Skip to content

Eyelid Surgery

Blepharoplasty in San Francisco

zoomed picture of woman's eye

Eyelid surgery, or blepharoplasty, is a cosmetic procedure to remove excess fat and skin from the eyelid to make the appearance more youthful. Many of these operations are completed at Bay Area Plastic Surgery each year by board-certified cosmetic surgeon, Dr. Leonard Gray. In the upper eyelid area, either a scalpel or a laser can be used as a cutting instrument. It is important to place the incisions precisely and symmetrically so that they lie in the crease and make any scarring difficult to detect. Dr. Gray always uses magnification telescopes and calipers to ensure accuracy during this cosmetic procedure.

Lower eyelid surgery is by nature a conservative cosmetic operation. Over the past 5 years, Dr. Gray has made an effort to remove less fat or no fat from the lower lid unless there is significant excess. Fat repositioning can be performed. Quite often Dr. Gray uses a filler, such as Belotero®, to fill the depression under the lower lid, and to restore the original contour to the lower lid area. Fat can be used as well in this area but it is less precise and predictable and has a significantly longer recovery time. 

Surgical Technique

The procedure may either be performed on the upper eyelid only or the lower lid, or both. There will be a difference in approaches when it comes to the upper and lower eyelids but the method is similar; removing any loose skin or tissue, and extracting or repositioning the fat deposit. There will also be separate incisions spots. It is important to understand that this will not help with other cosmetic issues such as crow’s feet, wrinkles or dark circles. The results of an eyelid surgery are fairly isolated within the upper and lower lid section only. There are other procedures that can be combined, for example the use of BOTOX®, to create a maximized outcome.


Blepharoplasty is a cosmetic surgical procedure that involves the reshaping of the eyelids to improve their appearance and address concerns such as excess skin, puffiness, and wrinkles. There are two main types of blepharoplasty: upper blepharoplasty and lower blepharoplasty. Each targets specific areas of the eyelids and can be performed by your Bay Area board-certified plastic surgeon individually or in combination.

The most common problem with the upper eyelid is excess skin that droops and hangs over the eyes. Not only does this look unappealing, but it can also obstruct vision for a patient. The doctor will create an incision along the natural fold of the eyelid and extract any excess fat and tissue to remove any bulges. Dr. Gray will remove a conservative amount of fat to improve the appearance but not so much to make the eye appear sunken. He buries his stitches along the suture line to avoid any stitch marks.

Upper blepharoplasty focuses on the upper eyelids. This procedure is often chosen to address:

  • Excess skin: Sagging or drooping upper eyelid skin that can impair vision or create a tired appearance.
  • Fat deposits: Pockets of fat that may cause puffiness or bulging in the upper eyelids.
  • Wrinkles: Fine lines and creases that develop on the upper eyelids due to aging.

During an upper blepharoplasty, your Bay Area board-certified plastic surgeon makes an incision along the natural crease of the upper eyelid. Excess skin and fat are then carefully removed, and the incision is closed. This results in a more rejuvenated and refreshed appearance of the upper eyelids.


There are two options for incisions when it comes to lower eyelid surgery. This treatment will improve any appearance of bulging and sagging below the eye. Incisions may be made just slightly below the lash line and excess fat, tissue or skin will be excised. Skin excision from this area also has to be conservative. Often times, Dr. Gray will use the Fractional CO2 Resurfacing laser to tighten the skin, remove fine wrinkles, and eliminate a crepe-like skin appearance. This resurfacing procedure, done in stages, can tighten the skin 3mm and is commonly known as the Madonna Eyelid Lift. If the skin has retained good elasticity, a transconjunctival incision may be a better option as the cut is made inside the lower eyelid, which effectively makes any resulting scar concealed. 


Lower blepharoplasty targets the lower eyelids and can address:

  • Under-eye bags: Puffy or swollen areas beneath the eyes caused by excess fat or tissue.
  • Excess skin: Loose or wrinkled skin in the lower eyelid area.
  • Tear troughs: Deep creases or hollows between the lower eyelids and cheeks.
Dr. Leonard Gray

Schedule A Consultation

Instilling Beauty
Inspiring Confidence

Dr. Gray is a board-certified plastic surgeon with over 20 years of experience conducting surgical procedures of the breast, body, and face. His emphasis on patient education and attention to detail have made him the top choice for plastic surgery in the Bay Area. Dr. Gray invites you to meet with him for a friendly and informative consultation.

During & After Surgery

Eyelid surgery is performed with general anesthesia. If the procedure involves both upper and lower eyelids, the plastic surgeon will typically manage the upper eyelid first. On average, it takes 1 – 2 hours to complete the operation. The patient will be sent home for recovery. For the first few days, there will be swelling and discoloration around the area. It is advised that the head is elevated for the first few days. Pain medications and antibiotics will be prescribed to manage the initial discomfort. Strenuous activities must also be restricted.

San Francisco Eyelid Surgery FAQ

Eyelid surgery, whether upper or lower, generally does not cause visible scarring. This is because the surgeon takes great care to ensure that the incisions are made within the natural lines and folds of the eyes. Once the surgical healing has passed, the incisions will not be noticeable even to the naked eye.


Crow’s feet and forehead wrinkles are better treated with procedures such as a facelift, browlift or a cheek lift as the results of the eyelid surgery are confined to the eyelids only. Eyelid surgery can also be combined with a nonsurgical procedure such as BOTOX, which combats wrinkles on the forehead and around the eyes. An injectable filler can also be effective because it adds volume to hollow areas for a softer, smoother appearance. 

Complications and irritations after surgery are rare. Patients must strictly adhere to care instructions prescribed by the surgeon to minimize any risks of infection as the eyes can be sensitive after surgery. Patients must always take precaution of protecting the eyes from the sun and wind during the first few weeks of recovery. 


Blepharoplasty not only corrects a cosmetic issue, but a functional one as well. Many patients with excess hanging skin on their upper eyelid are able to regain normal vision after surgery. For many, simply applying makeup without maneuvering around the excess skin is refreshing in and of itself.