The Sculptique Aesthetics
Upper vs Lower Eyelid Surgery: Which Blepharoplasty Do You Need?
How to tell hooded upper lids from lower-lid bags, when filler is the wrong tool, and what recovery and scars actually involve.
I ask you to look down, then up, then straight ahead. Hooded skin, a fat bag and a hollow under the eye are three different problems, and only some of them are a reason to operate.
— Dr. Aamod Rao
Upper eyelid surgery removes or repositions the skin and fat that hood the eye. Lower eyelid surgery treats the bags and, when needed, a small amount of loose skin under the eye. Many people need one. Some need both. Filler treats a hollow. It does not remove a fold of skin, and it can worsen a bag if the bag was the real problem.
A broader introduction sits in eyelid surgery in Mumbai. This article is the decision between upper, lower, both, or no surgery. The filler side of the same question is in under-eye bags: filler or surgery.
What each operation is for
Upper blepharoplasty is for skin that rests on the lashes, a heavy lid that makes you look tired, or a hood that blocks the upper field of vision. The incision sits in the natural crease. When it has healed and faded, it is the crease. A small amount of fat from the inner corner is sometimes reduced. Taking too much fat hollows the lid and ages it, so the aim is a cleaner crease, not a scooped eye.
Lower blepharoplasty is for the bags: fat pads that have pushed forward under the eye. If the skin quality is good and the problem is fat, the fat can often be reduced or moved through an incision inside the lid, a transconjunctival approach, which leaves no skin scar. If there is loose skin as well, a skin pinch or a short incision just under the lashes is added. Pulling the lower lid down, an ectropion, is the complication this operation is designed to avoid, which is why we look at lid laxity and snap-back before we promise a skin excision.
Both, when the upper lid is hooded and the lower lid is baggy. Doing them together is one recovery. It is not mandatory. If only one bothers you, we treat that one.
A brow that has dropped can look like excess upper-lid skin. Lifting the brow with a finger in the mirror is the test. If the hood disappears when the brow goes up, you may need a brow lift rather than, or as well as, an upper lid operation. Cutting away that skin without lifting the brow can look hollow and can make brow closure harder.
A simple way to sort the complaint
| What you see in the mirror | Likely plan |
|---|---|
| Skin folding onto the lashes | Upper blepharoplasty |
| The fold disappears when you lift the brow with a finger | Consider a brow lift, not lid skin alone |
| A soft bag that sticks out on the lower lid | Lower blepharoplasty, fat repositioned or reduced |
| A hollow groove, no real bag | Filler or fat, not skin removal |
| Pigment or dark colour with a smooth contour | Skin treatment, not surgery |
| Bag plus loose crepey skin | Lower blepharoplasty with a skin pinch |
| Dry, irritated eyes already | Surgery is planned more cautiously, sometimes deferred |
Dark circles from pigment are the complaint surgery disappoints. We say so. Hollowing from volume loss is a filling problem. A true bag is a surgical one.
Recovery in ordinary language
Upper lid bruises look worse than they feel. Most people are presentable, with a faint crease line and some swelling, in 10 to 14 days. Stitches, if not dissolvable, come out around a week. Makeup can cover the yellow stage. Contact lenses wait until the eye is comfortable and we have said the surface is ready.
Lower lid swelling lasts longer than upper lid swelling, and the lid can look tight or slightly rounded for a few weeks. A transconjunctival operation swells too. It is not a lunchtime disappearance. Sleep with the head up, avoid rubbing, and use the drops or ointment you are given. Dryness and a sandy feeling are common early on. Pre-existing dry eye is something to declare before surgery, because the lid operation can make it more noticeable for a while.
Contact sport, heavy lifting and swimming wait until the incision has sealed and the bruising is gone, typically a couple of weeks, longer if the lower lid was tightened.
Scars, vision, and what surgery will not do
The upper scar is hidden in the crease. The lower skin scar, when one is needed, sits at the lash line and fades. An inside-lid incision has no external scar. None of these operations change eye colour, vision prescription, or a brow that has dropped, and none of them remove pigment in the skin. They also do not replace a facelift when the real descent is the cheek. A bag caused by a fallen cheek sometimes needs the cheek supported, not just the fat trimmed. We will say if that is you.
Frequently asked questions
Yes. It is the more common single operation. If the lower lid does not bother you in a photograph taken straight on, in daylight, leave it alone.
It asks more of the surgeon because the lower lid can be pulled down if too much skin is taken or the lid is lax. That risk is assessed before the operation with a lid-laxity exam. It is not a reason to avoid a properly planned lower blepharoplasty. It is a reason not to shop for it on price.
Filler adds volume to a hollow. Surgery removes or moves fat that is already sticking out, and can remove skin. Filling a true bag makes the bag bigger. The two treatments are sometimes combined, later, if a hollow remains beside a bag that was treated surgically. They are not substitutes.
A surprised look comes from changing the brow, or from taking so much upper skin that the lid cannot close comfortably. The plan is an open, rested eye with the crease in its natural place. We measure skin with the eye closed so closure is preserved.
Look at the lid, the brow and the cheek as one
Bring a photograph in which the bags or the hood actually bother you, taken straight on, without a filter. At consultation we will separate skin, fat, hollow and brow, and we will tell you if eyelid surgery is the operation or if you have been looking at pigment and volume. One of those answers saves you an operation.
This article is for educational purposes only. It is not medical advice and does not replace a consultation with a qualified clinician.
