Upper or lower blepharoplasty: which one you need
Upper and lower eyelid surgery correct different problems through different incisions. This explains what each addresses, how the approaches differ, and when both are done together.
Blepharoplasty is often discussed as one operation. It is two. Upper and lower eyelid surgery address different anatomy, use different incisions and answer different complaints, and knowing which applies to you is most of the decision.
Upper blepharoplasty
The upper lid operation treats excess skin. As the skin loses elasticity it forms a fold that hoods the lid and, where it is marked, encroaches on the upper field of vision. The operation removes that excess skin, sometimes with removal or repositioning of fat, and occasionally with tightening of the underlying muscle.
The incision is placed in the natural crease of the upper lid, so the scar sits where the lid folds and is not visible with the eye open. Where the hooding was significant, patients notice a change in the field of vision as well as in appearance.
Lower blepharoplasty
The lower lid operation treats the bulge below the eye — the herniated fat pads that read as bags, together with the crepe skin and the hollow at the lid–cheek junction. Fat is removed or repositioned, and the skin is redraped.
Two approaches exist:
- Transcutaneous. The incision runs just below the lash line. It allows both fat and skin to be addressed.
- Transconjunctival. The incision is placed inside the lid, leaving no external scar. It suits patients who need fat addressed but have no real excess of skin.
Choosing between them
The complaint decides. Heaviness of the upper lid, a fold that rests on the lashes, or an obstructed upper field of vision points to the upper operation. Bags, puffiness and shadowing below the eye point to the lower one. A considerable number of patients have both, and both are then done at the same sitting.
The two are not interchangeable: an upper blepharoplasty will not improve under-eye bags, and a lower blepharoplasty will not lift a hooded upper lid.
Recovery
Both involve swelling and bruising. The instructions are the same in each case — keep the head elevated, use cold compresses in the first days, and avoid strenuous activity for the period your surgeon specifies. Upper lid recovery is generally the quicker of the two; the lower lid takes longer to settle. In both, the early appearance is not the result: swelling resolves over weeks and the scars continue to mature over months.
The procedure this relates to
Surgery to the upper eyelid, the lower eyelid or both, removing or repositioning skin, fat and muscle. It is done to soften the changes that come with age, and where drooping upper lids obstruct the field of vision.
Before you act on this
Everything here is general. What applies to you depends on your anatomy, your history and what you are trying to achieve, and none of that can be assessed from a page. If a question here is yours, bring it to a consultation.