If you’re frustrated with puffy eyes, sagging upper eyelids, or under-eye bags, the right eyelid surgery can restore the refreshed, youthful appearance you’ve always wanted.
In this guide, we’ll explain the difference between upper and lower blepharoplasty (eyelid surgery). You’ll learn how each procedure works, what to expect during recovery, and how to choose the right option—or combination—for your aesthetic goals.
If you’re ready to rejuvenate your look with eyelid surgery, schedule your consultation with Elite Facial Plastic Surgery today. Dr. Dominic Castellano uses precise techniques to remove excess skin and fat, smooth the eye area, and restore a younger, more “awake” appearance.
What Is an Upper Eyelid Blepharoplasty?
An upper eyelid blepharoplasty addresses sagging skin and tissues that naturally develop above the eyes as we age. This drooping typically involves the skin, the muscle underneath, and in some cases, excess fat, especially in the inner (medial) corner of the upper eyelid.
How Upper Eyelid Surgery Works
Your surgeon will make an incision in the upper eyelid crease, where the scar can be naturally hidden. Depending on your anatomy (deep-set vs. shallow-set eyes), your surgeon will remove the appropriate amount of skin, muscle, and fat to enhance the appearance of the eye and create a more open look.
After removing this tissue, your surgeon will place sutures along the incision line. These will be removed at a follow-up appointment about a week later.
Recovery Expectations for Upper Eyelid Blepharoplasty
After upper eyelid surgery, you may experience minimal swelling and bruising. For the following 1-2 weeks, you’ll gently clean the area with hydrogen peroxide and apply a small amount of antibacterial ointment. With proper care, the incision will heal and leave a minimal scar hidden in the eyelid crease.
What Is a Lower Eyelid Blepharoplasty?
A lower eyelid blepharoplasty reduces puffiness and bags under the eyes. These are usually caused by pseudoherniation of fat– the fat that normally cushions the eye begins to push forward as the tissues around it weaken with age.
The skin, muscle, and orbital septum (a supportive structure under the eye) begin to loosen over time, allowing fat to bulge outward, much like a belly might hang over a belt.
Techniques for Lower Eyelid Blepharoplasty
There are two main approaches to lower eyelid surgery:
1. Transcutaneous Approach
Your surgeon makes a small incision just below the lash line on the outside of the lower eyelid. Through this incision, fat is either removed or repositioned to reduce puffiness and smooth the contour under the eye.
This method provides direct access to both fat and skin, which is helpful if excess skin also needs to be removed. However, it comes with a higher risk of complications if not performed correctly. One of the most common risks is lower lid retraction, where the eyelid pulls away from the eye, resulting in a rounded or unnatural appearance.
2. Transconjunctival Approach
With the transconjunctival technique, the incision is made inside the lower eyelid through the pink inner lining (conjunctiva). This allows your surgeon to remove or reposition the fat without cutting the skin or disturbing the lower eyelid’s external support system.
This method:
- Preserves the natural structure and position of the eyelid
- Leaves no visible scar on the skin
- Minimizes the risk of complications like lid retraction
Once excess fat is removed, the incision on the inside of the lid usually heals on its own without the need for sutures.
Skin Tightening After Lower Eyelid Surgery
After lower eyelid surgery, many patients benefit from skin tightening to improve fine lines or skin laxity under the eyes. Your surgeon may recommend laser skin resurfacing to smooth and tighten the skin, resulting in a rejuvenated appearance.
There are two types of lasers commonly used:
- CO2 laser: More aggressive, deeper resurfacing with significant skin tightening
- Erbium: YAG laser: Milder treatment with a quicker recovery
Surgeons typically perform laser resurfacing simultaneously with lower eyelid surgery to rejuvenate the skin’s texture and tone, resulting in a more youthful and refreshed appearance in the area.
Recovering From Lower Eyelid Blepharoplasty
During recovery, you’ll use cosmetic pads soaked in distilled water to clean the area, then reapply ointment every 4–5 hours. Around days 5–7, you’ll transition from ointment to a gentle moisturizer.
Recovery feels like a strong sunburn for the first day or two—uncomfortable, but not painful.
Can Upper and Lower Eyelid Surgery be Combined?
Yes, upper and lower eyelid surgery can be safely performed simultaneously, and many patients choose this option to avoid multiple recovery periods. Combining both procedures enables a more comprehensive rejuvenation of the eye area while minimizing downtime.
Why Consider Upper or Lower Eyelid Surgery?
Many patients seek eyelid surgery because their eyes constantly look tired and puffy. This can be caused by:
- Excess upper eyelid skin that hoods over the eye
- Fat herniation in the lower lids
- Aging around the eye area makes you look less refreshed
- For women, excess upper eyelid skin can also make it difficult to apply eye makeup, like eyeliner and eyeshadow
By removing sagging skin and repositioning or removing fat, eyelid surgery opens up the eyes, smooths under-eye bags, and restores a more youthful, rested appearance. The result is a brighter, more alert look that better reflects how you actually feel.
Enhancing Blepharoplasty Results with Eyebrow Rejuvenation
If your upper eyelids are sagging, your eyebrows may be a contributing factor. As we age, brows can droop just like other areas of the face, contributing to a heavy or tired appearance. In some cases, your surgeon may recommend a brow lift along with or even before upper eyelid surgery.
Combining the two procedures can enhance your results by lifting the brow to its natural position and removing excess eyelid skin, creating a refreshed look that restores balance to the upper face.
Refresh Your Appearance with Elite Facial Plastic Surgery
If you’re looking to rejuvenate your eye area, Dr. Dominic Castellano can help you achieve a brighter, more youthful appearance with precise eyelid surgery. By removing excess skin, smoothing under-eye puffiness, and restoring natural contours, he creates refreshed results that still look like you—just more rested and awake.
Schedule your consultation with Elite Facial Plastic Surgery today and get the youthful appearance you’ve always wanted.
