Eyelid Surgery at Southwest Plastic Surgery: Tired Eyes, Bags, and Under-Eye Filler
The eyes are where most patients at Southwest Plastic Surgery in El Paso first notice age, and they are also where some of the smallest, best-hidden procedures live. Patients point at the same things: heavy upper lids, puffy lower bags, hollows that read as exhaustion, and old under-eye filler that never settled.
Here is how Dr. Frank Agullo explains the options.
Heavy Upper Lids Are Usually Skin, Not Muscle
When upper lids feel heavy and uneven, the cause is usually not the muscle. A true lazy eye is a muscle issue, but in most cases both lids sit the same distance from the pupil, which points to the fold and the weight of extra skin. For the upper lid, Dr. Agullo removes the fold of skin, and the scar sits inside the new crease, so it is not visible when the eyes are open.
The Procedure Does Not Change the Eye’s Shape
A common worry is that surgery will change the shape of the eye. Dr. Agullo only removes the fold and, in most cases, finishes right at the crease without extending to the side, which is exactly what avoids a pulled or altered look. The crease is already drawn by the patient’s own anatomy. The goal is more symmetry, not a different eye, with the natural side-to-side difference everyone has preserved.
What Eye Bags Are, and How They Come Out
Lower eyelid surgery removes the fat bag. Dr. Agullo works through an incision on the inside of the lid, so there is no external scar and no external stitches. He adds a little fat to blend the transition and often pairs the procedure with Morpheus8 microneedling to tighten the skin.
Hollows Are a Volume Problem
When the issue is hollowness rather than bags, Dr. Agullo adds volume with the patient’s own fat. Fat grafting under the eyes is very safe and routine, both on facelifts and on younger faces with less tissue. Because the body absorbs about thirty to forty percent of grafted fat, he slightly overfills, and as it settles the result looks completely natural.
A Clear Position on Under-Eye Filler
Dr. Agullo is cautious about filler under the eyes. It can hold water and stay puffy for years and tends to migrate rather than fully dissolve. Fat is the safer, more natural way to address true hollowing, and if a patient already has problem filler there, dissolving it is often the first step.
Eyes, At a Glance
| What a Patient Sees | What It Usually Is | What Dr. Agullo Does |
|---|---|---|
| Heavy upper lid | Fold and extra skin | Remove the fold, scar in the crease |
| Puffy lower bag | Fat bag | Remove from the inside, no external scar |
| Hollow, tired shadow | Volume loss | Fat grafting, slightly overfilled |
| Puffy for years | Old migrated filler | Dissolve first, then reassess |
Stitches, Scars, and Recovery
On the upper lid, the sutures are placed under the skin, so they do not leave visible track marks. A few small ones may fall out on their own. On the lower lid, done from the inside, there are no external stitches. Keloids on the eyelids and face are almost unheard of, since keloids tend to form on the ears, shoulders, sternum, and joints.
The procedure takes under two hours. Most patients are back to normal in three or four days, with some swelling and bruising. Bruising can take up to two weeks, though it is usually coverable with a little makeup after a week, and exercise resumes at about four weeks. ElixirMD LED therapy can speed early healing, and microneedling with PDGF, a growth factor stronger than PRP, can soften older scars over a few sessions at the Med Spa.
Who Is a Candidate
Eyelid surgery suits a patient whose upper lids feel heavy, whose lower lids carry persistent bags, or who looks tired in a way that rest does not fix. The best candidates are bothered by a specific feature they can point to, rather than seeking a wholesale change to the eye, since this procedure is about refinement and not transformation. Patients in good general health who do not smoke heal cleanest. Because the eyes age alongside the rest of the face, some patients find that a facelift or fat grafting addresses the deeper cause, and Dr. Agullo will say so honestly during the consultation rather than recommending eyelid surgery alone when something more fitting exists.
Pairing Surgery With Skin Care
Eyelid surgery removes skin and fat and repositions volume, but it does not change skin quality, which is a separate consideration. Crepey lower-lid skin and fine lines respond well to treatments at the Med Spa, including Morpheus8 microneedling and laser. Many patients pair surgery with a longer skin plan so the texture around the eyes matches the rested look the surgery creates, and the team maps that timeline so the skin treatments fall at the right point in healing.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and completed a plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, and a Castle Connolly Top Doctor for thirteen consecutive years. Eyelid work rewards restraint, and his goal is for patients to look rested, not operated on.
See the Other Versions
For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing question-and-answer version, see the companion post on agulloplasticsurgery.com.
Ready to Talk?
If people keep asking why you look tired, your eyes may be the answer. Come in to Southwest Plastic Surgery and let the team take a look.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
