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Upper or lower blepharoplasty, which do you need?

Upper blepharoplasty treats the skin above the eye. Lower blepharoplasty treats bags, puffiness and loose skin below it. They are different procedures with different recovery patterns, and many patients need only one.

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If your concern is a heavy or hooded upper lid, the upper procedure is the relevant one. If it is bags or shadowing beneath the eye, the lower procedure is. Where both are appropriate they can be carried out together, and your surgeon will advise whether treating them at the same time or separately suits your case.

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Three different problems are often confused with each other. Skin sitting heavy on the upper lid is usually treated with upper blepharoplasty, unless the cause is brow descent, in which case a brow lift or browpexy is the answer. Puffiness under the eye that changes through the day is fluid, and no procedure will remove it. A permanent bag beneath the eye is fat, and lower blepharoplasty is the only thing that takes it away. Crepey skin and fine lines around the eye respond to laser resurfacing rather than surgery.

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How much does blepharoplasty cost?

Blepharoplasty at The Pinewoods Clinic starts from £3,000.

Upper and lower blepharoplasty under general anaesthetic is priced on assessment. Your exact price is confirmed in writing after your consultation.
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What affects the price of eyelid surgery?

Four things move the figure. Whether the upper lid, the lower lid, or both are treated. Whether a supporting procedure such as browpexy or canthopexy is added. The anaesthetic appropriate to your case, since lower lid surgery under sedation costs more than a procedure under local anaesthetic. And the amount of skin to be removed, and whether muscle or fat also needs addressing, which varies between patients.

Upper blepharoplasty

Upper blepharoplasty, sometimes called an upper bleph, removes excess skin from the upper eyelid to lift a heavy or hooded lid and open the eye area.

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It suits adults whose upper lids carry enough excess skin to create heaviness, hooding, or interference with vision. The signs are practical rather than dramatic. Eyeshadow transfers onto the lid within an hour. The lid space has narrowed enough that eyeliner is difficult to place. Reading for long periods leaves the forehead aching, because the brow is working to hold the lid clear. And people ask whether you are tired when you are not.

Where the excess skin sits low enough to obstruct the upper field of vision, the procedure is functional as well as cosmetic. Your surgeon will assess this at consultation.

It is not the right procedure for everyone with a heavy lid. In some patients the cause is the position of the brow rather than the eyelid itself. As the brow descends with age it pushes skin down onto the lid, and treating the lid alone will not resolve it. Where that is the case, a brow lift or a browpexy may be recommended instead of, or alongside, eyelid surgery.

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Lower blepharoplasty for under eye bags

Lower blepharoplasty is the surgical treatment for under eye bags. It addresses the fat pad that creates a permanent bag beneath the eye, along with loose or creased skin and the hollow that can form between the lid and the cheek.

Not all under eye bags are surgical. Puffiness that is worse in the morning, or that changes with sleep, salt or alcohol, is fluid, and surgery will not change it. A true eye bag is fat that has moved forward through a weakened barrier in the lower lid, and it is the only version that responds to surgery. The consultation establishes which you have.

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Lower eyelid surgery can be performed through an incision just beneath the lash line, or from inside the lid where no external incision is needed. Which approach is appropriate depends on whether skin as well as fat needs to be addressed.

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Blepharoplasty results at The Pinewoods Clinic

Upper & lower blepharoplasty before and after at The Pinewoods Clinic Liverpool

Browpexy and canthopexy

Browpexy lifts and stabilises the outer part of the eyebrow and can be carried out through the same incision as upper eyelid surgery. It suits patients with mild to moderate brow descent, where lifting the brow slightly improves the result and means less eyelid skin needs to be removed.

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Canthopexy tightens and supports the outer corner of the eye, where the upper and lower lids meet. At The Pinewoods Clinic it is usually combined with lower blepharoplasty, both to improve the result and to support the lid position afterwards.

Neither adds a separate scar or a separate recovery period when carried out alongside eyelid surgery.

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