Upper vs Lower Eyelid Surgery: What’s the Difference?

Upper and lower eyelid surgery are both types of blepharoplasty, but they address different concerns. Upper blepharoplasty mainly treats excess skin and selected fat above your eyes, while lower blepharoplasty is often used to improve under-eye bags, prominent fat or excess lower-eyelid skin.

You may need upper surgery, lower surgery or a combination of both, depending on your anatomy and what you want to improve. The techniques and recovery can also differ, so your surgeon should assess your eyelids carefully and recommend the approach that is most suitable for you.

What Is the Main Difference Between Upper and Lower Blepharoplasty?

The main difference is the area and type of tissue being treated. Upper blepharoplasty usually focuses on excess upper-eyelid skin and selected tissue changes, while lower blepharoplasty more commonly addresses under-eye bags, prominent fat and selected lower-eyelid skin changes.

The two procedures also require different surgical planning because the upper and lower eyelids have different anatomy and functions. Your surgeon will assess your individual features to determine which approach is suitable while preserving normal eyelid closure, position and comfort.

Upper vs Lower Eyelid Surgery at a Glance

What Problems Does Upper Eyelid Surgery Treat?

Upper blepharoplasty is commonly used to improve excess skin that creates hooding or makes your eyelids look heavy. In some cases, the excess tissue can also affect your upper or peripheral field of vision, and surgery may provide a functional benefit as well as a cosmetic improvement.

Your surgeon may also adjust selected fat where appropriate, but excessive fat removal is generally avoided because it can alter upper-eyelid contour and contribute to hollowing. If your heaviness is mainly caused by low eyebrows or true eyelid ptosis, blepharoplasty alone may not fully address the problem, so careful assessment is important for you.

Research Insight

Upper blepharoplasty is not always purely cosmetic. When excess upper-eyelid tissue genuinely obstructs the visual field, surgery can provide a functional benefit as well as changing eyelid appearance. A 2019 systematic review by Hollander et al. included 28 studies of functional outcomes after upper blepharoplasty and reported favourable changes including enlargement of the visual field, although not every measured functional outcome was consistent across studies.

More recent American Academy of Ophthalmology evidence has also found improvements in validated patient-reported visual-function and quality-of-life outcomes after appropriately selected upper-eyelid surgery. These findings do not mean that every cosmetic upper blepharoplasty improves vision, because the benefit depends on whether tissue was physically obstructing the visual field beforehand.

What Problems Does Lower Eyelid Surgery Treat?

Lower blepharoplasty may improve prominent under-eye bags, selected excess skin and, in suitable patients, the transition between the lower eyelid and cheek. These bags may remain noticeable even when you are well rested because they can be caused by structural changes and prominent fat.

Your surgeon may remove or reposition selected fat and address loose skin where appropriate, depending on your anatomy. Because removing too much tissue can affect lower-eyelid position, your eyelid support and tone should be carefully assessed before deciding which approach is right for you.

Who May Be Suitable for Upper Eyelid Surgery?

You may be suitable for upper blepharoplasty if excess upper-eyelid skin is causing a concern that surgery can realistically address and you are medically suitable for the procedure. Your surgeon should first confirm that the heaviness is mainly caused by eyelid skin rather than low eyebrows or true eyelid ptosis, which may require a different approach.

Your eye health also matters when assessing whether surgery is right for you. You should discuss dry eyes, irritation, previous eye surgery or difficulty closing your eyes, as these factors can affect your recovery and comfort.

Who May Be Suitable for Lower Eyelid Surgery?

You may be suitable for lower blepharoplasty if persistent under-eye bags or selected skin changes are caused by structural features rather than temporary tiredness. Your surgeon should also assess your lower-eyelid support and make sure you have realistic expectations about what the operation can improve.

It is also important to distinguish under-eye bags from hollows, shadows or pigmentation, as these concerns may need different treatments. If your main concern is colour rather than excess fat or skin, lower blepharoplasty may provide limited benefit, so an accurate assessment is important for you.

How Is Upper Blepharoplasty Performed?

Upper blepharoplasty usually involves an incision within your natural upper-eyelid crease, helping the scar become less noticeable as it heals. Your surgeon carefully plans how much skin to remove while leaving enough tissue for comfortable eyelid closure, with selected fat or muscle adjusted when appropriate.

Upper blepharoplasty is commonly performed as a day-case procedure and may be carried out under local or general anaesthesia depending on the extent of surgery and your individual circumstances. Your surgeon should use a conservative approach because removing too much skin can affect your ability to close your eyes comfortably and may contribute to dryness or a tight appearance.

How Is Lower Blepharoplasty Performed?

Lower blepharoplasty can be performed through an incision just beneath your eyelashes or through an internal incision inside your lower eyelid. A transconjunctival approach may be considered when prominent fat is a main concern and external skin removal is not required, while an external approach may be used when selected skin also needs treatment.

Your surgeon may remove or reposition selected fat to create a smoother under-eye contour rather than removing everything that protrudes. If your lower eyelid is loose, additional support may also be needed, so the technique will be tailored to your anatomy and the changes you want to improve.

How Is Fat Treated Differently in Upper and Lower Surgery?

Changes in orbital fat can contribute to age-related upper- and lower-eyelid appearance, but the way fat is managed differs according to your anatomy. During upper surgery, your surgeon may adjust selected fat conservatively, while excessive removal can create a hollow or aged appearance.

In the lower eyelid, prominent fat is often a major cause of under-eye bags, so your surgeon may remove or reposition it to create a smoother transition into the cheek. The aim is to improve your overall contour rather than simply remove as much fat as possible.

Can Upper and Lower Blepharoplasty Be Performed Together?

Upper and lower blepharoplasty can sometimes be performed during the same operation when both areas have concerns that would benefit from treatment. Combined surgery may create a more balanced improvement around your eyes, but it is more extensive than treating only one area.

1. Treat Both Areas Together: Combined surgery can address upper-eyelid hooding and prominent under-eye bags during the same procedure.

2. Individual Assessment: Your surgeon should confirm that both your upper and lower eyelids genuinely require treatment before recommending a combined approach.

3. More Extensive Recovery: You may experience greater swelling, bruising and a longer recovery period than you would after limited upper-eyelid surgery alone.

4. Eye Health Matters: Your eyelid support, dry-eye symptoms and ability to close your eyes comfortably should be considered when planning combined surgery.

Combined surgery is not automatically better than treating one area alone and should only be considered when it suits your anatomy, eye health and treatment goals.

What Results Can You Expect from Upper Eyelid Surgery?

After upper blepharoplasty, you may notice less excess skin folding over your eyelids and a clearer natural crease. This can make your eyes look more open and less hooded without changing their actual shape or size.

You may experience an improvement in your visual field when excess upper-eyelid tissue was genuinely obstructing peripheral vision before surgery. However, upper blepharoplasty does not automatically correct low eyebrows or true eyelid ptosis, so some heaviness may remain if these concerns also contribute to your appearance.

What Results Can You Expect from Lower Eyelid Surgery?

After lower blepharoplasty, you may notice flatter under-eye bags and a smoother transition between your lower eyelids and cheeks. This may make your under-eye area appear less heavy or tired when prominent bags were the main cause of that appearance.

Your result will depend on your starting anatomy, so loose skin, hollowing and prominent fat can produce different outcomes. Fine lines, pigmentation and some skin-quality concerns may remain, and the aim should be a natural contour rather than completely flat skin.

Does Recovery Differ Between Upper and Lower Surgery?

Both upper and lower blepharoplasty can cause swelling, bruising and temporary tenderness, but the recovery experience can differ. An isolated upper blepharoplasty may involve a more limited area of postoperative swelling than lower or combined eyelid surgery, although individual recovery varies considerably.

You may need around two weeks away from work, although your recovery depends on the procedure you have and the nature of your job. If you have combined upper and lower surgery, you may need more recovery time than you would after a limited upper blepharoplasty.

UK Guidance Note

NHS guidance advises that many people take around two weeks away from work following blepharoplasty, although the exact time depends on the procedure and occupation. Bruising and redness can take several weeks to fade, while scars can remain visible or feel tight for a few months.

During early recovery, patients may also be advised to avoid strenuous exercise, swimming, contact lenses and rubbing the eyes. Individual instructions from your surgical team should take priority because upper, lower and combined procedures can have different recovery requirements.

Where Are the Scars for Upper and Lower Blepharoplasty?

Your upper blepharoplasty scar is usually placed within the natural eyelid crease, while an external lower blepharoplasty scar is generally positioned just beneath your lash line. Both scars can look more noticeable at first but should gradually soften and fade as your skin heals.

For selected lower eyelid procedures, your surgeon may use an internal transconjunctival approach, which leaves no external skin scar. The incision used for you will depend on whether your main concern is excess skin, prominent fat or a combination of both.

What Risks Are More Relevant to Upper Blepharoplasty?

After upper blepharoplasty, you may experience temporary bruising, swelling, numbness, irritation or dryness while your eyelids recover. Removing too much skin can sometimes make it difficult for you to close your eyes fully, which may increase dryness and irritation.

You may also notice asymmetry, differences in your eyelid crease, scarring or contour changes, although serious complications are uncommon. Your surgeon should assess your eyelid position, brow height and eye-surface health carefully to reduce the risk of treating the wrong underlying cause.

What Risks Are More Relevant to Lower Blepharoplasty?

Lower blepharoplasty carries general surgical risks such as bruising, swelling, bleeding, infection and asymmetry, but changes in your lower-eyelid position are particularly important. Retraction can make your lower lid sit too low, while ectropion can cause it to turn outwards, affecting both appearance and eye comfort.

Your surgeon will choose the technique based on your anatomy and the tissues that need treatment, as both external and internal approaches can be used safely in suitable patients. Although serious complications are rare, severe pain, rapidly increasing swelling or unexpected changes in your vision after surgery require urgent medical assessment.

Evidence Note

Lower blepharoplasty involves a balance between improving bags or excess tissue and preserving normal lower-eyelid support. NHS guidance recognises that lower-lid muscles and tendons may sometimes need additional support during surgery, while contemporary reviews show that postoperative outcomes vary according to anatomy and surgical technique.

This is why lower blepharoplasty should not be viewed simply as “removing under-eye bags”. Fat position, skin excess, lower-lid tone and the relationship between the eyelid and cheek all influence which technique is most suitable.

How Can You Decide Whether You Need Upper, Lower or Both?

Start by identifying what you actually want to improve. Hooding or excess skin above your eyes may point towards upper blepharoplasty, while persistent under-eye bags may make lower surgery more relevant.

Low eyebrows, ptosis, pigmentation or hollowing may also contribute to your appearance. Your surgeon should assess your eyelid anatomy and eye health before recommending upper, lower or combined surgery.

Myth vs Fact

Key Takeaways

1. Upper blepharoplasty mainly treats excess upper-eyelid skin and selected fat.

2. Lower blepharoplasty more commonly treats under-eye bags, prominent fat and selected excess skin.

3. Brow descent and true eyelid ptosis should be distinguished from simple upper-eyelid skin excess.

4. Lower-lid tone and support are important when planning lower blepharoplasty.

5. Upper incisions are usually positioned in the natural eyelid crease.

6. Lower blepharoplasty may use an incision below the lashes or inside the lower eyelid.

7. Lower-eyelid fat may be removed or repositioned rather than simply excised.

8. Upper and lower procedures can sometimes be performed together.

9. Functional upper blepharoplasty may improve an obstructed visual field but does not correct refractive errors.

10 .Lower blepharoplasty does not reliably correct pigmentation or every under-eye hollow.

Frequently Asked Questions

1. What is the main difference between upper and lower eyelid surgery?
Upper blepharoplasty mainly treats excess skin and selected tissue above your eyes, while lower blepharoplasty focuses more on under-eye bags, prominent fat and selected lower-eyelid skin changes. You may need one procedure or both, depending on the concerns you want to address.

2. Can upper eyelid surgery improve your vision?
Yes, if excess upper-eyelid skin is physically obstructing part of your visual field. Removing the appropriate amount of tissue can improve peripheral vision, but blepharoplasty does not correct short-sightedness, long-sightedness or the need for glasses.

3. Can lower eyelid surgery remove under-eye bags?
Lower blepharoplasty can improve under-eye bags caused by prominent or displaced fat. Your surgeon may remove or reposition selected fat to create a smoother transition between your lower eyelids and cheeks.

4. Can you have upper and lower eyelid surgery together?
Yes, upper and lower blepharoplasty can sometimes be performed during the same operation. Whether combined surgery is appropriate for you depends on your anatomy, eye health, treatment goals and the amount of surgery required.

5. Are the scars different for upper and lower eyelid surgery?
Upper blepharoplasty usually leaves a scar within your natural eyelid crease. Lower blepharoplasty may leave a scar beneath your eyelashes when an external approach is used, while a transconjunctival approach places the incision inside your lower eyelid.

6. Which procedure has a longer recovery?
Both procedures cause swelling and bruising, but recovery varies depending on how much surgery you have. Lower or combined upper-and-lower blepharoplasty may cause more swelling and can take longer to settle than a straightforward upper-eyelid procedure.

7. Can eyelid surgery correct dark circles?
Not necessarily. Dark circles can result from pigmentation, visible blood vessels, thin skin, hollowness or shadows, and blepharoplasty mainly addresses structural eyelid changes such as excess skin or prominent fat.

8. Can eyelid surgery make your eyes look bigger?
Upper blepharoplasty can make your eyes appear more open by reducing excess skin that covers part of the natural eyelid. It does not actually enlarge your eyes, and removing too much skin can affect eyelid closure and comfort.

9. What are the main risks of lower eyelid surgery?
Lower blepharoplasty can cause bruising, swelling, dryness, asymmetry and, less commonly, changes in lower-eyelid position. Retraction or ectropion can affect both the appearance of your eyelid and how comfortably it protects the surface of your eye.

10. How do you know whether you need upper or lower blepharoplasty?
The right procedure depends on what is causing the feature you want to change. Your surgeon should assess your skin, eyelid position, brow position, fat distribution and eye health before recommending upper surgery, lower surgery or a combination of both.

Final Thoughts: Choosing the Right Eyelid Surgery for You

Upper and lower eyelid surgery can address very different concerns, so the right procedure depends on what is actually causing the changes around your eyes. If you are considering eyelid surgery in London, understanding whether your main concern is upper-eyelid hooding, under-eye bags, excess skin, hollowing or another feature can help you have a more focused discussion with your surgeon.

If you’re looking for eyelid surgery in London, you can get in touch with us at the London Medical & Aesthetic Clinic.

References:

1. Zhang, S.Y., Yan, Y. and Fu, Y. (2020) ‘Cosmetic blepharoplasty and dry eye disease: A review of the incidence, clinical manifestations, mechanisms and prevention’, International Journal of Ophthalmology, 13(3), pp. 488–492. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7154208/

2. Gimenez, A.R. et al. (2025) ‘Safety and complications in lower eyelid blepharoplasty: A systematic review’, Plastic and Reconstructive Surgery – Global Open, 13(9), article e7102. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12456572/

3. Vagefi, M.R. et al. (2025) ‘Health-related quality-of-life outcomes for upper blepharoplasty and blepharoptosis surgery: A report by the American Academy of Ophthalmology’, Ophthalmology, 132(12), pp. 1445–1456. Available at: https://pubmed.ncbi.nlm.nih.gov/40913605/

4. Rodrigues, C., Carvalho, F. and Marques, M. (2023) ‘Upper eyelid blepharoplasty: Surgical techniques and results—systematic review and meta-analysis’, Aesthetic Plastic Surgery, 47(5), pp. 1870–1883. Available at: https://pubmed.ncbi.nlm.nih.gov/37430010/

5. Hollander, M.H.J., Contini, M., Pott, J.W., Vissink, A., Schepers, R.H. and Jansma, J. (2019) ‘Functional outcomes of upper eyelid blepharoplasty: A systematic review’, Journal of Plastic, Reconstructive & Aesthetic Surgery, 72(2), pp. 294–309. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1748681518304200