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Trimming the fat… or putting it to good use? city, state

Eyelid Rejuvenation

face of a young woman with blond hair tight at the back

There is a particular look to an overdone eyelid surgery, where all the fat around the eye has been removed. It looks hollow – likes the eyes are set back too deep – and patients can look tired or even ill. Though each patient is unique and requires an individualized approach to eyelid rejuvenation, I have found that some basic rules of thumb apply. In general, rejuvenation of the upper eyelids is primarily a skin procedure. Almost no fat should be removed in the great majority of cases, and when fat is removed, it’s usually the fat closest to the nose.

This helps to avoid the “scooped out” appearance and an apparent over-elongation of the upper eyelid. The result is a much more natural contour – and greater ease applying makeup to highlight the eyelids and lashes!

The lower eyelids are less straightforward. Many patients have fullness or “bags” under the eyes, particularly right under the eye and laterally. In some patients, even if they have “bags,” a hollow area is seen toward the nose (sometimes called the “tear trough” region). Lastly, there may be extra skin or redundant lower eyelid muscle as well. In many cases, surgeons recommend removal of the fat from the lower eyelid region from inside the eyelid (transconjunctival approach). This is sometimes paired with a trim of a tiny amount of skin under the lashes, or, in some cases, addition of fat taken from elsewhere on the body. In the former case, removing the fat from the lower eyelid region can actually make the eyes look older and more hollow. In the latter case, addition of fat from other parts of the body is unpredictable – it can lead to undertreatment, overtreatment, unevenness between sides, or no results at all.

In my practice, I recommend a lower eyelid procedure that uses the fat pads already present under the eye to fill in the tear trough. This fat is guaranteed to survive, since it remains attached to its blood supply; plus, it’s almost always just the right amount. Next, I lift the skin of the lower eyelid and upper cheek region, removing the excess by the outer corner of the eye. This helps to improve the lower eyelid contour, gets rids of folds and wrinkles, and avoids the hollow look that can happen with other approaches. Most importantly, the results look natural.

For more information about surgical and non-surgical rejuvenation, please visit or call 415-550-1077 today for a comprehensive consultation!

Evan R. Ransom M.D.
Board Certified Facial Plastic & Reconstructive Surgeon

Our Patient Reviews

San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery

5 / 5.0

Based on 23 reviews

Christina G.

I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!

Tk I.

I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!

Joey B.

I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.

Edward T.

Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.

Lisa C.

Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.

Cheryl H.

Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.

Jill P.

I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.

Arielle C.

Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.