Upper or Lower Blepharoplasty: Which One Do You Need?
Updated: 10 hours ago
Medical editor: Dr. Semih Yıldız, plastic, reconstructive and aesthetic surgeon (FEBOPRAS) · Last updated: October 2026
Upper blepharoplasty treats heavy, hooded upper eyelids by removing excess skin and, when needed, a little fat. Lower blepharoplasty treats bags and puffiness under the eyes, either by removing fat or by moving it into a hollow. If both areas bother you, they can be treated in one operation, but if the brow has dropped, eyelid surgery alone may not solve the hooding.
Which operation you need depends on where the tired look actually comes from, and that is decided by examination rather than by the mirror alone. The options below are the techniques used for blepharoplasty in Istanbul.
Hooding, bags or hollows: what the mirror shows
Three different problems are often described with the same words: tired, heavy or puffy eyes.
Hooding: a fold of skin rests on or over the crease of the upper eyelid and sometimes touches the lashes. Eyeshadow smudges and the eyes feel heavy by the end of the day.
Bags: a rounded bulge under the eye that is there all day, not only in the morning. It usually comes from fat that has moved forward as the tissue holding it weakens, and it is often more obvious when you look upwards.
Hollows: a groove or shadow between the lower eyelid and the cheek, often called the tear trough. A hollow can sit right below a bag and make the bag look larger.
Puffiness that changes from day to day and is worse after salty food, poor sleep or allergies is usually fluid rather than fat. Surgery does not treat fluid, and dark circles caused by pigment or thin skin do not disappear with surgery either.
Upper blepharoplasty: a lighter lid through a hidden crease
In upper eyelid surgery, the amount of skin to be removed is marked while you sit upright, because the lid looks different when you lie down. The incision follows the natural crease of the upper eyelid, so the scar sits in the fold and is hidden when the eyes are open.
Excess skin is removed and, when needed, fat, most often a small pocket near the inner corner of the eye that causes puffiness there. The aim is a lighter lid with a visible crease, not an empty one: removing too much skin or fat can make the eye look sunken or make it harder to close.
When heavy upper eyelid skin hangs into the field of vision, removing it may also improve side vision. Whether a functional benefit is likely needs a proper examination.
Lower blepharoplasty: removing fat or moving it
Lower eyelid surgery has two routes, and the choice depends mainly on the skin.
Incision just below the lashes
When there is loose or creased skin as well as bags, the incision is placed just below the lash line. This approach treats the fat and also allows excess skin to be removed, and the scar usually fades to a fine line.
Incision inside the eyelid
When the skin is firm and the problem is mainly fat, the bags can be treated through the inside of the lower eyelid (transconjunctival blepharoplasty). This leaves no visible scar. It suits patients without excess skin, often younger people, but it cannot remove loose skin.
In both routes the fat can be removed or repositioned. Repositioning means moving the bulging fat into the groove below it, so the bag flattens and the hollow softens at the same time. When a bag sits above a deep tear trough, this often gives a smoother transition from lid to cheek than removal alone, which can leave the area looking empty.
The lower lid also needs to keep its support against the eye. Its firmness is checked before surgery, because a change in lower eyelid position is one of the known risks of this operation.
Treating upper and lower eyelids together
Many people have hooding and bags at the same time, and all four eyelids can be treated in the same operation. It usually takes 1–2 hours under local anaesthesia with sedation or general anaesthesia, and you return to your hotel the same day.
A combined operation does not double the recovery time. The stitches are still removed around day 5–6 and most people are back at a desk after 7–10 days, although swelling and bruising are more noticeable when upper and lower lids heal at once.
When the eyelids are not the main problem
Before any eyelid surgery, the position of the brows is checked. A brow that has dropped pushes skin down onto the upper eyelid, and the hooding then looks like an eyelid problem. Removing eyelid skin does not lift a low brow, and taking extra skin to compensate can make the eye look tight or pull the brow lower. In that situation a brow lift, alone or combined with upper eyelid surgery, is often the more effective choice.
A few other findings change the plan:
an upper eyelid margin that sits low over the pupil (ptosis), which comes from the muscle that opens the eye and is not corrected by removing skin
dry eye, which can feel worse after surgery and is assessed first
thyroid eye disease, which can make the eyes look puffy or prominent for other reasons
previous eye surgery, which affects how much tissue can safely be changed
How the decision is made
The choice combines what bothers you with what the examination shows. Dr. Semih Yıldız assesses eyelid function, brow position and the health of the eye surface, then the skin, the fat pockets and any hollow. Front and side photos of your eyes, open and closed, are enough for a first online assessment, and the plan is confirmed at the face-to-face consultation before surgery.
It helps to be clear about what you would like to change: heaviness above, bags below, or the overall tired look. Photos from ten or fifteen years ago can also show which features have changed and which you have always had. Recovery, risks and preparation are explained step by step on our eyelid surgery page.
Frequently asked questions
Can lower blepharoplasty be done without a visible scar?
Yes, if the skin of your lower eyelid is firm enough. The transconjunctival approach treats the fat through the inside of the eyelid, so there is no scar on the skin. It cannot remove excess skin, though, so people with loose or creased lower eyelid skin usually need an incision just below the lashes, where the scar normally fades to a fine line.
Which is the more delicate operation, upper or lower?
Lower eyelid surgery is generally the more delicate of the two, because the lower lid has to keep its position and support against the eye after fat or skin is removed. That is why its firmness and the eye surface are checked carefully and why the plan is conservative. Upper eyelid surgery is more straightforward in most cases, but enough skin must always remain for the eyes to close fully.
Am I too young for eyelid surgery?
Age alone does not decide it. Some people inherit prominent under-eye fat or heavy upper lids and notice them in their twenties or thirties, while others develop hooding later with age. What matters is a real excess of skin or fat that surgery can address, healthy eyes and realistic expectations. Younger patients with bags and firm skin are often suited to the approach through the inside of the eyelid.
If you are not sure whether your upper lids, lower lids or brows are the cause, you can send front and side photos of your eyes, open and closed, for a free online assessment.
This article provides general information and does not replace a medical consultation. Results vary from person to person.
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