Upper or Lower Bleph? (photo)

Question

I am trying to decide if I should do upper or lower eyelids? Right now I can only one or the other but maybe in a year or so i can do the other. I would love some opinions on which would be more beneficial as BOTH are really bad. Thanks for any help!

Tanveer Janjua, MD · Answer

It always is easier to undergo upper blepharoplasty as the recovery is quicker and the results more impressive. However, some people like the look of hooded upper eyes and prefer not to have any bags in the lower eyelids.

	In essence, ask yourself what bothers you more, the upper eyes or lower and start with that.

	Regards

	Dr. J

	Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Michael R. Macdonald, MD · Answer

Preferred Recommendation: Be patient and do both together. If you can manage waiting a year, I would strongly recommend that you wait and do both upper and lower eyelid surgery together. It makes more sense for 3 reasons:

	
		It's usually more cost effective, with lower overall OR costs.
	
		You have only 1 recovery period to endure vs. 2.
	
		Patients are overwhelmingly much more satisfied with full rejuvenation of the eye area vs. partial if your condition warrants it, as yours does. As an analogy, you wouldn't do a facelift and not address a sagging neck as well.


	If you have to choose between upper & lower: If you absolutely feel you must address either the upper or lower now, then I recommend doing the lowers first.

	Addressing the puffy look in the lower eyelids, not only increases the youthfulness of your appearance, but it makes you look less tired. The correction of your lower eyelids could even be done through a hidden incision on the inside of your eyelids. In this way, recovery is somewhat quicker than with the upper eyelid surgery because there are no visible scars and no sutures to remove.

	Recovery time would depend only on how much you bruise. Bruising in the lower eyelids generally lasts anywhere from 2-10 days, depending on your individual response.

Nelson Lee Novick, MD · Answer

The region around the eye attracts so much attention on the part of the observer that anything we do to improve its appearance can make a disproportionately significant overall improvement in the way we look and how old we look.

	Happily, these days we can do a lot to improve the eye unit without having to resort to surgery or have to deal with the downtime and expense of surgery. For example, tear troughs, dark circles and hollow areas can be treated with fillers, my favorite for this delicate area is Belotero Balance, since it has little or no tendency to reflect a bluish discoloration (Tyndall Effect) after injection into the thin region under the eyes.

	If necessary to provide further support and buttressing to the undereye area in the mid-facial fat pocket area, a small amount of Juvederm UltraPlus XC can be injected to enhance contouring and ensure that there is a smooth grade from the cheek to the lower lid.

	To improve sagging of the upper brow, a tiny amount of Botox, Dysport or Xeomin may be injected into the tail of the eyebrow to restore the upward, outward flare of the youthful brow. In addition, a volumizing filler, such as Perlane L can be instilled directly under the outer third of the eyebrow to achieve the outward projection that characterizes youth and to provide additional support for the outer brow. If necessary a 3D vectoring pull upward from the direction of the upper lateral forehead and outward can be achieved with the combination of Radiesse and Restylane to "fix" the lateral brow upward. All of these maneuvers help somewhat to raise the brow off the upper lid to expose it and diminish brow sagging.

	Combining all these approaches into one treatment session (they can each be done separately) should take no more than twenty to thirty minutes to perform, is essentially painless when performed properly with the appropriate use of local anesthetic, and entails little or no downtime.

Anthony Corrado, DO · Answer

Although I can appreciate your desires to effect an immediate change on your appearance, I would have to agree with the other physicians that it is better to save your money and do both upper and lower blepharoplasty at the same time.

	You will benefit by having to only go through one recovery period instead of two.  Your cost with regards to facility fees and anesthesia will also be lower.

	Good Luck

Kenneth Hughes, MD · Answer

Upper eyelid surgery would help. I would have to examine you and determine what bothers you in the lower eyelid area. I would probably recommend something additional or apart from lower eyelid surgery. In general, you save money by doing the procedures at once. Kenneth Hughes, MD Los Angeles, CA

Mehryar (Ray) Taban, MD, FACS · Answer

You can benefit from both upper and lower blepharoplasty to achieve more youthful appearance. They are best done together as you only need to go through one recovery period. The cost of combined upper and lower blepharoplasty is also usually less than that if you separate the two.

Evan Ransom, MD, FACS · Answer

Jamie, thank you for this great question and for posting your photos. Though you may feel financial pressure to only have the upper or lower eyelids lifted, the reality is that, when indications exist for both, it is better to do all four eyelids together. This improves the overall harmony of the result, and will also mean that you only have to recover once. Lastly, many surgeons will give a discounted price if you combine multiple procedures. Ask your qualified surgeon if this is available. Best of luck!

Stephen Prendiville, MD · Answer

Based on the photos shown, there are strong indications for both upper and lower eyelid surgery. You can certainly have either one separately, but your level of satisfaction will be much greater by addressing the aesthetic concerns comprehensively. For patients seeking a step by step approach, upper lid blepharoplasty is easier, faster, and carries less downtime than lower eyelid surgery.

Gregory Sexton, MD · Answer

You should correct whichever bothers you the most. Your upper eyelids may be severe enough that insurance will pay for it, and then you could do both.

	Good luck.

Steven Wallach, MD · Answer

If you can only afford one it really is your choice, but it would probably be best to save to do both at the same time because you will only have to pay one facility fee.

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