The eyes tell the age. First and most.
The eyes are the first area of the face to show aging, and often the area where meaningful rejuvenation produces the most obvious refreshment. Excess skin on the upper lids, herniated fat pockets on the lower lids, and the 'tired look' that persists despite adequate sleep are all standard blepharoplasty presentations — and all typically respond to a well-performed procedure.
Blepharoplasty is one of the most commonly performed cosmetic procedures in the world, and one where technical experience genuinely matters. The eyelid anatomy is delicate, the tissue movement is millimetric, and the difference between a natural result and a hollowed or altered appearance depends on decisions made intraoperatively.
At NCSS, six of our affiliated surgeons perform blepharoplasty as part of their facial rejuvenation practice. Upper and lower blepharoplasty can be performed independently or together, and either can be combined with brow lift, facelift, LiteLift®, or fat transfer to face for comprehensive facial rejuvenation. What's right depends entirely on your specific presentation.
Who this procedure is designed for.
Blepharoplasty addresses the eyelid region specifically — the anatomy that most directly communicates age and fatigue.
Upper lid: excess skin covering the lid
The most common upper blepharoplasty presentation. Excess skin can occasionally extend enough to affect peripheral vision — a functional as well as aesthetic concern.
Lower lid: herniated fat pockets
The 'bags' under the eyes that don't resolve with rest, hydration, or non-surgical treatment. Addressed by repositioning or removing the herniated fat.
Lower lid: excess skin and fine wrinkling
Redraping of the lower lid skin, sometimes with adjunct laser resurfacing for texture.
Persistent 'tired' appearance
Despite adequate sleep and good health, the eyes appear tired — typically because of eyelid anatomy rather than fatigue.
Realistic expectations
Blepharoplasty rejuvenates the eyelid region specifically. It does not correct crow's feet (Botox), brow position (brow lift), or dark under-eye circles (may be pigmentation, hollowness, or vascular).
Smoking status matters — and approach varies by surgeon
Every surgeon at NCSS strongly recommends smoking cessation for at least 4–6 weeks pre-operatively. Smoking impairs eyelid healing and increases complication risk. We respect an individual's right to autonomy over this decision with full knowledge of the risks — and we are also transparent that some of our affiliated surgeons, Dr. Nichter among them, will not perform surgery on patients who continue to smoke. Others will proceed with candid discussion of the elevated risks.
Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before surgery day.
Three stages, one procedure.
Blepharoplasty is technically demanding but well-established, with several technique variations depending on the specific anatomy:
Upper blepharoplasty incision
Placed in the natural upper lid crease, where it becomes essentially invisible once healed. Excess skin (and occasionally a strip of muscle) is removed; the incision is closed with fine sutures.
Lower blepharoplasty: transconjunctival approach
Incision inside the lower lid, hidden from view. Best for patients whose primary concern is fat pockets rather than excess skin. No external scar.
Lower blepharoplasty: skin-muscle flap approach
External incision just below the lash line, used when skin excess is the primary concern. The incision is nearly invisible once healed.
Fat repositioning vs. removal
Modern technique often repositions herniated fat into the tear trough (the depression beneath the lower lid) rather than removing it entirely — producing a more youthful, filled result rather than a hollowed one.
Adjunct procedures
Laser resurfacing for skin texture, canthoplasty for lower lid support, brow lift for descended brow position — commonly combined with blepharoplasty when indicated.
Every case at NCSS is under physician anesthesia — no CRNAs — and Dr. Denise Scott (endocrinology) is on call for our surgical patients.
Two sites. One recovery.
Discharged the day of surgery. Cold compresses used intermittently. Mild-to-moderate discomfort with multimodal pain protocol. Head elevated for sleep.
Bruising and swelling most noticeable at 48–72 hours. Most patients stay home from public settings during this week. Vision may be slightly blurred from ointment; drops keep the eyes lubricated.
Bruising resolves; swelling largely dissipates. Most patients return to work by day 7–10 with makeup coverage. Sutures typically removed at day 5–7.
Return to full exercise. Fine incision lines continue to fade. Final contour becoming apparent.
Complete resolution of residual swelling. Incisions fade further to essentially invisible for upper blepharoplasty.
A well-performed blepharoplasty produces results that last 10–15 years or longer, though the face continues to age around the treated eyelids.
Every blepharoplasty patient at NCSS is covered by our Rest-Assure program: physician anesthesia on the day of surgery, one nurse from arrival through discharge, and post-operative direct access to your surgeon — not an answering service.
Six surgeons. Delicate work.
Blepharoplasty is one of the more technique-sensitive facial procedures. Meet more than one surgeon.
Dr. Toohey
All-UC · Full Facial ContinuumAll-UC training; three decades of aesthetic practice; blepharoplasty as core facial rejuvenation.
View surgeon →Dr. Hendricks
Whisper Rule · Refined Eye WorkTriple-boarded; refined blepharoplasty aligned with the whisper aesthetic.
View surgeon →Dr. Nichter
Facelift + LiteLift® Co-DeveloperTriple-boarded; four decades of facial and eyelid work.
View surgeon →Dr. Horowitz
Facelift + LiteLift® Co-DeveloperEmory + UVA under Milton Edgerton; four decades of facial rejuvenation.
View surgeon →Dr. Bernett
Female Surgeon · Facial PracticeUC Irvine trained; blepharoplasty as part of aesthetic and reconstructive facial practice.
View surgeon →Dr. Andre
New Generation · Coast-to-CoastCleveland Clinic + UC Davis + Loyola + Pacific Center; modern eyelid technique.
View surgeon →The right starting point is a conversation.
Every consultation at NCSS begins with time — time to understand your eyelid anatomy, distinguish upper from lower concerns, and determine whether blepharoplasty alone or combined with brow lift or facelift is the right fit.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Brow Lift
Upper facial rejuvenation — often the true source of what patients read as 'heavy eyelids.'
Learn more →Fat Transfer to Face
Volume restoration commonly combined with blepharoplasty for comprehensive periorbital rejuvenation.
Learn more →Facelift
Comprehensive lower-face rejuvenation, often combined with blepharoplasty for full facial refresh.
Learn more →