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Even small eyelid "bags" can create a tired, sad appearance. Many surgeons will remove the eyelid bag, which can create a hollowed, aged appearance. Better techniques use an incision located inside the eyelids and re-position the bag (which is fatty tissue) thereby creating a smooth transition from the eyelid to the cheek.
This is an example of the fat re-positioning technique used by Dr. Miller to provide a less tired, refreshed look.