Upper vs. Lower Blepharoplasty: Choosing the Right Eyelid Surgery

You’ve just had eight hours of sleep, but the first thing your friends ask when they see you the next day is, “Are you alright? You look tired.” If your eyes are making you look perpetually exhausted, consider getting an eyelid surgery, either an upper...

You’ve just had eight hours of sleep, but the first thing your friends ask when they see you the next day is, “Are you alright? You look tired.” If your eyes are making you look perpetually exhausted, consider getting an eyelid surgery, either an upper or a lower blepharoplasty.

At this point, you’re probably unsure which procedure is for you. That’s understandable. Many of our patients come to us because they as well are uncertain and want to learn more about upper vs. lower blepharoplasty and obtain a detailed assessment from our quadruple board-certified plastic cosmetic surgeon Dr. Chad Wu.

In this article, we compare upper vs. lower blepharoplasty and discuss what each procedure targets, how they differ, and how to determine which one might be right for you.

Key Takeaways

  • Blepharoplasty is a procedure that removes tissue or excess skin from the eyelids.
  • Blepharoplasty can lift or tighten the skin on the eyelids.
  • There are two types of eyelid lift surgery: upper blepharoplasty and lower blepharoplasty.
  • Upper blepharoplasty is done on the upper eyelid to shape or contour hooded eyes.
  • Lower blepharoplasty is for the lower eyelid and is done to remove eye bags and, in some cases, plump up sunken tear troughs.

Table of Contents

Blepharoplasty, also known as eyelid lift, is a surgical procedure that removes excess skin and repositions tissue, as needed, from the eyelids. It’s an eyelid rejuvenation strategy, as it tightens (i.e., lifts) the skin around the eyes and allows one to regain their youthful appearance.

There are two types of eyelid lift surgeries: upper blepharoplasty (upper eyelid lift) and lower blepharoplasty (lower eyelid lift). Choosing one or the other is essentially deciding between surgery for hooded eyelids vs. under-eye bags surgery.

Upper blepharoplasty is a contouring procedure that lifts the upper eyelids for functional or aesthetic reasons. It is performed to correct hooded eyes.

What Are Hooded Eyes?

Hooded eyes are a particular eye shape characterized by a fold of flaccid skin drooping or hanging over the lower half of the upper eyelid. When hooded eyes are open, the eyelid crease (or the entire bottom half of the eyelid) disappears under a hood of skin and fat.

Why Correct Hooded Eyes?

In severe cases, the fold of loose skin can feel heavy. Trying to lift the eyelid out of the way can induce someone with hooded eyes to constantly raise their eyebrows. This causes not only eye strain but, over time, it can lead to defined forehead wrinkles, for which you may need botulinum toxin injections.

Finally, loose skin covering the crease or the bottom half of the eyelid can make someone look older in apperance..

How Is Upper Blepharoplasty Done?

First, the surgeon plans and marks the site. Next, they apply local anesthesia (typically with sedation) to numb the area before they make a small, elliptical incision.

During the surgery, the surgeon removes the excess skin. They may also remove a little bit of fat, as needed. If the surgical plan requires, they may also perform a canthoplasty to raise the lateral eye..

Once they’re done, they stitch the incision closed.

After Upper Eyelid Surgery

After upper eyelid surgery, the skin on the eyelid will look tauter, tighter, and lifted for a more youthful appearance.

Will there be signs of the surgery? There will be bruising and swelling immediately after the surgery, but this will gradually diminish in a period of two weeks. Upper eyelid surgery scars are barely visible after a few months of recovery.

Lower blepharoplasty is an under-eye cosmetic procedure done to remove eye bags and fill the hollow of the tear trough as well as excessive skin.

What are Eye Bags and Tear Troughs?

Aging (and the resulting loss of skin and elasticity causes small pockets of fat that cushion the eyes to bulge forward. These create persistent, rounded pouches of fat under the eyes (i.e., eye bags).

The tear trough is the space between the lower eyelid and the upper cheek. As a person ages, they can lose fat or bone support in this area. The ensuing tear trough deformity leads to sunken, hollow-looking eyes.

Note: Genetics can also cause the hollowing of tear troughs.

Why Correct Eye Bags and a Deformed Tear Trough?

Eye bags make the eyes look puffy and swollen. Meanwhile, a hollowed-out tear trough casts a dark shadow over the lower eyelid.

Both are mainly superficial and harmless, but they can make one look fatigued and older in appearance. They’re also not easy to cover with makeup.

How Is Lower Blepharoplasty Done?

Lower blepharoplasty involves marking the incision site, numbing the area, and sedating the patient. The surgeon then cuts just below the lower eyelash line (sub-ciliary) or inside the lower eyelid (i.e., transconjunctival blepharoplasty).

After making the incisions, the surgeon removes the protruding fat pads to remove the under-eye bags or repositions them to add volume to the tear trough. Doing the latter allows them to remove the eye bags while plumping up the tear trough.

Excess skin is also removed, if necessary.

After Lower Eyelid Surgery

After a full lower eyelid surgery with fat removal and repositioning, the eye bags under the eyes should be gone, and the tear trough should look plumper and fuller with a significant reduction in creasing or indentation. The under-eye skin should look fairer, smoother, firmer, and less textured.

Side note: Can blepharoplasty fix dark circles? No, blepharoplasty does not fix dark circles, but filling in the tear trough can help reduce their appearance. Hollowed-out tear troughs cast dark shadows, so correcting them naturally leads to less darkness under the eyes.

Does lower blepharoplasty leave scars? Any scars should not be visible after full healing, especially if incisions were made inside the lower eyelid; transconjunctival blepharoplasty leaves no visible scars on the outer skin. For lower blepharoplasty, recovery time can take a few months, although the swelling and bruising should fade considerably in two weeks.

How do I know if I need upper blepharoplasty, lower blepharoplasty, or both?

The area of concern on your eyelids determines which procedure is right for you. Upper blepharoplasty addresses sagging or hooded skin on the upper lid that can make you look tired or, in more advanced cases, interfere with your vision. Lower blepharoplasty targets under-eye bags, puffiness, and excess skin below the eye.

Many patients have concerns in both areas and benefit from combined upper and lower eyelid surgery during a single procedure. Dr. Chad Wu will assess your eyelid anatomy, skin laxity, and aesthetic goals during a consultation to recommend the most suitable approach.

Can lower blepharoplasty improve dark circles, or is that a different issue?

Lower blepharoplasty can help improve the appearance of dark circles in cases when the darkness under the eyes is caused by under-eye bags, hollowing, or shadowing from excess fat and skin. In this case, lower blepharoplasty leads to eyelid rejuvenation and creates a smoother, brighter appearance.

However, dark circles caused by acquired pigmentation or a hereditary condition are a separate concern. In those cases, a chemical peel of the lower lids may be recommended as a complementary treatment. Dr. Chad Wu can assess whether surgery, an additional procedure, or both are appropriate during your consultation.

Where are the scars located for upper vs. lower eyelid surgery?

For upper blepharoplasty, the incision is placed within the natural crease of the upper eyelid, making the scar virtually invisible once healed. For lower eyelid surgery, the incision is made either just below the lower lash line or inside the eyelid. This technique is called the transconjunctival approach, which leaves no visible external scar at all.

How long do swelling and bruising usually last after eyelid surgery?

Most swelling and bruising after blepharoplasty subsides within one to two weeks, and the majority of patients feel comfortable returning to work and normal activities within that timeframe. However, full healing of the eyelid tissues takes considerably longer, with complete recovery typically taking three to six months.

During this period of recovery, wearing sunglasses is recommended to protect the eyes from the sun, the wind, and bright lights. Applying a cold compress in the early days after surgery may also help reduce swelling.

When can I wear makeup, contacts, and return to exercise after blepharoplasty?

Contact lenses are restricted for at least one to two weeks following eyelid surgery. Makeup on the eyes should be avoided until the incisions have healed. Light walking is okay, but strenuous exercises should be avoided for at least a month. Get your surgeon’s clearance before wearing contacts, applying eye makeup, or starting to exercise.

It depends on what issue you need to address. Deciding on upper vs. lower blepharoplasty is essentially weighing surgery for hooded eyelids vs. under-eye bags surgery.

Upper blepharoplasty is for hooded eyes. Lower blepharoplasty is for eye bags and indented tear troughs. If you have hooded eyes, eye bags, and indented tear troughs, you may have to get both procedures done. Your doctor may be able to do both at the same time.

To know for sure what surgery you need, sit down for a detailed consultation with Dr. Chad Wu.

Print page
0 Likes