Why I Believe Eyelid Surgery Should Preserve Rather Than Remove
A Conversation with Dr. Afshin Parhiscar
Q: Why do our eyes make us look older before the rest of our face?
The eyes are where people naturally focus when they look at us. As the lower eyelids age, they begin to tell a story that often isn’t true. Patients frequently tell me, “I feel energetic, but everyone keeps asking if I’m tired.”
The reason is that several changes occur at the same time. The skin becomes thinner, the tissues supporting the eyelid weaken, the fat pads begin to bulge forward, and volume beneath the eyelid slowly disappears. The combination creates under-eye bags, tear troughs, and a hollow appearance.
Most people don’t recognize these anatomical changes—they simply see someone who looks older or less rested.
Photo 1 – Anatomy of Lower Eyelid Aging
Labels: Fat pads • Tear trough • Central hollow • Thin skin • Eyelid support • Cheek descent
Q: Many people think eyelid surgery is simply removing bags. Is that how you see it?
Years ago, lower blepharoplasty focused on removing fat and skin. While that often improved the bags, it sometimes created a different problem—a hollow, over-operated appearance.
My philosophy is different.
Instead of asking, “What can I remove?” I ask, “What healthy tissue can I preserve?”
That shift in thinking changes the entire operation. My focus is to return structures to their natural position and contour. That lets you look like yourself yet rested and natural.
Q: What does “preservation” actually mean?
The fat that creates an under-eye bag is not bad tissue. In many patients, it is exactly the tissue needed to fill the hollow just below it.
Rather than removing it completely, I carefully reposition that fat into the tear trough and central hollow. At the same time, I address any looseness in the eyelid by restoring its natural support.
Instead of subtracting from the eyelid, I’m restoring its youthful anatomy.
3 key features are preserved:
1) Smooth contours
2) Shorter vertical height of the eyelid
3) Appropriate lower eyelid position and shape
Photo 2 – Fat Repositioning
Tear tough is filled with Repositioned fat • Smooth eyelid-cheek transition • Shortened vertical height of eyelid
Q: Why is eyelid support so important?
A beautiful eyelid isn’t just defined by how it looks in a photograph. It has to blink naturally, smile naturally, and maintain its youthful shape over time.
When necessary, I reinforce the natural support of the lower eyelid. This helps preserve its position and allows it to move normally after surgery.
For me, eyelid surgery is about both form and function. The shape and how it flows both matter.
Q: What do you want patients to notice after surgery?
Actually, I hope they don’t notice the surgery at all.
The best compliment my patients receive is not, “Your eyelids look great.”
It’s, “You look well rested.”
That tells me we’ve achieved the goal: restoring a younger version of the patient without changing who they are. Simple , natural and rewarding.
Case Study 1
Before
- Prominent under-eye bags
- Deep tear trough
- Central hollowing
Treatment
Preservation lower blepharoplasty with fat repositioning and eyelid support.
After
The bags are softened, the hollow is filled with the patient’s own tissue, and the transition from the eyelid to the cheek is smooth and natural.
Photo 3 – Before and After
Case Study 2
Before
A patient who appeared constantly tired because of under-eye bags and volume loss.
Treatment
Fat repositioning with preservation of normal anatomy.
After
Rather than looking “different,” she simply looks refreshed, rested, and more like the way she remembers herself looking years earlier.
Photo 4 – Before and After
My Philosophy
The evolution of lower blepharoplasty has been a shift from removal to restoration. This has lead to superior results that last well over time.
Whenever possible, I preserve healthy tissue, reposition it where it belongs, and restore the natural support of the eyelid. My goal is never to create a different face—it is to help patients look like themselves, only younger, healthier, and well rested.
That is what preservation eyelid surgery means to me.