In Dr. Frank Agullo’s words, “the first thing anybody looks at when they see somebody is their eyes. I think that’s what gives us an overall feeling about the patient, and it is the first thing that we will form an opinion on.”
The world agrees. The International Society of Aesthetic Plastic Surgery survey of procedures performed in 2025 puts eyelid surgery at number one, ahead of liposuction: 2,457,677 operations, up 16.2 percent in a year and 69.9 percent since 2021. Men are 22.3 percent of those patients. Hyaluronic acid filler, meanwhile, fell 25.2 percent.
| Worldwide 2025 | Procedures | Change vs 2024 |
|---|---|---|
| Eyelid surgery | 2,457,677 | plus 16.2% |
| Brow lift | 647,725 | plus 23.5% |
| Neck lift | 540,449 | plus 13.2% |
| Hyaluronic acid filler | 4,737,957 | minus 25.2% |
Source: ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025.
Why Patients Come In
Dr. Agullo: “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.”
“In the lower eyelids, they usually complain of also looking tired, with the bags under their eyes, which may be worse in the mornings, and the tear trough deformity.”
Filler Under the Eyes
“Fillers over time have started to come out of favor, as we are now noticing that the filler really never dissolves. The results can last about a year, but the filler does not dissolve, it just disperses. I have seen cases where it blocks the lymphatic drainage, and patients start having bags under the eyes, which are worse in the mornings, or they have discoloration or lumpiness.”
“Patients with festoons, thin skin, and true fat herniation are not the greatest candidates for fillers under the eyes. 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.”
For festoons, the med spa has a non-surgical option: “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.”
Upper, Lower, or Both
“Most patients come in for one or the other, but they may actually benefit from working on both. I think the lower eyelids are a lot more common, with people complaining about their lower eyelid bags, and these are maybe slightly younger patients. The older patients are definitely concerned about their upper eyelids, the hooding, and even the visual impairment it’s causing.”
Recovery
“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.”
“The procedures to fix these complaints are usually short, can be performed under local anesthesia or even IV sedation, and have short recovery times.”
The full post, with the older-patient discussion and the brow lift numbers, is on the Agullo Plastic Surgery site.
Why Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor every year from 2014 through 2026.
Schedule a Consultation
To ask about eyelid surgery or under-eye treatment at Southwest Plastic Surgery, call (915) 590-7900, text 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
