Upper Blepharoplasty for Puffy, Sagging Eyelids?

I have very puffy eyes, sagging towards sideway. It is hard and tiring to open my eyes big. Sometimes, I unconsciously raise my eyebrows so that my eyes look brighter and energetic. Continuously raising eyebrows causes me headache. Are my eyelids becoming heavier and affecting my vision due to aging? Will Upper Blepharoplasty help? What are the risks of this procedure? Any other alternative?

Doctor Answers 9

Upper blepharoplasty could help

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

When there is excess skin laxity in the upper lids, it causes the tired look. Excess skin hanging on the upper eyelids creates heaviness and weight on the upper lids. Therefore, patients tend to lift their eyebrows to be able to see better. This can cause frontal headaches from muscle contraction. The goal of upper blepharoplasty surgery is to remove primarily excess skin on the upper lids and a small amount of fat that creates the puffy look. This will improve both appearance and function of the upper lids. At least 30% of the visual field has to be reduced before an insurance company may consider payment for this procedure. Risks from the procedure are very minimal and rare but can include on an extremely rare basis, blindness, double vision, and asymmetrical eyelids.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Asian blepharoplasty is an art

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Asian blepharoplasty certainly can help you, but you need to find an expert who has experience with this procedure. Many American plastic surgeons create an open Occidental look which destroys the natural beauty of the Asian eyelid.

From your picture I think your brow position looks normal but I cannot be certain without examining you.

Only very conservative fat removal should be done for if too much fat is removed the upper eyelid will look hollow and unnatural in the Asian eyelid.

A small amount of skin resection and re inserting the eyelid tendon a little higher will create a natural Asian eyelid fold which will look pleasing and appropriate.

A small amount of skin should be left to fall over the fold incision to hide the incision and create a natural look which is desired in the Asian eyelid.

You really need to find an expert who has experience in this procedure if you want a naturalo looking result.

If you want an open, Occidental or Caucasian look this is also possible, but be certain, as you cannot regain your natural look once that is done.

I always ask my patients to bring a photograph from a magazine which shows what they consider the ideal upper Asian eyelid that they would like to have.

See before and after pictures of Asian upper blepharoplasty and Caucasian blepharoplasty and brow lift.

Blepharoplasty will help

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Blepharoplasty will help you, but you need to go to a surgeon who specializes in asian eyelids. You would likely benefit from the double fold surgery. Good luck.

Asians can get brow lifts, too!

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In review of the many suggestions that you have received from the doctors below, the credible suggestions include double eyelid procedures.

Stay away from Thermage and fancy creams with doctors' names on them. The best things in life are surgical! You can also consider a browlift as part of the double eyelid procedure. It will especially help relieve the stress that is giving you headaches.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have Asian eyes which has a slightly different anatomy than the western eye. Never the less, you are noting that the upper lid is starting to block vision, and countermeasures are causing headaches. I recommend a visit to a plastic surgeon.

You may be experiencing these things due to drooping of the forehead/brow as well as aging of the upper lid. I think that surgery may help, but it must be determined which procedure is indicated. If it can be documented that you have "visual field cuts" due to obstruction, perhaps insurance will cover it.

Upper eyelid surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

you complain about fullness and extra skin on your upper eyelid can be resolved with upper blepharoplasty . This will remove extra skin and also extra fatty tissue. The may concern is that your ethnic look may change. Make sure to get consultation with a board certified plastic surgeon with previous experience with asian eyes. Ask for pre and post op picture and make sure you are comfortable with the changes.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Brow position and upper eyelid fold heaviness are related

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Tingmm,

You are absolutely working your forehead to elevate the upper eyelid fold. The signal to work the forehead is caused by the awareness of the upper eyelid fold resting on your eyelashes. Elevating the forehead surgically would reduce the amount of work your forehead muscles need to do. However, as noted by Dr. Yuan, you have a single fold configuration upper eyelid. This results and eyelid that is difficult to apply make up on because you lack a visible eyelid platform, the space between the upper eyelid lashes and the upper eyelid crease.

Double fold surgery works when a strong adhesion is made about 5 to 6.5 mm above the upper eyelid lashes and the levator aponeurosis, the tendon of the muscle that raises the upper eyelid. A small amount of skin is also removed based on the amount of eyelid platform that the surgeon and patient decide should be visible below the eyelid fold. Very little fat in the upper eyelid should be disturbed as part of the double fold surgery to maintain the full quality of the upper eyelid. A firm attachment between the upper eyelid platform and the the levator aponeurosis is more likely to form if the surgeon uses anchor blepharoplasty techniques. When an external suture double fold method is used such as Pang sutures, it is less likely that a permanent connection between the eyelid platform and the levator aponeurosis will form.

It is a good idea to look through magazines and find eyelid that you like and bring these to the consultation with the eyelid surgeon. In particular, you need to be very clear with the potential surgeon what you are looking for. If the upper eyelid incisions is made too high, the eyelids can be Westernized and this undesirable result is very difficult to revise. It is helpful if you have friends who have had surgery with a particular doctor and you are familiar with the type of results they produce. Sure credentials are important but at the end of the day, what kind of work will your surgeon actually do?

Please share you experiences with the Realself community.


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

Double eyelid surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your appearance is probably due to the lack of attachment of your levator muscle, the muscle that lifts your upper eyelid, to a crease in the skin. This allows the skn to fall over your lid. You can have a so-called double eyelid procedure to alleviate this. There a many methods to achieve this. It is usually very safe with the main complications being asymmetry of the crease and loss of the double fold due to inadequate fixation of the muscle to the skin. You should be aware if you have any intrinsic asymmetry to the size and shape of your eyes that may become uncovered when the surgery is performed.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Upper eyelid surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The eyes are the windows to the soul. All too often, however, they seem to reveal exhaustion. The very delicate skin around the eyes tends to get crepey and puffy due to fatigue and stress. Eyelid surgery has become one of my most popular procedures. If excess upper eyelid skin is hooding the eye and needs to be eliminated, an incision is made in the crease at the top of the lid and excess fat and skin are removed. The incisions are closed and sutured on the underside of the skin.

Topical creams can reduce some lines and wrinkles around the eyes almost immediately, even without surgery. Topical creams like Dr Michelle Copeland Rewind Eye Formula containing pentapeptides and antioxidants help reduce the appearance of fine lines around the delicate eye area, increasing collagen production and reducing dark circles and puffiness over time.

Another effective non-surgical option is Thermage, which can tighten the skin around the eyes. Thermage is a non-invasive (no incision!) treatment that can tighten skin and stimulate your body to make healthier collagen—the building block that provides structure to your skin. Fast and easy, Thermage requires no downtime from normal activities.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 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.