Upper Eyelid vs Lower Eyelid Surgery: Which Do You Need?

Key Takeaways: Upper vs Lower Blepharoplasty

• Upper blepharoplasty addresses hooded eyes and excess skin on the upper eyelid, while lower blepharoplasty targets under-eye bags and puffiness
• Signs you might need upper blepharoplasty include excess skin creating a fold over the eyelid crease, difficulty applying makeup, and impaired peripheral vision
• Lower blepharoplasty is ideal for persistent under-eye bags, dark circles, and excess skin creating fine wrinkles beneath the eyes
• Combined upper and lower eyelid surgery offers comprehensive rejuvenation in a single procedure but involves more extensive initial recovery
• Recovery from upper blepharoplasty typically takes 7-10 days, while lower blepharoplasty recovery may extend to 10-14 days with more pronounced swelling
• Both procedures deliver high satisfaction rates (over 90%) with results typically lasting 7-10 years
• A thorough consultation with a specialist is essential to determine which procedure will best address your specific concerns

Table of Contents

• Understanding Eyelid Surgery: Upper vs Lower Blepharoplasty Basics
• Signs You Might Need Upper Blepharoplasty for Hooded Eyes
• When Lower Blepharoplasty is Right for Under Eye Bags
• Can You Benefit from Combined Upper and Lower Eyelid Surgery?
• Recovery Expectations: Upper vs Lower Blepharoplasty Healing
• Comparing Results: Which Eyelid Surgery Delivers Better Outcomes?
• Making Your Decision: Consultation and Assessment Process

Understanding Eyelid Surgery: Upper vs Lower Blepharoplasty Basics

Eyelid surgery, medically known as blepharoplasty, is a specialised procedure designed to rejuvenate the appearance of the eyes by addressing excess skin, fat deposits, and muscle laxity. When considering this transformative treatment, it’s essential to understand the fundamental differences between upper and lower blepharoplasty.

Upper blepharoplasty focuses on the upper eyelids, targeting hooded or droopy skin that can create a tired appearance and sometimes even impair vision. The procedure involves carefully removing excess skin and fat through a discreet incision in the natural crease of the eyelid, resulting in a more alert, youthful look while preserving natural eye contours.

Lower blepharoplasty, conversely, addresses the under-eye area, specifically targeting puffiness, bags, and wrinkles beneath the eyes. This procedure may involve removing or redistributing fat deposits, tightening loose skin, and sometimes reinforcing supporting structures to create a smoother, more rested appearance.

The anatomical differences between these areas necessitate distinct surgical approaches. Upper eyelid procedures typically focus on skin removal and reshaping, while lower eyelid surgery often requires more complex techniques to address fat repositioning and skin tightening without altering the natural shape of the eye.

Both procedures can be performed under local anaesthesia with sedation, typically taking 1-2 hours depending on complexity. While they share the common goal of rejuvenating the eye area, the specific techniques, recovery considerations, and ideal candidates differ significantly between upper and lower blepharoplasty.

Signs You Might Need Upper Blepharoplasty for Hooded Eyes

Upper blepharoplasty is particularly effective for addressing hooded eyes, a condition that develops when excess skin on the upper eyelid creates a drooping appearance. Recognising the signs that indicate you might benefit from this procedure can help you make an informed decision about seeking treatment.

The most common indicators that upper blepharoplasty might be appropriate include:

• Excess skin creating a fold or “hood” over the natural eyelid crease
• Difficulty applying eye makeup due to limited lid space
• A persistently tired appearance despite adequate rest
• Visible sagging or puffiness in the upper eyelid area
• Impaired peripheral vision, particularly in the upper and outer parts of your visual field
• Forehead strain from unconsciously raising eyebrows to see better

Many patients with hooded eyes report feeling that their eyes appear smaller or that they look constantly fatigued regardless of their energy levels. This condition can be genetic, present from a young age, or develop gradually with ageing as skin elasticity diminishes and tissues weaken.

For those experiencing functional vision impairment due to severely hooded eyes, upper blepharoplasty may be considered medically necessary rather than purely cosmetic. In such cases, visual field testing can document the extent of vision obstruction, which may influence treatment decisions and potentially insurance considerations.

Upper blepharoplasty for hooded eyes effectively creates a more defined eyelid crease, removes redundant skin, and can restore a more alert, youthful appearance while potentially improving visual function. The procedure is particularly rewarding for patients who have struggled with the aesthetic and functional limitations of hooded eyelids.

When Lower Blepharoplasty is Right for Under Eye Bags

Lower blepharoplasty specifically targets the under-eye area, addressing concerns that can significantly impact facial appearance. This procedure is particularly effective for treating under eye bags, which develop when fat deposits protrude through weakened orbital septum tissue and create a puffy, swollen appearance beneath the eyes.

You might be an ideal candidate for lower blepharoplasty if you experience:

• Persistent puffiness or bags beneath the eyes that remain despite adequate sleep
• Dark circles that create a perpetually tired appearance
• Excess skin creating fine wrinkles or crepe-like texture
• Hollowness or tear troughs that create a sunken appearance
• Festoons or malar bags (fluid accumulation on the upper cheeks)
• Lower eyelid laxity causing structural changes or exposure of the lower rim

Unlike upper eyelid concerns which often develop primarily with age, under eye bags can affect individuals of various age groups due to genetic predisposition. Many patients report that these bags create an appearance of fatigue or illness that doesn’t reflect their actual health or energy levels.

Modern lower blepharoplasty techniques have evolved significantly to address not just excess fat but also its distribution. Rather than simply removing fat (which can create a hollow appearance), surgeons now often reposition fat to fill tear troughs while removing only what’s truly excessive. This approach creates a smoother transition between the lower eyelid and cheek.

For patients with primarily fat protrusion without significant skin excess, a transconjunctival approach (from inside the eyelid) may be recommended, leaving no visible external scars. Those with skin laxity may require a transcutaneous approach with an incision just below the lash line to address both skin and fat concerns.

Can You Benefit from Combined Upper and Lower Eyelid Surgery?

Many patients wonder whether they should address both upper and lower eyelids simultaneously or focus on one area first. Combined upper and lower blepharoplasty offers comprehensive rejuvenation of the entire periorbital region in a single surgical session, but determining if this approach is right for you requires careful consideration.

Combined eyelid surgery may be particularly beneficial if:

• You have significant ageing changes in both upper and lower eyelids
• You wish to minimise overall recovery time rather than undergoing two separate procedures
• Your upper and lower eyelid concerns create a harmonious ageing pattern that would benefit from simultaneous correction
• You have realistic expectations about the more extensive recovery associated with combined procedures
• Your overall health supports a slightly longer procedure under anaesthesia

The advantages of combined surgery include a single recovery period, cost efficiency compared to separate procedures, and harmonious results across the entire eye area. Additionally, addressing both areas simultaneously often creates more balanced facial rejuvenation, as ageing rarely affects just one portion of the periorbital region.

However, combined procedures do involve more extensive swelling and bruising during recovery. The total healing time may not necessarily be longer than individual procedures, but the initial recovery phase may be more pronounced. Patients should be prepared for approximately 10-14 days of noticeable swelling when both areas are addressed simultaneously.

For some patients, a staged approach may be preferable—particularly if one area presents more significant concerns than the other, or if there are specific health considerations that make a shorter procedure advisable. During your consultation, your surgeon will evaluate your unique anatomy, discuss your aesthetic goals, and recommend whether combined or staged procedures would best achieve your desired outcome.

Recovery Expectations: Upper vs Lower Blepharoplasty Healing

Recovery experiences differ significantly between upper and lower blepharoplasty procedures, with each presenting unique healing considerations. Understanding these differences can help you prepare appropriately and set realistic expectations for your post-operative journey.

Upper Blepharoplasty Recovery:

• Initial swelling and bruising typically peak within 48 hours
• Sutures are usually removed between 5-7 days post-surgery
• Most patients can return to desk work within 7-10 days
• The incision in the natural eyelid crease typically heals with minimal visible scarring
• Complete resolution of subtle swelling may take 2-3 weeks
• Sensation changes along the incision line generally resolve within 3-6 months

Lower Blepharoplasty Recovery:

• Swelling tends to be more pronounced and persistent compared to upper eyelid surgery
• Bruising may be more visible and last 10-14 days on average
• Return to work typically takes 10-14 days for most patients
• Transconjunctival approaches (from inside the eyelid) heal without visible external scars
• External approach incisions beneath the lash line typically fade significantly within 3-6 months
• Residual swelling, particularly in the morning, may persist for several weeks

For both procedures, sleeping with the head elevated for the first week helps minimise swelling. Cold compresses are typically recommended for the first 48 hours, followed by warm compresses to promote circulation and healing. Sun protection becomes essential once incisions have healed, as new scar tissue is particularly vulnerable to hyperpigmentation.

It’s worth noting that lower eyelid surgery generally requires more careful post-operative management to prevent complications like lid malposition. Patients may need to perform specific eyelid exercises or massage techniques as directed by their surgeon to ensure optimal healing and positioning.

The blepharoplasty recovery timeline varies between individuals, with factors such as age, skin type, surgical technique, and adherence to post-operative instructions all influencing healing progression. Most patients find that the temporary discomfort and social downtime are well worth the long-lasting rejuvenation achieved.

Comparing Results: Which Eyelid Surgery Delivers Better Outcomes?

When evaluating which eyelid procedure might deliver superior results, it’s important to understand that “better” is entirely subjective and depends on your specific concerns and aesthetic goals. Both upper and lower blepharoplasty can provide dramatic improvements, but they address fundamentally different aspects of periorbital ageing.

Upper blepharoplasty typically delivers excellent results for:

• Creating or restoring a visible eyelid platform for makeup application
• Eliminating the heavy, hooded appearance that contributes to a tired look
• Improving peripheral vision when excess skin has created functional limitations
• Creating a more alert, refreshed appearance
• Addressing asymmetry between upper eyelids

Lower blepharoplasty excels at:

• Smoothing the transition between the lower eyelid and cheek
• Reducing or eliminating under-eye bags
• Minimising dark circles caused by shadowing (though pigmentation-related dark circles may require additional treatments)
• Correcting festoons or malar bags that create a chronically puffy appearance
• Addressing hollowness in the tear trough area through fat repositioning

Patient satisfaction rates are consistently high for both procedures, with studies showing over 90% of patients reporting satisfaction with their results. The longevity of results is comparable, with both procedures typically lasting 7-10 years before natural ageing may prompt consideration of revision.

When comparing before and after results, many patients find that upper blepharoplasty creates more immediately noticeable changes in facial appearance, as it directly affects the visible portion of the eye. Lower blepharoplasty results, while equally significant, can sometimes be more subtle—creating a rested, refreshed appearance rather than an obviously different look.

The most dramatic transformations often come from combined procedures that address the entire periorbital region, creating harmony between upper and lower eyelids. This comprehensive approach ensures balanced rejuvenation that appears natural and avoids the disconnected look that can occur when only one area is addressed while significant ageing changes remain in another.

Making Your Decision: Consultation and Assessment Process

Deciding between upper blepharoplasty, lower blepharoplasty, or combined procedures requires thorough assessment and expert guidance. The consultation process is a crucial step in determining which approach will best address your specific concerns while delivering natural-looking results.

During your initial consultation, expect a comprehensive evaluation that includes:

• Detailed facial analysis examining the position of your brows, eyelid skin quality, fat distribution, and underlying muscle tone
• Discussion of your aesthetic goals and what specifically bothers you about your eye area
• Review of your medical history, including eye conditions, previous surgeries, and medications
• Examination of tear production and eye function to ensure surgery won’t compromise eye health
• Digital photography to document your current appearance and assist in surgical planning
• Discussion of realistic expectations and potential limitations based on your unique anatomy

A qualified plastic surgeon specialising in blepharoplasty will help you understand whether your concerns stem primarily from eyelid issues or if adjacent structures like the brow position or midface are contributing factors. Sometimes what appears to be an upper eyelid issue may actually be caused by brow ptosis (drooping), which would require a different approach.

The consultation should include a thorough discussion of costs, which typically range from £3,000-£5,000 for single procedures and £5,000-£8,000 for combined upper and lower blepharoplasty in London. These figures vary based on complexity, surgeon expertise, and facility fees.

When selecting a surgeon, prioritise those with specific expertise in oculoplastic or ophthalmic plastic surgery. Review their blepharoplasty before and after portfolio, focusing particularly on patients with similar concerns and facial structures to yours. The ideal surgeon will present all available options—including when non-surgical alternatives might be appropriate—rather than pushing a one-size-fits-all approach.

Remember that blepharoplasty is a highly individualised procedure. The right choice depends not