Revisionary surgeries are always more difficult than surgery on an area never touched. For eyelids this concept holds even more. There is minimal excess tissue around the eye. when operating a second time on eyelids, specially the lower eyelids, a good understanding of what was done in the last surgery is very important. The question becomes, is there lack of tissue or excess tissue, most commonly the problem is not excess fat but rather lack of fullness and hollowness that occurs with age or due to too much tissue having been removed. As an experienced Sacramento plastic surgeon I always have patients look at photos from 20 to 30 years a go to see the extent of volume loss. A good outcome in eyelid surgery involves replacing this loss with micro fat grafting along with tightening as needed, not just the old technique of removing what may look like excess tissue but is not. When undergoing repeat surgery bring photos of yourself from different years and also inform your surgeon of any previous surgery whether performed in Sacramento or not like it.