Upper or Lower Bleph? (photo)

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.

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.

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.