Complimentary Nurse Consult -- There are two main methods of reducing lower eyelid bagginess and loose skin. The first method is via the inside of the eyelids and for use in those with baggy eyes, but not a lot of loose skin. Some patients may have minimal loose skin and laser can be employed to reduce the wrinkles and tighten the loose skin to some degree. For those with excessive loose skin an outside the eyelid procedure is employed. This can be a full incisional blepharoplasty, or a pinch blepharoplasty. The latter is preferred in most cases because tightening the outer eyelid excessively can pull the eyelid margin outwards, causing irritation and tearing to the eye. Adjunctive procedures are then needed which are better avoided. For the upper eyelid, the procedure can include excision of skin, muscle and fat, or just the main component that is causing the loose skin. As mentioned previously, a brow lift or forehead thread lift is sometimes needed to elevate the eyebrows. The important point of this procedure is not to take excessive skin or tissue out, causing the eyelid to not close. The patient at one year should review to see if any extra tissue should be removed, as the aim here is to get the correct amount out, not an excessive amount. Many patients think the upper eyelid is the problem when it can, in fact be the brow and fore lid that is actually sagging down. Unfortunately for some patients, they not only have heavy eyelids, but a heavy brow. This is seen quite frequently. Some patients wish to only address one area, and they must be realistic as this is not addressing the whole problem. During the consultation this will be explained as it is an extremely important concept to understand. The lower eyelid also has some peculiarities that need to be understood. Many patients think they have they have eye bags, when in fact they have troughs or tear troughs.