Liapakis IE, Paschalis EI, Zambacos GJ, Englander M, Mandrekas AD. Redraping of the fat and eye lift for the correction of the tear trough. J Craniomaxillofac Surg 2014 Oct;42(7): 1497-1502

Liapakis IE, Paschalis EI. Liposuction and Suspension of the Orbicularis Oculi for the Correction of Persistent Malar Bags: Description of Technique and Report of a Case. Aesthetic Plast Surg 2012 Jun;36(3): 546-549

The laxity of the skin at the upper and the "bags" at the lower eyelids (even at younger ages) can be addressed by blepharoplasty.

The upper eyelid incision is hidden within the eyelid crease and excess skin/fat is removed medially to the nose. Because the scar follows the natural fold of the upper eyelid, it is very well camouflaged.

If there is blepharoptosis, it will be repaired at the same time by levator muscle tightening sutures.

If the upper eyelid skin laxity is accompanied by sagging of the eyebrows, then a brow lift/"fox eye" is been done.

The lower eyelid incision is usually hidden below the eyelid lashes. Through this incision, excess skin and fat is removed. Fat is repositioned when we need to improve the "tear troughs". Other adjustments such as canthopexy and eyelid lift are done to lift the canthus and improve the soft tissues laxity. Croton oil/phenol peel or Erbium/YAG laser resurfacing is used in conjunction, to eliminate the small wrinkles under/around the eyes.

We also transfer fat/stem cells when we need to give volume at the area of the cheeks and the "tear troughs".

Skin "dark circles"  beneath the eyes are treated by bleaching solutions and smoothing of the "crow's feet" require Botulin toxin type A injections.

The patients are usually back to their daily activities within 10-12days. Although rare, you may have "dry eye syndrome" after the procedure which requires eye drops for several weeks (https://www.visioncenter.org/conditions/dry-eye/). Mild swelling persists for over 1month in some cases while the most of the patients see swelling resolve in just a few days.