By Dr. Ali R. Abtahi, DO MSc | Amor Propio Aesthetic Surgery | Dallas, TX
If you have been researching eyelid surgery, also known as blepharoplasty, you have probably come across the distinction between upper and lower eyelid procedures. Patients often arrive at consultations unsure which one they need, or whether they need both. The answer depends on where your primary concerns lie, what is actually causing them, and what outcome you are hoping to achieve. Here is what you need to know.
What Does Upper Eyelid Surgery Do?
Upper blepharoplasty targets excess skin, herniated fat, and occasionally redundant muscle in the upper eyelid. As we age, the upper eyelid skin loses elasticity and begins to droop, creating a heavy, hooded appearance that can make a person look tired, older, or even perpetually sleepy, regardless of how they actually feel.
For some patients, this excess skin becomes significant enough to intrude on the superior visual field, making upper blepharoplasty a functional procedure as well as a cosmetic one. In these cases, the surgery may be covered at least partially by insurance.
Upper blepharoplasty is performed through an incision placed within the natural crease of the upper eyelid. When the eye is open, this scar is completely invisible. The procedure is frequently performed under local anesthesia, making it one of the most patient-friendly of all surgical procedures.
What Does Lower Eyelid Surgery Do?
Lower blepharoplasty addresses puffiness, bags, and hollowing beneath the lower eyelids. Lower eyelid bags are caused by herniation of the fat pads that normally cushion the eye within the orbit. Over time, the septum that holds these fat pads in place weakens, allowing the fat to bulge forward and create the characteristic puffiness we associate with aging, fatigue, and genetics.
Lower eyelid surgery can involve fat repositioning or removal, skin excision, or a combination of both, depending on the patient’s anatomy and concerns. For patients whose primary issue is fat herniation without significant skin excess, Dr. Abtahi frequently uses the transconjunctival approach, placing the incision entirely inside the lower eyelid to leave no visible external scar.
Which Do You Need: Upper, Lower, or Both?
You likely need upper eyelid surgery if: Your upper eyelids feel heavy, you notice hooding or skin folding over your lash line, your eyes appear smaller or more tired than they used to, or you have been told you look tired or sleepy when you are not.
You likely need lower eyelid surgery if: You have persistent puffiness or bags beneath your lower eyelids that does not improve with sleep, you notice a shadow or dark area beneath your eyes caused by fat prolapse, or you have loose, crepey skin in the lower eyelid area.
You may benefit from both (quad blepharoplasty) if: You have concerns in both areas simultaneously, and want to address the full eye area in a single procedure with a single recovery period. Quad blepharoplasty is one of the most commonly performed and consistently satisfying combinations in facial rejuvenation.
The best way to know exactly which procedure, or combination of procedures, is right for you is a thorough in-person consultation with a board-certified plastic surgeon. During your consultation at Amor Propio Aesthetic Surgery, Dr. Abtahi will assess your eyelid anatomy, discuss your concerns and goals, and recommend the approach that will deliver the most natural, lasting result for your specific situation.
What About Non-Surgical Options?
For patients who are not ready for surgery or who have very early-stage concerns, non-surgical options including neuromodulators (Botox), dermal fillers for the tear trough, and laser or radiofrequency skin resurfacing can provide modest improvement to the periorbital area. However, for patients with true excess skin, herniated fat, or significant tissue laxity, surgery remains the only approach that can deliver meaningful, lasting results. Dr. Abtahi will discuss all available options during your consultation and help you determine the right approach for your goals and your timeline.
Ready to learn whether upper, lower, or combined eyelid surgery is right for you? Schedule a consultation with Dr. Ali Abtahi at Amor Propio Aesthetic Surgery in Southlake, TX. Call (469) 293-2533 or request your consultation online.