What surgery will help with puffy upper eyelids? (Photos)

Question

I am getting a lower blepharoplasty early next year to address concerns with undereye bags. As I am aging, my upper eyelids are becoming increasingly puffy and droopy. My eyes look nearly closed when I smile and my upper eyelids keep appearing bigger. Would ptosis correction, blepharoplasty, or something else altogether be best to address this?

Gary DeCesare, MD · Answer

A blepharoplasty procedure addresses these concerns. Ptosis is when the upper eyelid 'droops'. Normal position is for the upper eyelid margin, or edge of the eyelid, to sit roughly 1-2mm below the iris, which is the colored ring around the pupil. Blepharoplasty may address the fat and skin but not ptosis. Ptosis correction is a distinct procedure that may be done simultaneously with blepharoplasty. An in person history and physical would help to determine which type of ptosis, if any, is present

Lexie Wang, MD · Answer

yes you could consider an upper bleph with fat reduction in the upper lids if fat is truly the concern. it kind of also looks like you may have some allergy fluid build up when I see these photos. it also appears as if you have some brow drop and finally clearly hyperactive orbicularis oculi muscle- botox will help for sure!!

Yucel Sarialtin, MD · Answer

Thank you for your question and photo. 
Based on your description and the visible signs of upper eyelid heaviness, it’s possible that a combination of upper blepharoplasty and ptosis repair may be appropriate. Upper blepharoplasty addresses excess skin and puffiness from fat protrusion, improving eyelid definition and opening the eyes aesthetically. However, if your eyelids appear low due to weakening of the levator muscle (true eyelid ptosis), then a ptosis correction is likely necessary to elevate the eyelid margin itself, not just remove skin. These procedures are often performed together when both excess tissue and muscle laxity are present. A full evaluation by an oculoplastic or facial plastic surgeon will help determine if the droopiness is due to skin redundancy alone or underlying ptosis requiring functional correction.

Chet Mays, MD · Answer

Thank you for your inquiry! We would love to sit down with you to discuss your concerns. A blepharoplasty removes fullness and excess skin. It uncovers the shape of your natural eye. Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand from your question If you could send us detailed photographs taken at 95-degree angles from the front and side profiles, we would be able to make a more accurate assessment. From what I can see, lower and upper blepharoplasty would be a better option for you.
Best Regards!

Eric M. Joseph, MD · Answer

The orbicularis roll is the heaping up of your orbicularis muscle under your lower eyelashes with smiling. Since this is not fat, it cannot be removed, and in our experience, Botox has not been terribly helpful. I wish I had a better recommendation for you. Sincerely, Dr Joseph

James N Long, MD, FACS · Answer

Your photos show a redundancy of skin in the upper lids but I don't appreciate any ptosis. Your situation, I believe, would be best addressed with a simple upper lid blepharoplasty.

Zoran Potparic, MD · Answer

Whether upper eyelid surgery would create an improvement would be difficult to suggest  based on these photos. You should discuss this issue with a surgeon who is doing your lower eyelid surgery. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment we need better pictures. Try including standard facial pictures the way plastic surgeons take before and after pictures. Avoid facial expression in the pictures. 
For ptosis assessment consider consulting with oculoplastic surgeons in your area.
Mats Hagstrom MD

What surgery will help with puffy upper eyelids? (Photos)

Answers (9)

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