Hollowness under the eyes often creates a very drawn or tired appearance. In order to correct this it is important to understand the aging process. Essentially when one ages, the lower eyelid complex goes from a shorter/fuller appearance to a deflated elongated lower eyelid. There can often be puffiness or excess skin of the lower eyelid. Everyone is different regarding the components of their lower eyelids that make them look tired. Blepharoplasty is essentially a generic term that describes the surgical procedure to improve the cosmetic appearance of the lower eyelids. In almost all of our patients we do incorporate a fat transfer or lipo-transfer procedure with blepharoplasty since this addresses the hollow or deflated area. Many times the patients do have a small amount of skin removed. If there is a large lower eyelid bag or puffiness, this is addressed as well. In summary, the approach that we use with blepharoplasty is different in almost every patient because it is important to tailor the approach to the particular patient’s anatomy so as to leave them with a rested appearance to the lower eyelids. In many patients this requires a fat transfer but it is not unusual to incorporate other techniques in conjunction with that to achieve the results we are looking for.