Should I Get an Eye Lift?

When it comes to aging, eyes are often the first thing to go. I remember putting in contact lenses for the first time in my thirties and having a bit of a jump scare when I saw my reflection clearly after years of blurry vision. Who was this tired-looking woman staring back at me? At the time, I was a young mom, not getting much sleep, and I had the dark circles and puffiness to prove it. Fast forward to 54, and things have escalated. My upper lids, always slightly hooded, now have a distinct Basset Hound quality: heavy, a little mournful, faintly pleading.

The skin around the eyes is the thinnest on the body, which is another way of saying it doesn’t forgive much. It sags, it hollows, it puffs. It remembers every late night, every allergy, every questionable decision involving tear-trough filler.

Julius Few, MD, trained specifically in the eye area (it’s what he did his fellowship in) and has spent more than 25 years focused on it. He has, unsurprisingly, a lot to say about what happens to the eye area as we age—and what, if anything, is worth doing about it.

A Q&A WITH JULIUS FEW, MD

Amy Synnott: Let’s start with the basics: how aging manifests in the eye area, when it begins, and how it differs by genetics.

Julius Few, MD: The aging process is rooted in anatomy. The eyelid skin is the thinnest on the body. It’s essentially the top coat of the eye structure, and because it’s so thin, it’s vulnerable. Sun exposure, genetics—all of it shows up here first. The skin pigments easily, wrinkles easily, and becomes crepey because collagen and elastin break down starting in the late 20s.

More and more people are coming in focused on their eyes. It’s often ignored in non-surgical treatments, and some of those treatments actually make things worse. One of the biggest issues I see is injector-induced problems. For example, over-treating the forehead with Botox can weigh down the brows and make the eyes look worse.

A.S.: That’s happened to me. I have hooded brows, and if someone hits the wrong muscle, everything drops. It really comes down to knowing anatomy.

J.F.: Exactly. For patients under 45, I’d say at least half the time, that’s the root issue. When they let the Botox wear off, things improve.

Skin type also matters. Lighter skin tends to wrinkle faster; more melanin-rich skin shows wrinkles later but has different aging patterns. In one study I conducted comparing ethnic groups, patients of African ancestry showed greater brow descent but less wrinkling. That’s why treatment should be based on presentation, not age.

Another key point: Brow position comes first. You can’t just do an upper eyelid lift without evaluating the brow. If you ignore it, you can create a problem that’s very difficult to fix.

A.S.: I think this explains why some people in the public eye look so different after surgery. The hooded eye is part of their identity. When it’s gone, they don’t look like themselves.

J.F.: It comes down to proportions. The relationship between the brow, the eyelid crease, and the lash line must remain consistent. If surgery alters those ratios, even subtly, the person won’t look right. You may not know why, but you’ll see it.

The goal is to improve someone without changing who they are. That’s the art.

A.S.: So, in the right hands, this is doable?

J.F.: Absolutely. It’s about expertise. You should look at before-and-after photos and make sure patients still look like themselves—just better. If that’s not evident, walk away.

Also, being a great facelift surgeon doesn’t mean someone is great at eyelids. The anatomy is different, and the eyes are far less forgiving.

A.S.: That’s interesting because in facelift reporting, the emphasis is often on doing everything at once—face, neck, eyes.

J.F.: You can absolutely do eyes alone. It doesn’t create a mismatch. But doing the face without addressing aging eyes can look odd. Eyes are central and precise; millimeters matter. Overdo them even slightly, and it shows.

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The relationship between the brow, the eyelid crease, and the lash line has to stay consistent. If surgery alters those ratios, even subtly, the person won’t look right. You may not know why, but you’ll see it.

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A.S.: Let’s talk skincare. Do you need a dedicated eye cream, or can you use your face products?

J.F.: You need something formulated for eyelid skin. It’s more sensitive and prone to irritation. Peptide-based formulas designed not to cause congestion are ideal.

Prevention should start in your 20s. I’ve seen identical twins age very differently based on sun exposure and skincare habits. Sunscreen around the eyes is critical.

A.S.: So what’s a good routine?

J.F.: Daytime eye cream should ideally include SPF. If you’re using something like vitamin C, you need sun protection on top of it.

At night, a peptide-based cream works well. Retinol can be used, but very cautiously—it’s easy to irritate the eyelid skin.

A.S.: What about devices—LED masks, lasers, all of that?

J.F.: They offer temporary benefits by improving circulation. To maintain results, you need to use them daily.

A.S.: Before resorting to plastic surgery, what are some in-office treatments that actually work?

J.F.: Radio frequency, focused ultrasound—like Ultherapy—and lasers can all help tighten skin. I’ve personally had Ultherapy around my eyes, and it helped with puffiness.

A.S.: Cost?

J.F.: Around $1,500 to $2,000 for the eye and cheek area.

A.S.: And lasers?

J.F.: Halo or ProFractional are strong options. For just the eyes, it’s typically $2,500 to $3,000. One treatment can deliver meaningful results, but downtime is about five to seven days.

A.S.: I want to ask about under-eye filler. I had it years ago, and now I have a visible divot when I smile.

J.F.: This is very common. I follow an “85 percent rule”—you never fully fill the tear trough. Filler in this area can swell over time, especially because of the lymphatics. About 25 percent of people are prone to puffiness there.

If someone wakes up with puffy eyes, I would never use filler.

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Being a great facelift surgeon doesn’t mean someone is great at eyelids. The anatomy is different, and the eyes are far less forgiving.

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A.S.: I am wildly allergic to cats and just spent a week in close quarters with two of them, and the area right under my eyes blew up like a balloon. Should I dissolve the filler?

J.F.: Yes. I do that frequently. The downside is the skin may look more wrinkled afterward, but it’s usually worth it. If needed, you can address that with a laser.

A.S.: Even years later, the filler is still there?

J.F.: I've seen filler last in this location for a decade.

A.S.: Is there anything else new or emerging? I recently heard about something called “jelly roll Botox.”

J.F.: Jelly roll Botox is very specific. It’s for people with hyperactivity along the lower lash line. That muscle can push fat forward, making puffiness more noticeable. Relaxing it can smooth the area.

But it’s overdone. In younger patients, especially, I don’t think it’s necessary. It’s become a bit of a fad.

A.S.: We talked about filler risks in the tear trough. Is there any scenario where you would use filler around the eyes?

J.F.: Yes, but very conservatively. If someone is a true candidate—no chronic swelling, clear tear trough—I might use a third of a syringe and discard the rest.

The problem is that most injectors feel they need to use the whole syringe. That’s where things go wrong. The key is not being afraid to throw product away.

A.S.: And with Botox...you mentioned that where you don’t inject is just as important as where you do.

J.F.: It’s critical. If you overtreat the forehead, you weigh down the brows. That’s what creates a worse-looking eye.

I prefer to treat the lateral areas and the glabella carefully, but preserve enough movement so the brow can sit naturally. If you don’t respect that balance, you create heaviness.

I’ve seen Botox last there for a decade. There’s very little movement in that area, so it just sits there.

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Eyes are central and precise; millimeters matter. Overdo them even slightly, and it shows.

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A.S.: When it comes to surgery, where do you start?

J.F.: Most patients address both upper and lower eyelids. But everything starts with proper assessment. You’re looking at brow position first, always. Then skin excess, then fat herniation. If you don’t evaluate in that order, you can make mistakes that are difficult to correct.

A.S.: If someone comes in for surgery—upper, lower, or both—what does that actually look like in terms of cost, timing, and recovery?

J.F.: Recovery depends a lot on the surgeon’s technique. I’m expensive. The upper and lower eyelids together typically cost $25,000 to $30,000. National averages are closer to $10,000 to $15,000.

Most of my patients can wear makeup, everything but mascara, after one week. By two weeks, they’re very presentable. Glasses help hide any residual signs.

A.S.: That’s actually a good trick. If someone just does uppers, how quickly can they be back at work? What do they look like the next day?

J.F.: The next day, there's usually puffiness and light bruising. By seven to eight days, most people who’ve done just uppers can be back at work.

A.S.: So realistically, you need about a week. Not something you do and go back the next day.

J.F.: Correct. Not without explaining it.

A.S.: When you show patients before-and-after photos, what should they be looking for?

J.F.: They should look like the same person—just cleaner. That’s the goal.

You remove excess skin, reduce puffiness, and restore proportion. The identity should remain intact.

A.S.: Some of the examples you showed are subtle, but others are more dramatic.

J.F.: Exactly. It depends on what you’re correcting. If it’s just skin, the change is subtle. If there’s fat herniation (puffiness) that’s more noticeable because you’re removing volume as well as tightening skin.

A.S.: So the through line in everything you’re saying is restraint.

J.F.: Restraint and precision. This is an area where millimeters matter. It’s less forgiving than almost anything else in the face.