Interview | What to do About Sagging Eyelids

As you may imagine, I am asked often about what to do about sagging eyelids. Since eyes are quoted as being “the windows to the soul” people start to worry as they age that their lids are sagging and they always look tired. Besides eye creams, serums and gadgets, I decided to seek the opinion of a medical expert who deals with reversing the effects of aging eyes. I turned to Dr. Andrew Barnett, a top Plastic Surgeon in San Francisco for the answers.

Dr. Barnett is a board-certified plastic surgeon who takes a unique approach to the art of surgery. Dr. Barnett utilizes his passion for sculpting and painting to beautifully shape his patients’ appearance. He completed his undergraduate training at Yale University before attending Johns Hopkins University School of Medicine. A life-long artist, Dr. Barnett employs his aesthetic senses to find balance in surgery.

Dr. BarnettDr. Barnett, would you tell me about eyelid surgery; what are the benefits of it?

Shelley, it’s a pleasure to speak with you. Scientific studies have shown that when you interact with another person 80% of the time you are looking at their eyes. The appearance of your eyes is critical – perhaps the single most important part of your face. Think about cosmetics – the drama is always in the eyes. When I say “eyes”, I mean the eye itself and the frame – the eyelids, the eyebrows, and upper cheek.

Eyelids express emotion. Your eyelids can make you look tired, angry, sad, or happy, energized, and engaging.

Eyelid surgery, addressing either the upper eyelids or the lower eyelids, or both, is designed to make your eyes more attractive. In some patients, that means reversing the signs of aging – in others, it’s changing the overall shape – and in some, it’s both.


eyelid surgery

What are some of the main concerns that your patients express?

The number one fear that patients express is the concern about looking “done” – the overly open, surprised look. That should never happen. In my practice, safety is first, looking natural is second, and what the patient wants is third. That means that I will do everything that I can to get you the look you want, as long as it’s safe AND it looks natural.

Another concern is looking hollow.  This can occur when too much fat is removed from either the upper or lower eyelids.  Many patients have an interesting situation where they have eyelid bags on the lower lids – fat pockets that bulge out (and that fat needs to be removed at surgery).  But they also have lost fat in the area we call the “tear trough” – the diagonal line from the inner corner of your eye running down to your cheek.  So in some cases, we remove the fat pads and fill the tear trough.  Overall, most surgeons are being more conservative about fat removal to prevent the hollow look.

Another concern is an injury to the eye.  This is very uncommon and should not be a major concern to patients.

What results are your patients expecting?

Some patients have very specific desires and expectations. They come to the office with photos of celebrities or models and say – “I want my eyes to look like hers”. Other patients say “I want to look more rested” or “I don’t want to look sad”, or “My eyes are making me look old.” The benefits of going to an expert are that he or she will work with you to first define what you want, and then to create a surgical plan that will get you as close to your desired look as is physically (and safely) possible.

How important is the consultation with regards to building relationships with your patients?

The consultation is critical. The first visit is education – and education goes both ways. My patients first educate me on what they want, and then I educate them on what can be done, how it’s done, what the recovery will be like when they’ll look presentable, when they’ll look good, and when they’ll look great. Doctor’s unwilling to spend time with their patients before surgery may deliver a technically excellent result that is not what their patients want. I occasionally have patients that don’t know what they want – they just want to look better. Spending time with them – asking questions, showing photos – lets us both define the desired outcome. Time is critical.

Do you feel that your approach is different than that of a traditional cosmetic surgeon due to your passion for painting and sculpting?


eyelid surgery


I firmly believe that without studying art one can’t create beauty.  When one studies painting and sculpture, one learns about low light and high light, shapes, mass, balance, and aesthetics.  I was always amazed that in my years at Stanford during my plastic surgery training there was very little discussed about these issues – yet Stanford has a spectacular collection of Rodin sculptures which taught me so much.

When I was in medical school at Johns Hopkins, I taught anatomy classes to students at the Maryland Institute of Art.  I’d do dissections to show them how the muscles, bones, and fat under the skin created shadows and highlights on the skin.  After class, we’d often sit, drink coffee, and discuss where the magic and beauty in certain famous classical paintings and sculpture came from.  Every time I enter the operating room, I think about beauty.

How do you prepare for a case?

The preparation starts with the first consultation – I first have to understand my patient’s goals. Once we’ve collaboratively created a plan – I study the patient in person and in the photos that I take. Having performed thousands of eyelid surgeries, it’s rare that I encounter something truly new or different, but eyelid surgery is not cookie cutter surgery – without listening to my patient, and studying the entire face, I cannot come up with a plan that allows me to produce the lovely, elegant, balanced result that I strive for.

I learned that you operate with a very efficient team of surgical techs, nurses, anesthesiologists. Tell me about how working with such a tight-knit group influences your outcomes.

I’ve been working with the same group of nurses, OR technicians, and anesthesiologists for over two decades.  Efficiency in the mechanics of the surgery, which comes from working with a tight-knit group, allows me to take the time to focus on the artistry of surgery.

Will you please describe the healing process? When does the patient see the positive changes?

Some changes are apparent immediately after the surgery, but in general, I tell my patients that it will be a few weeks before they see a truly positive result. Most patients take 5-7 days off from work but even at that point, they are not looking their best. By two weeks they are seeing positive results and at 6 weeks they are ready for photos.

How do you want patients to feel six months after surgery?

The most common response from patients at six months is frustration that they waited so long to have the surgery. “Why didn’t I do these years ago?” Eyelid surgery, when done well, has extremely high satisfaction. Often at six months, my patients will say… “What else can we do?” That means they are happy – and that makes me happy!

To find Dr. Barnett, you may visit his website or call the office 415-855-4115 where his lovely office team, Laurie and Renee will assist you and put you right at ease.

Thank you for reading The Freckle blog! Please subscribe to stay informed of all things relating to skin care. Also, check out my website and YouTube channel for product news and recommendations.

Shelley Skin Care
Your Guide to Good Skin


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