Eyelid surgery, especially lower eye lid surgery, can be incredibly effective at refreshing one’s appearance. When the smooth nature of the lid itself diminishes and when the junction between the lid and the cheek becomes more demarcated (from fatty bags and shadowy depressions) one can appear tired, drawn, and aged. Fortunately there are many options, both surgical and non-surgical, available to improve the appearance of the lower eyelids. Each component of the aging lid must be considered; the skin, muscle, and fatty pads. If fine lines are the only issue, a chemical peel or laser resurfacing alone may suffice. A tear trough, the shadowy area where concealer is applied, can be treated very effectively with fillers like Restylane or Belotero. As more features of the eye show signs aging, more involved surgical procedures may be needed to achieve a rejuvenated appearance. The fatty pads that cause puffy eyes can be removed through an incision on the inside of the eyelid (the pink area). This is a less invasive procedure that does not address the muscle or skin, so it is sometimes combined with the removal of a pinch of skin or a peel depending on the presentation. More advanced procedures which involve tightening the skin, muscle, and fat are done through an incision under the eyelashes. This is one of the only procedures that can also lift the cheek however the recovery is a bit longer. Talk with your plastic surgeon and consider your goals, the features of your eyelids, and available down time when making the decision on what procedure might be most appropriate for you.