Would only doing lower blepharoplasty leave my eyes unbalanced looking? (Photos)

Question

I'm getting lower blepharoplasty in the next month or so and I've been recommended to get upper blepharoplasty as well, but I'm unsure if i need it? I guess iI have some upper eyelid hooding and a bit of laxity but not sure if it bothers me enough, but more importantly if just doing lower will leave my eyes unbalanced?

Andrew Miller, MD · Answer

The different photos you show cause a little confusion. The first one looks fine, while the other two have some issues. It's important to revies the upper lids when your eyes and forehead are very relaxed so you won't have extra movement affecting the analysis. But you are definitely a good candidate for lower eyelid surgery and it's perfectly fine to do the lower lids by themselves if that's what you want to do. Be sure to see a rhinoplasty expert for consultation.

Richard V. Balikian, MD, FACS · Answer

In order to give you a proper answer, I would need to see you in person. However, I can address upper and lower blepharoplasty in general and provide a video explaining the differences between the two procedures in greater detail.
Upper and lower blepharoplasty treat different things. An upper blepharoplasty removes excess skin that is folding over the upper eyelid. A lower blepharoplasty addresses the fat pockets and shadows underneath the eyes.
We really have to look at both the upper and lower eyelids to make sure everything stays harmonious and balanced, because that’s what makes a pretty result. However, that does not necessarily mean both areas need surgery.
An in-person evaluation would allow your surgeon to explain whether the upper blepharoplasty needs to go together with the lower blepharoplasty and why, or whether it is an additional procedure that you can choose to add or not.

Julian De Silva, MD · Answer

Hi Witty239770, thank you for asking this before surgery rather than afterwards.

Doing the lower lids alone does not automatically leave the eyes looking unbalanced. It happens in some people and not in others, and which group you fall into depends on what is actually driving the appearance.

The usual mechanism is this. Lower blepharoplasty tends to open and freshen the lower half of the eye. Where there is significant upper hooding, the contrast between a refreshed lower lid and an unchanged upper lid can become more noticeable than it was before, simply because the eye is now framed differently. Where the upper laxity is mild, most people perceive no imbalance at all.

The second point is about sequencing rather than necessity. If upper surgery is something you are likely to want within a few years, doing both at one sitting means one recovery and one anaesthetic. If the hooding genuinely does not bother you, there is nothing wrong with doing the lower lids now and revisiting the uppers later. Eyelids are one of the areas where staged surgery is straightforward.

One caveat that matters. Brow position contributes a great deal to upper lid hooding, and some people who believe they need an upper blepharoplasty in fact have a descended brow, where skin removal alone would not be the right answer. That distinction is made on examination rather than from photographs, so it is worth asking your surgeon to show you exactly what they are treating and why.

Would only doing lower blepharoplasty leave my eyes unbalanced looking? (Photos)

Answers (3)

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