Upper Blepharoplasty
Upper blepharoplasty is surgery for upper eyelids that have changed with age. It removes loose skin that hangs over the crease, trims or reshapes bulging fat when needed, and sets a clean crease again. It does not lift a low eyebrow or strengthen a weak eyelid muscle, so the first step is finding out which of these problems you actually have.
At Violacell Plastic Surgery, Dr. Kim currently provides non-surgical treatment and does not perform upper blepharoplasty there. This page is a plastic surgeon's guide: what upper blepharoplasty can and cannot do, and how to tell whether your concern needs surgery or can be treated without it, for example with Thermage with the eye tip.
- What it treats
- Excess upper eyelid skin, hooding over the lashes or crease, bulging fat (often near the nose), and a crease that has become hidden or uneven.
- Anesthesia
- Usually local anesthesia, often with light sedation. The choice depends on your health, your comfort level and whether other procedures are done at the same time.
- Operating time
- Typically around 1–2 hours for the upper eyelids alone. It varies with the amount of correction and any combined surgery.
- Stitches
- Commonly removed about 5–7 days after surgery.
- Swelling and bruising
- Most noticeable in the first 1–2 weeks. The crease usually keeps softening and settling over several months.
What a Surgeon's View Adds to Eye-Area Treatment
Heavy upper eyelids can come from skin, fat, a low brow or a weak eye-opening muscle. Telling them apart decides whether a non-surgical treatment can help.
Skin, brow or muscle
Dr. Kim checks brow position and eye-opening strength first, because only some causes respond to non-surgical treatment.
Thermage eye tip
When the issue is mainly thin, crepey eyelid skin, Thermage with the eye tip can firm it without an incision.
Ulthera for the brow
When a slightly low brow adds to the heaviness, Ulthera over the brow and forehead may lift it a little.
How the Options Differ
Skin removal at the crease
The most common form of upper blepharoplasty. A strip of loose skin is removed through an incision placed in or near the eyelid crease, so the scar sits in a natural fold when the eyes are open.
It works best when the main problem is extra skin and the eyebrow sits in a reasonable position.
Skin plus muscle or fat
When the eyelid also looks puffy or heavy, a thin strip of the eyelid muscle (orbicularis oculi) may be removed and bulging fat may be trimmed or repositioned through the same incision.
Removing fat is done conservatively. With age the upper eyelid often loses volume, and taking too much can leave a hollow, tired look.
Sub-brow excision
Skin is removed just below the eyebrow instead of at the crease. This can suit thick eyelid skin with heavy outer hooding, or people who want to keep their existing crease shape.
The scar sits along the lower edge of the brow. It does not treat fat or create a new crease.
When the problem is not the eyelid
If the eyebrow itself has dropped, removing eyelid skin can pull the brow even lower. A forehead lift may be the better first step.
If the eyelid margin covers part of the pupil, the lifting muscle may be weak (ptosis). This needs ptosis correction, which can be combined with blepharoplasty.
Glossary
- Blepharoplasty
- Eyelid surgery that removes or reshapes skin, muscle and fat. "Upper" refers to the upper eyelid.
- Dermatochalasis
- Loose, excess eyelid skin that develops with age.
- Hooding
- Skin that folds down over the crease or lashes, especially at the outer corner.
- Brow ptosis
- A low or descended eyebrow that pushes skin down onto the eyelid.
- Blepharoptosis (ptosis)
- A drooping eyelid margin caused by a weak or stretched lifting muscle, not by extra skin.
- Levator muscle
- The main muscle that opens the upper eyelid. Its tendon-like extension is called the levator aponeurosis.
- Orbicularis oculi
- The ring-shaped muscle around the eye that closes the eyelids.
What Changes in an Aging Upper Eyelid
A heavy upper eyelid rarely has a single cause. Several layers change at once, and each one needs a different solution. Identifying the main contributors comes before choosing an operation.
| Change | What you may notice | What usually helps |
|---|---|---|
| Loose skin | Skin rests on the lashes, hides the crease or makes eye makeup smudge. | Upper blepharoplasty or sub-brow excision |
| Bulging fat | A soft puffy bulge, often on the inner side near the nose. | Conservative fat trimming or repositioning during blepharoplasty |
| Volume loss | A sunken, hollow upper eyelid with a deep groove under the brow. | Careful skin removal with fat preserved; removing more tissue can make hollowing worse |
| Brow descent | The brow sits low, especially at the outer end, and you raise your forehead to see better. | A forehead lift or brow lift, sometimes with blepharoplasty |
| Weak eyelid lifting muscle | The eyelid margin covers part of the pupil, the eyes look sleepy, and the crease may move higher. | Ptosis correction |
| Outer-corner fullness | A bulge at the outer upper eyelid that may be the tear (lacrimal) gland, not fat. | The gland is repositioned, not removed, if it needs treatment |
Thyroid eye disease, allergies and fluid retention can also make eyelids look puffy. These are not surgical problems.
Eyelid, Brow or Ptosis?
Many people come in asking for eyelid surgery when part of the heaviness actually comes from the eyebrow or from the eyelid muscle. Telling these apart matters, because the wrong operation can leave the problem unsolved or make it look worse.
A simple check at home: relax your forehead completely, look in a mirror, then gently lift your eyebrow with a fingertip to where it naturally belongs. If most of the heaviness disappears, the brow is a large part of the problem. If loose skin still rests on the lashes, the eyelid skin itself is a factor. If the eyelid edge still covers part of the dark center of the eye, the lifting muscle may be weak.
This is only a rough guide. Dr. Kim examines brow position at rest, eyelid margin height, lifting muscle function, skin thickness, fat, the tear gland and the symmetry of both sides before suggesting a plan. You can read more in Upper eyelid surgery or a forehead lift?
Signs Worth Mentioning
- You habitually raise your eyebrows to see, and your forehead feels tired by evening.
- Your outer field of vision feels blocked, especially when reading or driving.
- One eyelid looks lower than the other.
- Your crease has moved higher while the eye looks smaller.
- You have had eyelid surgery before.
- You have dry eyes, wear contact lenses, or have had laser vision correction.
- You have a thyroid condition or take blood thinners.
Who It May Suit
- Adults whose upper eyelid skin has loosened and hangs over the crease or lashes
- People with puffy upper eyelids from bulging fat
- People whose crease has become hidden, uneven or broken into several folds by loose skin
- People whose eyebrow position is acceptable, or who will address the brow separately
- People in good general health with realistic expectations
When Something Else May Be Better
- Low eyebrows A forehead or brow lift may be needed first, or instead.
- Eyelid margin covering the pupil Ptosis correction is needed; skin removal alone will not open the eye.
- Hollow upper eyelids Removing more tissue can deepen the hollow.
- Severe dry eye or poor eyelid closure These need assessment before any skin is removed.
- Active eye infection, uncontrolled thyroid eye disease or uncontrolled medical conditions Surgery is postponed until these are managed.
- Mild skin laxity only Non-surgical skin tightening may be discussed, although it cannot remove excess skin.
How the Operation Is Done
The plan is drawn on the skin while you are sitting upright with your eyes open and closed, because eyelid skin falls differently when you lie down. The crease line is marked first, then the amount of skin to remove is measured above it. Enough skin must be left between the brow and the lashes so that the eyes can still close fully after healing.
After local anesthetic is injected, the marked skin is removed. Depending on the plan, a thin strip of eyelid muscle may also be removed, and bulging fat is trimmed or moved to fill a nearby hollow. Bleeding is controlled carefully, because bleeding behind the eye is one of the few serious risks of this operation. The incision is closed with fine stitches.
For Asian eyelids, crease height deserves particular attention. Many people want a natural crease that suits their face rather than a high, deep fold. In older eyelids that never had a crease, or where the crease has faded, the surgery may also form a crease by connecting the skin to the deeper eyelid structures. How visible the crease should be is discussed before surgery. More about crease-forming surgery is on the eyelid surgery overview.
Sub-brow Excision as an Alternative
In sub-brow excision (also called a lower brow lift or infrabrow excision), the skin is removed just below the eyebrow rather than at the crease. Skin close to the brow is thicker than skin near the lashes, so removing it there can reduce heavy outer hooding while leaving the thin skin near the crease untouched.
It may suit people with thick eyelid skin, heavy outer hooding, or a crease they want to keep exactly as it is. It does not raise the eyebrow, remove fat, correct ptosis or create a new crease.
Scars and Trade-offs
The scar runs along the lower border of the eyebrow. In many people it becomes hard to see as it matures, but it may remain visible in people with sparse brow hair, light brows or a tendency to form raised scars. Brow tattoos or semi-permanent brow makeup affect where the incision can be placed, so tell the surgeon if you have them.
Crease incisions and sub-brow incisions each hide the scar in a different place. The choice depends on skin thickness, where the hooding is heaviest, the shape of your current crease and how you wear your brows.
When Ptosis Correction Is Added
In acquired ptosis, the tendon-like part of the lifting muscle (the levator aponeurosis) stretches or slips with age, long-term contact lens wear or eye rubbing. The eyelid edge then sits lower over the eye, and the crease often moves higher. Removing skin does not change this, because the problem is in the muscle, not the skin.
When ptosis is present, the levator can be shortened or reattached through the same crease incision used for blepharoplasty. This raises the eyelid margin. Because it changes how far the eyelid opens, the height needs careful adjustment, and the two sides may still heal slightly differently.
Incisions and Scars
With the crease approach, the scar sits in the fold of the eyelid and usually extends a little beyond the outer corner if outer hooding is being treated. Eyelid skin generally heals well, but scars can look pink and slightly firm for the first few months before they soften.
No eyelid incision is scar-free. How visible a scar becomes depends on skin type, healing tendency, sun exposure and aftercare.
Anesthesia
Upper blepharoplasty is commonly done under local anesthesia, sometimes with intravenous sedation. Under local anesthesia you may be asked to open and close your eyes during surgery, which helps check eyelid height and symmetry when ptosis correction is included.
General anesthesia may be considered when the eyelid surgery is combined with larger procedures such as a forehead lift or facelift. The anesthetic plan is decided with your health history in mind.
Recovery Timeline
| Timing | Typical course |
|---|---|
| First 48–72 hours | Swelling and bruising increase. Cold compresses, keeping the head raised and resting the eyes help. Vision may be slightly blurred from ointment or swelling. |
| About 5–7 days | Stitches are commonly removed. Bruising begins to fade from purple to yellow. |
| About 1–2 weeks | Many people return to desk work and light daily activities. Makeup over healed incisions is often allowed after stitch removal, as advised. |
| 2–4 weeks | Strenuous exercise, swimming and contact lenses are usually resumed only after you are cleared. |
| 1–3 months | Residual swelling, a slightly high or deep-looking crease and firm scars gradually settle. |
| 3–6 months and beyond | The crease and scar continue to soften. The final shape is usually judged after several months. |
The course varies with the extent of surgery, combined procedures and individual healing. Follow the instructions you are given after surgery.
Risks
- Swelling, bruising and asymmetry Common early on. Small differences between the two sides are normal; persistent asymmetry may need adjustment.
- Dry eye and irritation Often temporary. People with existing dry eye need special care.
- Incomplete eyelid closure (lagophthalmos) Usually temporary from swelling. If too much skin is removed it can persist and may need treatment.
- Crease problems A crease that is too high, uneven or doubled may need revision.
- Hollow appearance Can occur if too much fat is removed.
- Visible or thickened scars Uncommon on the eyelid but possible.
- Infection and bleeding Uncommon. Bleeding behind the eye (retrobulbar hemorrhage) is rare but can threaten vision and needs emergency care. Sudden severe pain, a tense swollen eye or loss of vision should be reported immediately.
What It Cannot Do
- It does not lift a low eyebrow.
- It does not correct a weak lifting muscle unless ptosis correction is added.
- It does not remove crow's feet or forehead lines.
- It does not treat under-eye bags or dark circles; those involve the lower eyelid.
- It does not stop aging. The eyelid and brow continue to change over the years.
- Perfect symmetry cannot be guaranteed, because the two sides of a face are rarely identical to begin with.
Combining with Other Procedures
Upper eyelid heaviness is often part of wider changes in the upper face. When the brow has descended, a forehead lift may be planned first or at the same time, and the amount of eyelid skin removed is then reduced accordingly. Doing blepharoplasty first and lifting the brow later can leave too little eyelid skin.
Lower eyelid surgery, ptosis correction and double eyelid surgery are described on the eyelid surgery overview. If the cheeks and jawline have also descended, eyelid surgery may be combined with a mini facelift or facelift.
Non-surgical treatments such as Ulthera or Thermage can tighten skin to a degree, but they cannot remove excess eyelid skin.
Frequently Asked Questions
Will upper blepharoplasty change the shape of my eyes?
It changes how much skin hangs over the eye and how visible the crease is, which can make the eyes look more open and rested. The shape of the eye opening itself changes only if ptosis correction or other procedures are added. The goal is usually to look refreshed rather than different.
How do I know if I need a brow lift instead?
If gently lifting your eyebrow to its natural position removes most of the heaviness, the brow is likely a large part of the problem. A low brow may need a forehead or brow lift first or at the same time. An in-person examination is needed to confirm this.
What is the difference between upper blepharoplasty and ptosis correction?
Blepharoplasty removes excess skin and sometimes fat. Ptosis correction tightens or reattaches the muscle that lifts the eyelid so the eyelid margin sits higher. Some people need one, some need the other, and some need both in the same operation.
Can I keep my current crease?
Often, yes. The crease approach can follow your existing crease, and sub-brow excision leaves the crease area untouched. Whether this is possible depends on your skin, the position of the hooding and whether ptosis is present.
How long until I can go out without obvious signs of surgery?
Many people feel comfortable in public after about 1–2 weeks, once stitches are out and bruising has faded. Mild swelling and a slightly stiff crease can remain for several weeks and settle over months. Recovery differs from person to person.
Will the scar be visible?
With the crease approach, the scar sits in the eyelid fold and is usually hard to see once healed, though it can look pink for a few months. With sub-brow excision the scar sits along the lower edge of the eyebrow. No incision is completely invisible.
Is it safe if I have dry eyes or had laser eye surgery?
It may still be possible, but these conditions need to be assessed before surgery because eyelid surgery can temporarily worsen dryness. A more conservative skin removal or an eye examination beforehand may be advised.
How long do the results last?
Removed skin does not grow back, so the improvement is usually long-lasting. However, the skin and brow continue to age, and some heaviness can return over the years. The timing is different for everyone.