Are there different techniques to upper blepharoplasty for hooded eyes?

I am a patient in my early 20's looking to make my eyelid creases more parallel and less tapered, as well as increasing my crease height. I am planning to go with the incisional method. Are there several techniques to this type of procedure or do all surgeons follow one basic technique? If there is more than one technique, is one better than the other? Thanks in advance.

Doctor Answers 8

Crease asymmetry

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Hello, there are a multitude of reasons for your asymmetry - i.e. preexisting asymmetry in the eyelid or crease, subtle blepharoptosis, congenital asymmetry between the orbital apertures, or even occasionally something sinister.  Sometimes the best answer is an upper eyelid blepharoplasty to even and reestablish your eyelid crease but that is not the only reason. Occasionally a photo can be helpful if you can post one. I would recommend you have an evaluation with someone proficient in eyelid plastic surgery- specifically trained in oculoplastics surgery would be the best.

Saint Louis Oculoplastic Surgeon


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Hi flustered,Although it is unusual for a patient in their 20’s to need eyelid surgery, some people have extremely hooded eyes from childhood.  There are several techniques available for this procedure, all of them involving incisions.  It is not possible to say that any one of these techniques is better than the other.  It really just depends on your very specific eyelids.Best,Warwick Nettle

Upper eyelid surgery in 20 year-old

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Thanks for the question.  My first question would be why are you unhappy with your current upper eyelid crease position?  Are you unhappy with the lack of upper eyelid crease definition or that the crease is too low?  These answers will determine what is the best option for intervention.  The upper eyelid crease is typically 5-10 mm above the lash line in the 'Caucasian' eyelid.  The crease is created by the insertion of the levator aponeurosis (the muscle unit that lifts the upper eyelid) to the overlying skin.  Changing or elevating the fold involves some intervention which changes the level of insertion of the aponeurosis.  There are different techniques to accomplish this goal but the basic principles remain the same.  Finding a surgeon experienced in one of the techniques is the most important criteria for success.

Upper eyelid surgery candidate

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Upper eyelid surgery is usually performed with an incision placement at the upper eyelid crease. Skin, muscle, and fat can all be addressed, but thespecific procedure is based upon the patient's unique anatomy. This decision is performed at the time of the consultation and examination. For more information and many examples of blepharoplasty, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Upper lid surgery

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There can be variations of techniques to achieve an improvement in the upper eyelid. You would have to be seen in person. A person in their early 20's usually does not need their upper lids treated.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Techniques for upper blepharoplasty.

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There are many techniques for upper lid rejuvenation and you should never assume everyone is the same. The best results come come careful assessment of the problem, your goals, and the correct approach to follow. If you are in your early 20s be cautious and make sure the diagnosis or issues are properly identified.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Blepharoplasty Technique

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Thank you for your question.  The basic blepharolasty technique is similar for most patients.  The main variables are placement of the height of the lids crease, weather to also take more than just skin, and also if there is fat that needs to be addressed.  Also it is extremely important to evaluate the brows as well.  And also to identify any ptosis that sometimes can effect the height of the lid crease.  So I would strongly suggest a full examination by an oculoplastic surgeon, who can evaluate everything and then make suggestions.

Jessica Lattman, MD
New York Oculoplastic Surgeon
4.7 out of 5 stars 28 reviews

Different Blepharoplasty techniques

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The main issue with upper eyelids is to make the proper diagnosis to begin with. If there is excess upper eye lid  skin, is the skin redundant eyelid skin or is it droopy brow skin or is it both. Excess eyelid skin is treated with simple skin removal ie blepharoplasty. Droopy brows creating excess upper eyelid skin are treated with a brow lift. Some patients have both issues in play and need both surgeries for full correction. You have provided no pictures so it is impossible to know if your concerns could be corrected by either method. I would say that I have rarely operated on a twenty six year old for upper bleph so seek a board certified plastic surgeon to make sure this is what you need. Good luck.

Robert Graper, MD
Charlotte Plastic Surgeon
4.4 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.