Blepharoplasty: Upper or Lower? Should You Get Both?

close up of young woman's blue eyes

Sagging upper eyelids, dark circles under the eyes, and under-eye bags can make you look tired and old. Eyelid surgery, also known as blepharoplasty, at my Brentwood practice is the ultimate solution for my patients’ droopy and baggy eyelids.

The procedure can be completed for either the upper or lower eyelids and, for some patients if needed, both. The blepharoplasty procedure typically involves the removal of excess skin, fat, and muscle surrounding the eye area.

What Is the Benefit of Blepharoplasty?

As people grow older, their eyelids begin to stretch and the muscles that support them begin to weaken. The eyelids can no longer hold the fat, which then gathers above and sometimes below. As a result, you will see that your eyebrows are saggy while your upper eyelids begin to droop.

At the same time, the bags under your eyes become more pronounced. When you look in the mirror, you may not recognize your reflection. You may see a person who looks older than you feel. You can learn more about the signs that you need blepharoplasty in our related blog post.

Droopy eyelids are not just an aesthetic issue; sometimes they can affect your peripheral or side vision. If this is the case, the blepharoplasty procedure provides a solution since the surgery can eliminate, or at least reduce, vision issues. 

In addition, you gain the advantage of having eyes that make you look younger and feel more beautiful!

How Do I Prepare for Upper or Lower Eyelid Surgery?

Before scheduling an appointment, it is important to set realistic expectations for the surgery, as results can vary from one person to another. Dr. Michael Boggess has 19 years of experience in facial cosmetic procedures, including thousands of successful eyelid surgeries. He is highly qualified to perform and provide you with information about eyelid surgery.

Preparation is crucial before any surgery or procedure. At Youthful Reflections, we take time to make sure that you are informed and that we have answered any questions or concerns you have, including any potential risks of the procedure. You will receive preoperative and postoperative directions, which you should follow carefully. These detailed instructions will help you ensure that everything goes smoothly before and after the procedure in order to achieve the best results!

To ensure your full safety, you may also have to stop taking certain medications, including but not limited to: 

• Warfarin

• Aspirin

• Ibuprofen

• Naproxen

The medications listed above are known to increase bleeding. You should consult Dr. Michael Boggess, or any of the experts at Youthful Reflections, to find out if and when you need to stop taking medicine. It is also not advised to smoke for several weeks before the procedure as it can reduce your natural ability to heal.

What Can I Expect After Eyelid Surgery?

Be sure that you have someone who will drive you home after eyelid surgery.

It is possible to experience watery eyes, blurry vision, and even light sensitivity after the procedure. WebMD offers more information about the potential side effects of eyelid surgery.

You can see some of our patients’ blepharoplasty before and after pictures to get an idea of the type of results that are possible after eyelid surgery. And take a look at the Instagram post below to see how beautifully eyelid surgery complements a facelift:


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A post shared by Youthful Reflections (@youthful_reflections)

Do I Need Upper or Lower Eyelid Surgery?

As previously mentioned, blepharoplasty can be performed on the upper and lower eyelids. These two procedures are quite different. Here are the differences between the two:

Upper Eyelid Surgery

This procedure is performed to stop the drooping of the upper eyelids. The lids tend to sag because of the excess skin, fat, and muscles in the area. It may also be due to wrinkles on the upper lids. Drooping eyelids can make some people look angry or sleepy. In this procedure, the excess skin will be removed on the upper lids and the natural-looking results will give you a more youthful appearance.

The surgery involves making an incision on the skin of the upper eyelids. Typically, the incision is placed in the natural crease of the lids. Dr. Boggess will remove the excess skin and then stitch the area closed. After the treatment, you will see that your eyelids are tighter and smoother.

Lower Eyelid Surgery

When the skin loses its elasticity or has collected herniated fat, the under-eye area can appear dark and puffy. Also known as the eye bag treatment, this surgery reduces the prominence of the bags under your eyes so you do not look tired or sleepless. 

During the surgery, an incision may be made just below the lash line of the lower lids (transcutaneous) or on the inside of the lower lids (transconjunctival), and excess fat is removed. With the transcutaneous approach, excess skin and muscle are removed along the incision line, as needed.  There are also procedures where laser resurfacing may be helpful in tightening the loose skin of the lower eyelids. Dr. Boggess is happy to discuss this treatment option with you if you are interested.

Can You Get Upper and Lower Eyelid Surgery at the Same Time?

Some patients will only require one of these two procedures, while others may require both. Many patients choose to go through upper and lower eyelid surgeries in one session to reduce the time required for recovery. Contrary to popular belief, having the two surgeries together will not add more risk to the patient.

Though it is generally up to the patient to decide if they want to have both procedures, Dr. Boggess is here to help you determine which blepharoplasty option is best for you. If you’re in the Nashville area, contact Youthful Reflections today to set up your complimentary consultation and begin your journey to feeling and looking more refreshed!

Originally published August 2019; Updated April 2022.

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Worth Waiting For

We understand you want your facial plastic surgery right away, but this is an instance where patience pays off. Our surgeries are often booked out a few months because Dr. Boggess:

  • Is highly accomplished, and his services are in demand.

  • Takes his time to ensure outstanding safety, care, and results.

  • Offers personalized techniques that aren’t available elsewhere.

We are worth the wait.

Learn more about why the best facial plastic surgeons are worth the wait, and how you can make the most of that time in this blog post.

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