Face · 8 min read · February 28, 2026

Upper vs. Lower Blepharoplasty: Which Eyelid Surgery Is Right for You?

Cited Research

Few procedures change the way a person looks rested, alert, and youthful as quickly as eyelid surgery. Yet the question we hear most often in consultation is almost always the same: do I need my upper eyelids done, my lower eyelids done, or both? The honest answer depends on anatomy, age, ethnicity, and the specific complaint that brought you to the mirror in the first place.

What blepharoplasty actually treats

Blepharoplasty is the surgical recontouring of the eyelid skin, muscle, and fat. It is not a brow lift, it is not Botox, and it does not address the under-eye hollow created by tear-trough volume loss alone. According to the American Society of Plastic Surgeons, more than 325,000 eyelid procedures were performed in the most recent reporting year, making it one of the top five cosmetic surgeries worldwide.

Upper blepharoplasty — for the heavy, hooded lid

Upper-lid surgery removes a precise crescent of redundant skin and, when needed, conservative pockets of orbital fat. The incision is hidden inside the natural lid crease and typically heals to a near-invisible line within three months. Patients who benefit most are those whose upper-lid skin touches or crowds the lash line, who feel they look tired even after a full night's sleep, or who have begun adjusting their eyeliner technique to compensate for hooding.

Lower blepharoplasty — for bags, hollows, and crepey skin

Lower-lid surgery is more nuanced. The contemporary approach is rarely about removing tissue and almost always about repositioning fat from the bag into the tear-trough hollow beneath, restoring a smooth lid-cheek transition. A transconjunctival approach (incision hidden inside the lid) leaves no external scar, and skin tightening can be added with a pinch excision or laser resurfacing if needed.

Combined upper and lower — when both make sense

Approximately 40% of our blepharoplasty patients in the 50–65 range benefit from a combined approach. Doing both at the same time means a single recovery, a single anesthesia event, and a more harmonious result — the upper lid is no longer the only refreshed feature on the face. Recovery for combined surgery is typically 10–14 days of visible bruising, with final settling at three months.

How recovery actually feels

  1. 01 Days 1–3: cool compresses, head elevated, minimal bruising for upper-only patients.
  2. 02 Days 4–7: sutures removed; bruising peaks then fades; most patients are presentable with light makeup by day 10.
  3. 03 Weeks 2–6: incisions pink, gradually fading; light exercise resumes at week 2.
  4. 04 Months 3–6: final scar maturation and settling of contour.

What modern eyelid surgery does NOT look like

The 'pulled', wide-eyed look of older techniques came from over-resecting skin and fat. Today's standard, supported by the published outcomes literature on PubMed, prioritizes preservation: keep the orbicularis muscle, reposition rather than remove fat, and respect the patient's ethnic and individual eyelid identity. This is especially critical in Asian blepharoplasty, where the goal is refinement, never Westernization.

Choosing the right surgeon

Look for a surgeon who photographs every patient pre-op, who shows you a wide variety of healed results (not just the photogenic ones), and who is willing to tell you when surgery is not the right answer. A great consultation should include eyelid measurements, a Snellen vision check if upper-lid hooding is significant, and a realistic discussion of asymmetry that pre-existed your surgery.

References & Further Reading

This article is general information about procedures we perform. It is not medical advice and does not replace an assessment by a physician who has examined you. Individual results, risks and recovery vary.