower eyelid surgery does not have any visible scars. Most patients return to work after a week using a little bit of makeup to cover any bruising if necessary. Some patients actually return to work earlier and use thick-rimmed glasses to kind of hide the surgical aspect.”
“Recovery for men is usually seven to ten days, but many return to work sooner, as there is really no pain after eyelid surgery; it’s mostly just the bruising and swelling. We do coach men on how to use makeup to hide bruising if it’s still present when they want to return to work, and we also recommend thick-rimmed eyeglasses to hide the area around the eyes during recovery. Elixir MD LED therapy helps with reducing recovery time.”
Why Choose Dr. Agullo
Double board-certified, by the American Board of Plastic Surgery and the American Board of Surgery. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years. Upper and lower eyelid surgery, fat grafting to the tear trough, and the deep plane facelift and ponytail lift it is often combined with, all in one practice in El Paso.
Starting prices are on my fees page; the exact quote follows the consultation.
Ready to Talk?
You do not need a new face. You need the one you have to stop lying about how you slept.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. #StayBeautiful
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