Upper and lower bleph, face and neck lift - What is the standard order of face procedures?

Question

When a plastic surgeon performs upper and lower blephs plus a facelift and neck lift during the same session . What is the standard order of the procedures?

Safa Manav, MD, FEBOPRAS · Answer

Thank you for your question. There isn't one universal order. Surgeons follow a logic based on how each procedure affects the others, and each has their own routine.
In my practice, the upper eyelids are usually marked with the patient sitting upright before surgery, because the amount of skin to remove must be judged before the face is lifted or swollen. The operation itself often starts with the neck (through a small incision under the chin, if the platysma muscle needs tightening). Then comes the facelift on each side, which also re-drapes the neck skin. The eyelids are usually done last.
The reason for doing the eyelids after the facelift is that lifting the cheeks and midface changes the tension on the lower eyelids. Finishing them last lets the surgeon remove exactly the right amount of skin and avoid pulling the lid down. Some surgeons prefer to do the upper eyelids first, while the tissues aren't swollen yet. That is also perfectly acceptable.
More important than the exact sequence is that the surgeon plans the procedures as a whole, and that total operating time is kept reasonable with an experienced anesthesia team.
Best wishes,Dr. Safa Manav

Ozge Ergun, MD · Answer

Hello, thank you for sharing your question. When upper and lower blepharoplasty, facelift, and neck lift are planned together, I prefer to perform all of these procedures during the same operation when medically appropriate. The reason is that the lower eyelid and midface tissues can be affected by the facelift. If the lower blepharoplasty is performed first and the facelift is subsequently performed as a separate procedure, the lower eyelid may require further correction afterward. Performing the procedures together allows the eyelids, midface, face, and neck to be planned and treated as one integrated procedure, providing better overall harmony and avoiding unnecessary repetition of surgery.

Best regards,
Ozge Ergun, MD

Best regards,
Ozge Ergun, MD

Elie Ramly, MD · Answer

There is no single standard order that every plastic surgeon follows when performing upper and lower blepharoplasty together with a facelift and neck lift as one combined procedure. The sequence can vary between surgeons and can also depend on the patient’s anatomy, the details of the operation, and how the procedure is being tailored to that individual patient.
Personally, when performing these procedures together, I generally prefer to perform the upper and lower eyelid surgery first, followed by the face and neck lift.
This is because the eyelids are very delicate anatomical structures and measurements, symmetry, and refinements come down to millimeters. I prefer to perform that precise work at the beginning of the operation, before any swelling from adjacent facial surgery has had an opportunity to develop and potentially alter the tissues or landmarks I am evaluating.
Other surgeons may use a different sequence with great results. Ultimately, the specific order is less important than having a thoughtful, consistent operative plan tailored to the individual patient and the procedures being performed.

Rudolph J. Triana, Jr., MD, FACS · Answer

Hi, when upper and lower blepharoplasty are performed together with a facelift and neck lift, the order of procedures may vary depending on the surgeon’s technique and the patient’s individual needs. In our practice, the procedures are typically performed in the following order:
Upper blepharoplastyLower blepharoplastyFacelift and neck lift

Serdar Bora Bayraktaroglu, MD · Answer

I ensure these combined procedures follow a strict anatomical sequence:Facelift and Neck Lift Dissection: We begin with lower-face incisions, flap elevation, and deep muscular tightening to establish foundational tension.Upper Blepharoplasty: Upper eyelid skin and muscle are addressed next.Lower Blepharoplasty: Lower eyelid fat and skin adjustments are completed with meticulous care.Facelift Closure: Finally, we redrape the facial skin flaps, precisely trim excess tissue without tension, and close the incisions.This precise order prevents rapid eyelid swelling from obscuring critical deep structural landmarks during your surgery.

Semih Yildiz, MD, FEBOPRAS · Answer

There is no single required order, and experienced surgeons may sequence these procedures differently. The important steps are careful preoperative marking while you are upright, eye protection, good hemostasis, and avoiding excessive skin removal around the eyelids when a facelift is being done at the same time.
A common sequence is to complete the upper blepharoplasty first, then lower blepharoplasty, and then proceed with the face and neck lift. Some surgeons prefer to do the neck and facelift work first and finish the eyelids later so they can reassess eyelid tension and facial balance after the lift. Either approach can be appropriate.
What matters more than the exact order is that the surgeon plans the eyelids, cheeks, and neck as one unit. Lower eyelid support, cheek position, skin tension, and swelling all interact, so the safest plan is the one your surgeon uses consistently with predictable results.

Stephen Prendiville, MD · Answer

Thank you for the question.  This is more an issue of Surgeon preference than anything else. I prefer to perform lower and upper eyelid blepharoplasty first (in that order).  Is it wrong to do the inverse? Not necessarily.

Jeffrey M. Darrow, MD · Answer

Each surgeon would have their own order for how they perform a facelift and neck lift with upper and lower blepharoplasties. My personal preference is to perform the facelift first, followed by the lower blepharoplasty and then the upper blepharoplasty. This is done in order of difficulty, leaving the easiest surgery for last. It also gives me a chance to examine the facelift at the end of the eyelid surgery to be sure there is not anything that I would have to deal with before bringing the patient to the recovery room.  Best wishes.

Lexie Wang, MD · Answer

I think most surgeons do the eyes first, then the face/neck, because the eyes, esp the upper bleph, relies very much on small measurements and you don't want to have any swelling to confuse the potential result.

Jeffrey Lisiecki, MD · Answer

The exact order depends on the surgeon, but I do upper blepharoplasty, then lower blepharoplasty, then fat transfer, then neck, and face last.

Upper and lower bleph, face and neck lift - What is the standard order of face procedures?

Answers (12)

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