It’s been well over a decade now that we’ve come to appreciate the major role that volume loss plays in the appearance of facial aging. But prior to that, the best institutions, the textbooks and the journals were still teaching us that excess fat in the lids was a major culprit and that it needed to be rather enthusiastically removed. Aside from the foundational understanding that we tailor each procedure to the individual and that at least some minor amount of fat removal is a part of many upper and lower lid blepharoplasties, we are a lot smarter now than in decades past about preserving volume around the eyes and lids.
So the short answer to your question is “Yes”. However, we have certainly evolved in our techniques so that should no longer be an issue. Know however, that just having birthdays causes our eyes to sink somewhat. As I’ve discussed (probably ad nauseam to most of my patients), our skulls shrink significantly over time and we can see from imaging reconstructions that the body of the skull gets smaller and all the holes -- that would include the orbits (eye sockets) – get bigger. And that’s part of the reason why our eyes tend to sink back and down, even without any help from an old-fashioned blepharoplasty.
On the other hand, the “sags and bags” of aging lids can make us look and even feel tired or sad; and a well-done blepharoplasty can wake up the entire face and be immensely life-affirming.