Upper Bleph Appropriate? (photo)

I'm 34 years old and for the most part happy with my facial aesthetic. However, over the past couple years I've noticed considerable drooping of my upper lids, especially on the left side. My upper lids and crease used to be visible when I was in my 20's. I've tried Botox for 'crow's feet' and was unhappy with how it affected my smile - I felt as though I couldn't smile. Most bleph descriptions I find online are patients older than me, is there any advantage in waiting?

Doctor Answers 17

You are a candidate..

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I routinely perform upper eyelid blepharoplasty in clients your age and even younger. Since genetics is an important factor that contributes to upper eyelid hooding, this procedure is not something for which you’re too old. It may be helpful to you to know that we have a client who is in her 20’s and was featured in one of our education videos.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Upper Bleph Appropriate? (photo)

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These are all good questions.  They are better answered after an appropraite examination so all your options can be given to you.  The short answer is that your age is not a contraindication to blepharoplasty, and if there is truly extra skin that is bothering you, it can be removed. 

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Eyelid surgery and Botox

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  The third photo does indeed show your problem which is excessive fullness and skin of the upper eyelids. The term for this is dermatolochalasis. Although most patients who seek help for this are older than you, I have operated on patients younger than you who were just genetically predisposed to this problem.

  The problem can be corrected via an in-office surgical procedure under local anesthesia. Excess skin and fat are removed and sutures are placed which are removed after one week. After surgery, you will look less tired and it will be easy to put on eyelid make-up again.

  Your inability to smile after Botox to your crow's feet happened because the Botox was injected into the wrong place where it affected a muscle which turns up the corner of your mouth. If you noticed worsening of your eyelid problem after receiving Botox to your forehead, then the Botox was placed in the wrong place once again, causing your eyebrows to drop which makes your eyelids seem puffier. Botox works for forehead wrinkles and for crow's feet but an understanding of anatomy is required.

 Hope this helps!

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.7 out of 5 stars 3 reviews

Eyelid surgery in young people

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Morning Mireillev,


I do see what you are describing.  I think you could do a couple of sessions of fractionated CO2 laser work of the upper eyelids given your age and limited amount of laxity.  You're at one of these in-between stages where you have enough laxity to cause things like:

1.  Some visible laxity

2.  Makeup doesn't go on very smoothly

3.  The eyelid feels a bit heavy


Surgery would probably be overkill at this point.  Now, for the Botox, that may still be helpful but it really depends on how and where you inject it.  If it had a negative effect on your smile then it was not inject in the right place most likely.  You'll want to inject that laterally and in the upper half of the crow's feet and just under the outer portion of your eyebrow.  That should lift the brow and the loose skin a bit.


The laser work would cause about 2 to 4 days of down time with some mild pinkness to the skin for a week or so but you can wear make up at that point.


Best of luck


Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

When is the best time for upper blepharoplasty?

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In general, age is a minor consideration in terms of when to have surgery.  Much more important are the physical findings, your state of health, and how much the current situation bothers you.

From your pictures, it looks like you could benefit nicely from an upper blepharoplasty.  Please make sure to select a surgeon who is judicious in the amount of  fat removed.  If too much fat is taken, the eyelid will get a hollow look that looks increasingly severe over time.


If is very important with this type of surgery that the plastic surgeon and the patient should have a similar sensibility about what looks attractive.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Upper bleph surgery

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Thank you for the question and the photos. If you compare the photos, from age 28 to 34 you will notice several changes around the eye. You brow has dropped slightly. This gives you that heave look in the upper eyelid area. There is some excess skin in the upper eyelid. The lower lid has changed as well. The lower lid cheek junction has dropped due to check descent.

Doing an upper bleph will give you some improvement, but will not address all the changes.I suggest you get a consultation with a board certified plastic surgeon. Good luck.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Right Time for an Upper Blepharoplasty

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You are right in that most people who have upper eyelid surgery are in their 40's, 50's or older. However, you have some extra skin on your upper eyelids so if it bothers you, you should discuss it with a Board Certified Plastic, Facial Plastic or Occuloplastic Surgeon. 


As for the Botox affecting your smile, consider asking your surgeon to use a bit less and not injecting it in the lower eyelid area.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Very helpful to have the photo from 6 years before.

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First there is a striking difference in facial shape due to body mass.  Between age 28 and age 24, you have gained approximately 10 lbs which probably makes little difference for your figure but is is confounding in trying to understand the difference in facial appearance.  The increased facial volume softens your facial contour.


BOTOX for the crows feet is insufficient to lift your brow.  You can study my website on the Microdroplet botox forehead lift.  However I suspect you need more than this.  There is a significant issue with performing an upper bleph.  First while many doctors will tell you "conservative blepharoplasty"  what do they really mean by that.  I encourage you to print some of the before and afters from my website and show them to your potential surgeons to really make the point that you are looking for conservative surgery.  What is conservative upper eyelid surgery?  It is the removal of just enough upper eyelid skin to exposed the desired amount of upper eyelid platform.  Additionally, you have a small degree of upper eyelid ptosis.  The actual lid margin strikes the cornea lower now than 6 years ago.  This needs to be corrected as part of your "conservative eyelid surgery"  Crease height: Surgeons place the crease too high in the vast majority of eyelids.  Why does this happen?  So simple.  The plastic surgery text books quote a figure for making the upper eyelid crease at a height that is too high.  For women this is often cited as 10 mm and for men 8-9 mm.  This is simply too high unless you are looking for the "surgical' look.  Where should the crease be made?  Generally for a western eyelid at 6 to 8 mm for women.  The crease will not stay at this position.  As it heals, it tends to creep up 1 to 1.5 mm.  This means that a crease made at 10 mm can heal to 11.5 or 12 mm.  That is tends to hollow the upper eyelid.  


Next skin excision:  Surgeons often remove too much skin in the upper eyelid.  There are all sorts of formulas. Mostly they are nonsense.  The excision is best determined by individually assessing how much fold lays over the upper eyelid platform.  By estimating were the upper eyelid will rest once the upper eyelid ptosis is corrected and how much eyelid platform one wants exposed, and knowing how much eyelid is needed to turn at the eyelid fold, one can make a simple calculation as to how much skin should be excised.  If your potential surgeon can't walk you through this calculation, you are probably in the wrong office.  In a personal consultation I would also discuss with you options to address your sun damage which also contributes to the difference in your overall appearance from 6 years ago.  You had sun damage then but you have a bit more now.  Simple treatments like photo facial and even consistent use of sun screen can be very helpful.


Bottom line is be careful out there because sometimes you think you know what you are asking for but get something else.  Make your potential surgeon communicate what they understand of your concerns.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Upper lid blepharoplasty

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An upper lid blepharoplasty has no specific age limit. I have treated many women in their 30's who have heavy upper eyelids. The key is not to be too aggressive and keep most of the upper eyelid fullness.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Upper blepharoplasty

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The only advantage to waiting for the blepharoplasty is that you'll probably see a more dramatic result the longer you wait.

It all depends on how much you are bothered by the upper lid fullness. A "skin only" blepharoplasty will give you a nice result.

As far as the botox goes, you may be happier with a lower concentration of botox used that would minimize the wrinkles, without "freezing your eyes".


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.