Of all the procedures in facial plastic surgery, blepharoplasty — eyelid surgery — consistently produces some of the highest patient satisfaction scores. The reason is straightforward: the eyes are where aging shows itself earliest and most prominently, and the improvement from surgery is significant, relatively quick, and long-lasting.
But "blepharoplasty" is not one procedure. Upper blepharoplasty and lower blepharoplasty address completely different problems with completely different techniques. And not every concern around the eyes is best addressed surgically — some are better managed with fillers, some with Botox, and some require a combination approach. This guide will help you understand what each procedure actually does and whether you are likely to be a good candidate.
Upper blepharoplasty: What it addresses
Upper blepharoplasty removes excess skin from the upper eyelid. The ideal candidate has hooding — skin that droops over the eyelid crease and sometimes impairs the upper visual field — and a desire to restore a more open, alert, rested appearance.
The procedure is performed through a carefully placed incision within the natural eyelid crease, which makes the resulting scar essentially invisible when healed. Recovery is 7–10 days. The results are long-lasting — typically 10+ years before any further intervention might be considered.
"Upper blepharoplasty is one of the highest-value procedures in facial plastic surgery. The recovery is manageable, the result is significant, and in many patients it also produces a functional improvement in their visual field."
What upper blepharoplasty cannot do
Upper blepharoplasty corrects excess eyelid skin. It does not lift the brow. If the primary concern is a low or heavy brow position rather than eyelid skin excess, the correct procedure is a brow lift — not blepharoplasty. Performing upper blepharoplasty on a patient whose primary issue is brow descent can worsen the brow position over time.
This distinction is one of the most common errors in consultations. Always ensure your surgeon evaluates your brow position as part of the upper eyelid assessment.
Lower blepharoplasty: What it addresses
Lower blepharoplasty addresses under-eye bags — the herniated orbital fat that creates a persistent puffy appearance regardless of sleep quality or hydration. It is one of the most impactful rejuvenation procedures available for the lower eye area.
In most cases, I perform lower blepharoplasty through a transconjunctival approach — the incision is placed entirely inside the lower eyelid, leaving no visible external scar. Fat is either removed or redistributed to eliminate the bag and smooth the transition between the lower lid and the cheek.
What lower blepharoplasty cannot do
Lower blepharoplasty addresses structural fat herniation. It does not fill the tear trough — the hollow under the eye that can create a dark shadow or tired appearance. Tear trough hollowing is best addressed with hyaluronic acid filler (specifically placed by an experienced injector), not surgery. In many patients, a combination of lower blepharoplasty and tear trough filler produces the most complete result.
Signs that surgery is the right option
- Upper lid hooding that you can pinch between your fingers
- A sense that your upper eyelids feel heavy or limit your visual field
- Under-eye bags that persist regardless of sleep, hydration, or lifestyle factors
- A result you want to be permanent rather than requiring regular maintenance
Signs that non-surgical options may be more appropriate
- Tear trough hollowing (dark shadow) with no significant puffiness above
- Fine lines and texture concerns rather than structural fat herniation
- Skin quality concerns that skincare, peels, or energy devices may address