Upper blepharoplasty treats hooded upper lids by removing excess skin, and sometimes fat, through an incision hidden in the eyelid crease. Lower blepharoplasty treats bags and puffiness under the eyes, usually through an incision just below the lashes or inside the lid. They address different problems, have different recoveries, and can be done separately or together.
Upper blepharoplasty: what it treats
Upper eyelid surgery is for excess, stretched skin that creates hooding, makes the eyes look tired, or rests on the lashes. It may also remove or reshape a small amount of fat, often from the inner corner. The incision sits in the natural crease, so the scar is usually well hidden when the eyes are open. It can be performed under local anaesthetic, with or without sedation, or under general anaesthetic.
Lower blepharoplasty: what it treats
Lower eyelid surgery addresses bags caused by fat bulging forward, loose or crêpey lower-lid skin, and the hollow at the junction between the lid and the cheek (the tear trough). Depending on your anatomy, fat may be removed or repositioned to smooth the contour. The incision may be placed just below the lash line (transcutaneous) or inside the lower lid (transconjunctival), leaving no visible scar. Lower blepharoplasty is more technically complex because of the need to maintain lower-lid support, and is usually performed under general anaesthetic.
Side-by-side comparison
- Main concern: upper: hooding and excess skin; lower: bags, puffiness and hollows.
- Incision: upper: in the eyelid crease; lower: below the lashes or inside the lid.
- Anaesthetic: upper: local or general; lower: usually general.
- Recovery: upper: typically around one to two weeks of visible bruising; lower: often slightly longer.
- Specific risks: upper: over-removal making lid closure difficult; lower: pulling down of the lower lid (ectropion) or a change in eye shape.
Is blepharoplasty the right treatment?
Mr Nassab will examine the brow, lids, eye-lid support and cheeks. A low brow may be responsible for heaviness that looks like upper-lid excess, and true ptosis (a weak lid-lifting muscle) needs different surgery. Dark circles caused by pigmentation or thin skin do not respond to blepharoplasty. If you have dry eyes, thyroid eye disease or have had previous eye surgery, these will be taken into account.
Non-surgical alternatives
Dermal filler in the tear trough can soften a hollow under the eye in carefully selected patients, but can worsen puffiness if bags are the main problem. Anti-wrinkle injections can lift the brow slightly. Neither removes excess skin or fat.
Recovery and risks
Cold compresses and head elevation help reduce swelling. Most people return to desk work in about ten days to two weeks, and should avoid heavy exercise for a few weeks. Scars usually fade over several months. Risks of eyelid surgery include bleeding, infection, asymmetry, dry or watery eyes, difficulty closing the eyes, lower-lid malposition and, very rarely, loss of vision. Any sudden increase in pain, swelling or change in vision after surgery needs urgent attention.
Preparing for eyelid surgery
Before surgery, you will be asked about your general health, any eye conditions and your medication, including blood thinners and supplements that can increase bruising. An up-to-date eye test from your optician can be helpful. You should stop smoking well before surgery, as smoking slows healing. Arrange for someone to take you home and to help for the first day or two, and plan to rest with your head elevated. Contact lenses and eye make-up should be avoided for a period after surgery; you will be given specific advice on when to restart them.
Cost
Upper blepharoplasty costs from £5,000 under local anaesthetic or £6,500 under general anaesthetic. Lower blepharoplasty costs from £7,500. Upper and lower blepharoplasty together cost from £9,500. The £150 consultation is separate and not included in surgical prices. Cosmetic eyelid surgery is for adults aged 18 and over.
Frequently Asked Questions
Can upper and lower blepharoplasty be done together?
Yes. Combining them means one recovery period, and the combined procedure costs from £9,500.
Which is more painful, upper or lower?
Both are usually well tolerated with simple painkillers. Lower eyelid surgery can involve slightly more swelling and a longer recovery.
Will there be visible scars?
Upper scars sit in the crease and usually fade well. Lower scars are just below the lashes or hidden inside the lid.
Can you stay awake for upper blepharoplasty?
Yes, it is often performed under local anaesthetic, costing from £5,000 compared with from £6,500 under general anaesthetic.
