Upper Blepharoplasty: What It Fixes and What to Expect

Heavy, hooded upper lids are one of the first signs of aging people notice in photos. They can make you look tired or stern when you are neither, and in some people the extra skin starts to sit on the lashes and block side vision. Upper blepharoplasty, also called upper eyelid surgery, is the operation that corrects it. This guide covers what the surgery does, who it suits, how the incision is hidden and what recovery looks like.

What upper blepharoplasty treats

Upper eyelid aging is mostly a problem of excess. As skin loses elasticity, extra skin gathers on the upper lid and the natural crease drops lower or disappears. In some people a small pad of fat also pushes forward near the inner corner of the eye. The result can range from a mildly heavy look to a fold of skin that rests on the lashes.

Upper blepharoplasty removes that extra skin and, when it is present, the excess fat. It restores a clean, defined crease and a more open, rested look. It does not change the shape of your eyes, and it does not treat bags under the eyes, which is the job of lower blepharoplasty.

Who is a good candidate

You may be a good candidate if:

Your upper lids look heavy, puffy or hooded, or the crease has faded.
Extra skin rests on your lashes or makes your eyes feel tired by the end of the day.
Excess skin is starting to limit your side vision.
You are in good general health and your eyes are healthy.

Dr. Newman examines your upper and lower lids carefully, assessing the amount and spread of excess skin and fat, skin texture, lid position and brow height. Dry eye, thyroid eye disease and some other conditions need a careful look before surgery, which is why your eye history is part of the consultation.

Lid or brow? The question that changes the plan

Not every heavy upper lid is a lid problem. When the eyebrows drop with age, they push skin down onto the lids, and the hooding looks the same in a mirror. Removing lid skin in that situation can bring the brows even closer to the eyes. If brow descent is part of the picture, a brow lift may be the better operation, or it may be combined with eyelid surgery. The guide to hooded eyes explains how to tell the two apart, and brow lift in Beverly Hills covers the brow side.

How the surgery is done

The surgeon marks the natural crease of the upper lid with you sitting up, then measures exactly how much skin can be removed while still letting the eyes close comfortably. Through an incision placed in that crease, the extra skin is removed, along with a small amount of fat where it is needed. The incision is closed in layers with fine stitches. The surgery is usually done as an outpatient procedure, and your surgeon will discuss the anesthesia approach with you.

Dr. Newman performs upper blepharoplasty, lower blepharoplasty, and combined upper and lower blepharoplasty. Combining both lids, or adding a brow lift or facelift, can refresh the whole upper face in one recovery period.

The scar

The upper blepharoplasty incision sits within the natural lid crease, the fold that forms when you open your eyes. When your eyes are open the scar is tucked inside that fold, and once it matures it is usually very hard to see. It starts pink and fades over the following months. The guide to blepharoplasty scars covers healing and scar care in detail.

Recovery

The first few days. Expect swelling, some bruising and a tight feeling in the lids. Cold compresses and keeping your head raised help.
Stitches. Fine stitches are typically removed within the first week.
Getting back to normal. Many people return to desk work and social plans within about two weeks, once the bruising has faded.
Activity. Avoid heavy lifting, bending and hard exercise until your surgeon clears you, and protect your eyes from sun and wind.
The final result. The lids keep softening and refining for a few months as the last swelling settles.

Insurance and upper eyelid surgery

Upper blepharoplasty is one of the few cosmetic eyelid operations that insurance may help with. When the extra skin is heavy enough to block your side vision, a condition called dermatochalasis, the functional part of the surgery may be covered if it meets the insurer's criteria. That usually means a visual field test and photographs. Any purely cosmetic part of the surgery remains the patient's responsibility. For pricing in general, see blepharoplasty in Beverly Hills.

The short version

Upper blepharoplasty removes extra skin, and sometimes fat, from the upper lids through an incision hidden in the natural crease. It suits people whose hooding comes from the lid itself, and it can help with side vision when the skin is heavy enough. If your brows have dropped, a brow lift may be part of the answer. A consultation that looks at the lids and brows together is the best way to know which operation will give you the result you want.

Are heavy upper lids making you look tired?

A consultation looks at your lids, your brow position and your eye health together, then explains whether upper eyelid surgery, a brow lift or both would give you the result you want.

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Upper eyelid surgery. It removes excess skin, and when present excess fat, from the upper eyelids through an incision placed in the natural crease of the lid, so the eyes look more open and rested.

In the natural fold of the upper lid, the crease that forms when you open your eyes. Once it heals it is usually very hard to see, because it sits inside that fold.

Most bruising and swelling settles over the first couple of weeks, and many people return to desk work and social plans within that time. The lids keep refining for a few months as the last swelling fades.

It can be when the extra skin is heavy enough to block your side vision, a condition called dermatochalasis. The insurer usually wants a vision test and photographs. Any cosmetic part of the surgery stays the patient's cost.

Sometimes. If your brows have dropped, they push skin down onto the lids, and removing lid skin alone will not fix that. Some patients need a brow lift, some need eyelid surgery and some benefit from both.

Yes. Combining them treats hooded upper lids and under-eye bags in one operation and one recovery period.