Upper and lower eyelid surgery explained by board-certified plastic surgeon Dr. Michael K. Newman, MD, FACS. What it corrects, who qualifies, what recovery looks like, and realistic cost ranges.
Blepharoplasty, commonly called eyelid surgery, is one of the most consistently requested procedures in a Beverly Hills plastic surgery practice. The eyes are the first place facial aging becomes visible, and they are also the most expressive feature of the face. When the upper eyelids begin to hood or the lower lids develop persistent puffiness and dark shadows, the change in appearance is significant.
This guide covers both upper and lower blepharoplasty: what each addresses, who is a good candidate, what the surgical technique actually involves, what recovery looks like week by week, and what patients can realistically expect from their results.
Eyelid aging develops through several distinct mechanisms, and understanding which of these is affecting a given patient determines whether upper blepharoplasty, lower blepharoplasty, or both are indicated.
| Concern | Location | Cause | Procedure That Addresses It |
|---|---|---|---|
| Hooding and heaviness | Upper lid | Excess skin from collagen loss and gravitational descent | Upper blepharoplasty |
| Lateral hooding (outer brow) | Upper lid, outer corner | Brow ptosis, not just lid skin | Upper bleph often combined with brow lift |
| Ptosis (drooping lid margin) | Upper lid | Weakened levator muscle (often separate from skin excess) | Ptosis repair, may be combined with bleph |
| Under-eye puffiness | Lower lid | Herniated orbital fat pushing forward | Lower blepharoplasty (fat removal or repositioning) |
| Tear trough hollowness | Lower lid | Volume loss at orbital rim, fat descent | Fat repositioning, sometimes combined with filler |
| Lower lid skin laxity | Lower lid | Excess skin and reduced elasticity | Transcutaneous lower bleph with skin excision |
| Fine wrinkles under eye | Lower lid | Sun damage, collagen loss | Laser resurfacing, often combined with bleph |
Upper blepharoplasty is indicated when excess skin on the upper eyelid creates hooding, heavy appearance, or in more significant cases, actual obstruction of the peripheral visual field. The ideal candidate has good lid position (no drooping of the lid margin itself), realistic expectations about what skin removal will accomplish, and is in good general health.
The incision for upper blepharoplasty is placed within the natural crease of the upper eyelid. This crease exists in virtually all patients and provides a natural location for scar concealment. Through this incision, a measured strip of excess skin is removed, sometimes along with a small amount of orbicularis muscle and herniated fat. The incision is closed with fine sutures or tissue glue, and the resulting scar is hidden within the eyelid crease.
The procedure is typically performed under local anesthesia with sedation (twilight anesthesia), takes 45 to 90 minutes for both upper lids, and does not require an overnight stay.
When excess upper eyelid skin is severe enough to obstruct the superior visual field, insurance may cover the functional component of the surgery. This requires a formal visual field test performed by an ophthalmologist documenting the degree of visual field obstruction with and without the skin manually elevated. If obstruction meets the insurance carrier's threshold, the functional portion of the surgery may be covered, though any cosmetic component remains out-of-pocket.
Lower eyelid surgery is technically more complex than upper and requires careful patient selection. The two primary approaches are transconjunctival (incision inside the lower lid, no external scar) and transcutaneous (incision just below the lower lash line).
| Approach | Incision Location | Best For | Scar |
|---|---|---|---|
| Transconjunctival | Inside lower lid (no external incision) | Patients with fat herniation, good skin tone, minimal skin excess | No visible scar |
| Transcutaneous | Just below lower lash line | Patients with skin laxity plus fat herniation | Heals very well in the lash line, rarely visible |
| Fat repositioning | Transconjunctival or transcutaneous | Patients with both fat herniation and tear trough hollowness | Depends on approach chosen |
A critical distinction in lower blepharoplasty is whether excess fat should be removed or repositioned. Traditional lower blepharoplasty removed herniated orbital fat, which corrected the puffiness but could leave the lower lid appearing hollow or skeletonized over time as natural volume continued to decrease. Modern technique in many cases involves repositioning the fat over the orbital rim to simultaneously fill the tear trough while removing the puffy appearance. Which approach is optimal depends on the individual anatomy of each patient.
| Timeframe | What to Expect | Activity Level |
|---|---|---|
| Day 1-2 | Swelling, bruising, mild tightness. Ice compresses helpful. Vision may be slightly blurry from ointment. | Rest at home, head elevated |
| Days 3-5 | Bruising peaks, swelling begins to reduce. Most patients sensitive to light. Sutures in place if used. | Light activity indoors |
| Days 7-10 | Sutures removed (if applicable). Most bruising resolves. Swelling substantially improved. Most patients return to office work. | Desk work, no strenuous activity |
| Weeks 2-3 | Swelling continues to resolve. Results becoming clearly visible. Light makeup permitted over most areas. | Most normal activities |
| Weeks 4-6 | Most swelling resolved. Final scar softening underway. Results stable and visible. | Full activity, exercise permitted |
| 3-6 months | Scars fully matured and softened. Final results visible. Routine follow-up. | All activities |
Eyelid surgery is frequently performed alongside complementary procedures to address the full picture of periorbital and facial aging. Common combinations include:
| Procedure | Beverly Hills Range | What Drives the Cost |
|---|---|---|
| Upper blepharoplasty (both lids) | $3,000 to $5,000 | Surgeon fee, anesthesia, facility |
| Lower blepharoplasty (both lids) | $4,000 to $7,000 | Technique complexity, fat repositioning vs removal |
| Upper and lower combined | $6,000 to $10,000 | Combined procedure efficiencies reduce anesthesia and facility time |
| With laser resurfacing | Add $1,500 to $3,000 | Laser type, treatment area, equipment used |
| With brow lift | Add $3,000 to $5,000 | Brow lift technique, whether endoscopic or direct |
These ranges reflect Beverly Hills pricing for a board-certified plastic surgeon. Total cost includes the surgeon's fee, anesthesia fee (if applicable), and facility or office-based surgical suite fee. Quote discrepancies between practices often reflect differences in technique, surgeon experience level, and whether the procedure is performed in a hospital, ambulatory surgery center, or physician office suite.
Good candidates for blepharoplasty share several characteristics:
Dr. Michael K. Newman, MD, FACS is a board-certified plastic surgeon in Beverly Hills specializing in facial rejuvenation procedures including blepharoplasty. Contact us to schedule your consultation.
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