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.

In my 20 years of practice, people have come to me with similar situations saying that they don’t like their lower eyelids. I would not push them to do anything else even though I noticed that their upper eyelids would also benefit from surgery. After I did their lower eyelids, they’d come back to me and ask why I didn’t advise them to have their upper eyelids done also. I would explain that they came in complaining only about their lower eyelids.

If you have to make a choice, from my experience, doing the lower eyelids has a greater overall impact on your eyes because puffiness under the eyes makes people look like they’re always tired. If your problem is about doing the two eyelids separately because of financial issues, then you may just want to wait to do them both together.

In our office, when we do either a lower or upper eyelid surgery, we have our own facility that caters to your needs. The patient basically is paying for the facility fee, the surgeon and even the anesthesia. Usually in my situation, once you’ve met the cost, the additional procedure is usually much less expensive compared to going to the facility twice and paying two separate anesthesia and facility fees.

Aesthetically, it is better to do the upper and lower eyelids together because it is where we are able to balance the appearance of both. As the saying goes, the whole is greater than the sum of its parts. That being said, if you can manage it then do both together is ideal. However, if you have to choose one, I would suggest that you consider doing the lower eyelids first.  I hope that was helpful, and thank you for your question.