Freshening Up Droopy Eyes

By Dr. Hugo Higa
Interviewed by Rasa Fournier
Wednesday - May 04, 2011
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Dr. Hugo Higa
Opthalmologist and Oculoplastic surgeon at the Aesthetic Vision Center

Where did you receive your schooling/training?

I did my undergrad at UCLA and went to the University of Wisconsin-Madison for my medical schooling. I came back to Hawaii for my transitional intern year and then moved back to Wisconsin for my opthalmology training. I then moved to Australia for training in corneal surgery and plastic surgery of the face, and returned to Hawaii to start my practice and make it my home.

How long have you been practicing?

Almost 14 years in Hawaii.


Can you talk about your role as an oculoplastic surgeon?

One of the biggest advantages of being in oculoplasty - or plastic and reconstructive surgery to the eye and surrounding areas - is that I’m still an ophthalmologist. When I do an eyelid surgery, I understand how to avoid any problems with the eye and vision.

What does eyelid and under-eye surgery involve?

Deciding to have eyelid surgery is important to my patients for their appearance, as well as their vision. The primary eyelid procedures I do are ptosis and blepharoplasty.

Ptosis occurs when the levator muscle is not lifting the eye up to the proper position. There are several causes of ptosis including aging, cataract or other eye surgery, injury or an eye tumor. People who wear gas permeable contact lenses also are at higher risk of developing ptosis before age 60 because of the way they put their lenses in and take them out - pulling the lid to pop them out. Usually, a small tuck in the levator muscle can make the eyelid raise the lid sufficiently.

Dr. Hugo Higa measures the height of Deborra Montgomery’s eyelid. Nathalie Walker photo .(JavaScript must be enabled to view this email address)

Blepharoplasty is one of the most in-demand cosmetic surgeries, most commonly performed to treat under-eye bags, which can make you look tired and older. Fat is removed or redistributed and, if needed, under-eye skin wrinkles may be smoothed with a laser. Blepharoplasty may be used for upper lids as well.

Do you do mostly functional or cosmetic surgery?

I do more functional surgery, but there is a transition happening where the cosmetic surgery side has been growing steadily each year. Many of my medical patients come in, and once they can see clearly, they comment on how old they look and become cosmetic patients. Many women - and men, recently - come in purely for cosmetic. Our patients become our best advertisement when they have good surgery results.

Any other important procedures that you do?

As an ophthalmologist, I treat changing vision, cataracts, glaucoma, macular degeneration and other conditions of the eye. One thing I’ve been seeing a lot of lately is blepharitis (inflammation that can be a symptom of dry eyes). Tears are made up of oil, mucus and water. Most people treated for dry eyes are treated for the water portion, so they are given eye drops and medications to increase the tearing. The oil portion of the tears is not addressed. In addition to the tear drops, I put people on a protocol to increase the oil release mixing into the tear. This actually keeps the tear on the eye longer and prevents it from dehydrating, because oil prevents the water from evaporating. This is important when I do my eyelid surgeries as well. After eye surgery, one’s eyes may initially be more exposed and they can have difficulty with dryness. People who have droopy lids have been kind of protected by the overhanging lids. Once you do the surgery, their eyes are more exposed, so most patients will start to have problems with dryness. I address that as well.

Is the scar visible?

With upper eyelid surgery, I carefully measure where I’m going to put the crease, mark it, and make the incision in that crease line. After surgery, the scar will be in that crease and the skin above it will hide the scar. In the course of about a year the scar fades anyway. With the lower lids, I like to do my surgeries externally, from the outside, usually along the lash line. Because the skin is so thin there, it rarely scars.

Can you say something about expectations and reality?

Generally, eyelid surgery lasts for a number of years. The important thing to know about plastic surgery is that you’re “resetting” that area to a certain time period. Natural aging is still going to continue from there, so you need to take care of yourself and realize that you may want to repeat these surgeries in the future to maintain the youthful look.


Communication is crucial, and I explain to my patients what we can expect as well as the limitations, and that really helps with the outcome. The worst thing is to tell a patient who is 50 or 60, “We’re going to make you look 20 years younger!” We can do a great, natural-looking job, but it’s wrong to give unrealistic expectations.

There really is no age limit to having eyelid surgery. Usually, patients are between 35 and 70. The older patient may suffer from droopy eyelids and surgery may be covered by insurance if the lid impairs vision. When patients are younger, it’s usually cosmetic and not covered by insurance. However, a lot of my patients choose to combine cosmetic with insurance procedures. I’ll do an upper lid surgery covered by insurance, and I’ll do the lower lids, which are not covered by insurance. It’s a lot easier to combine surgeries at one time than it is to do them separately.

Some people just want to look better, not necessarily younger, but like they’re less tired or they want to look their age rather than looking older than they are. I have a patient who was born with droopy eyes and all her life people have told her she looks tired. Some people have under-eye bags when they get older, others may be born with them, so aging is not always the factor.

Cosmetic surgery consultations are complimentary. Potential patients can make an appointment to talk about their options with no pressure at all.

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