When considering eyelid surgery, or blepharoplasty, many patients ask: “Should I get an upper, a lower, or both?” The truth is, one isn’t “better” than the other—they address entirely different signs of aging around the eyes. Choosing the right procedure depends entirely on your specific cosmetic concerns and goals. What are the differences between upper blepharoplasty and lower blepharoplasty?
Upper Blepharoplasty: Solving Sagging Eyelids
An upper eyelid lift primarily focuses on the skin and tissue above your eye. Over time, the skin here can stretch, leading to hooded eyelids that make you look tired or angry. In some cases, the sagging skin can even impair peripheral vision, making it a functional procedure as well as a cosmetic one.
During an upper blepharoplasty, excess skin is removed and, often, a small amount of underlying fat and muscle through an incision placed discreetly in the natural crease of the eyelid. This procedure effectively brightens the eye area, creates a more alert appearance, and can even make the application of eye makeup easier. This is the ideal choice if your primary concern is droopy eyelids or excess skin bunching over your upper lash line.
Lower Blepharoplasty: Eliminating Bags and Puffiness
A lower eyelid lift targets the area beneath your eye, focusing on what are commonly called eye bags, puffiness, and prominent dark circles caused by shadows. These issues are typically caused by fat pads under the eye protruding forward or the loss of volume in the cheek area.
A lower blepharoplasty is done by either making an external incision just below the lashes (transcutaneous) or an internal incision inside the eyelid (transconjunctival). The goal is to reposition or remove excess fat to create a smoother transition from the lower eyelid to the cheek. This procedure is a good answer for patients looking to correct under-eye bags and achieve a less tired, younger appearance.
The Best Choice: Combination Surgery
The answer to “which one works better?” is often both. Since aging simultaneously affects the upper and lower eyelids, many plastic surgeons recommend a combination approach for the most comprehensive and natural-looking rejuvenation. A combined blepharoplasty ensures the entire eye area is addressed harmoniously, preventing a scenario where one part of the eye looks refreshed while the other still shows signs of aging.