Upper and/or Lower Eyelid Surgery: What Is Right for You?

Blepharoplasty is commonly known to patients as an eyelid tuck or eyelid lift. Blepharoplasty can be helpful for people who are unhappy with how their eyelids look, either due to genetics or aging. During eyelid surgery, Sacramento plastic surgeon Debra J. Johnson MD removes excess eyelid skin and fat that can obscure the natural contours of the eye.

Eyelid surgery can treat the upper lids, lower lids or both. In this post, Dr. Johnson breaks down the differences between upper and lower eyelid surgery.

Upper Eyelid Surgery at a Glance

Best for:

• treating heavy upper lid skin and fat that hangs over the natural fold and onto the lashes
• removing excess skin and fat that obstructs the field of vision

The skin of the eyelids is very thin and stretches out over time. If the skin is loose enough, it can spill over the upper lash line, impairing vision. Some people with this problem develop a habit of tilting their heads back, or raising their eyebrows to see what’s in front of them more clearly.

Upper eyelid surgery removes this loose skin and excess fat and tightens the tissues to create smoother upper eyelids. The surgical improvements can open up the visual field and make it easier to apply cosmetics to the eyelids. Upper eyelid surgery is performed by making an incision in the natural crease of the eyelid. The resulting scar cannot be seen with the eye open, and often fades so well that it is difficult to see with the eye closed.

Lower Eyelid Surgery at a Glance

Best for:

• reducing bags or puffiness of the skin of the lower eyelids
• smoothing lower eyelid skin

There are pockets of fat around the eyeballs that act as “insulation” to protect the globe when you run, bounce or fall. With age, this fat grows, and because it is sitting within a cup of bone, it has nowhere to go but to protrude out, creating puffy bags or pooches beneath the lower eyelids. The thin skin of the lower eyelids can stretch, creating a “crepey” look or wrinkles.

Lower eyelid surgery repositions or removes the fat to smooth out abnormal contours beneath the lower lids. Redundant eyelid skin can also be removed to smooth the lower lid so the eyes appear more rested.

There are two ways to perform lower eyelid surgery. One approach is to create an incision just beneath the lower lashline, where the resulting scarring is well camouflaged. Another approach is to make the incisions on the inside of the eyelids, which leaves no external scarring. This approach works best in patients with fatty prominence but no excess skin.

Eyelid surgery does create swelling and some bruising. The eyeballs can feel dryer than normal and more sensitive to the sun for a period of time. Eye ointment at night, eyedrops during the day and the use of sunglasses is helpful for the first few weeks after surgery. If you choose to have both the upper and lower lid surgeries together, there is obviously a little more swelling, bruising, and dryness. You tend to look a little “beat up” for longer. But most patients are presentable to the public in two to three weeks, without anyone being the wiser.

Care That’s Personalized to Your Needs

The best way to determine the procedure that is right for you is to consult with Dr. Johnson about your options. She will examine your eyelids and ask you what you would like to improve with your surgery. Dr. Johnson can also give you a more specific idea of what you could expect to achieve through upper and/or lower eyelid surgery.

Request a consultation with Dr. Johnson by calling or emailing our Sacramento plastic surgery practice today.