The eye area is often one of the first parts of the face to show visible signs of ageing. Drooping upper eyelids, under-eye bags, loose skin, and a tired expression can develop gradually, even in otherwise youthful faces.
For many patients, blepharoplasty is an effective surgical solution to restore a fresher, more rested appearance while maintaining natural facial harmony.
One of the most common questions during consultation is simple: Should I choose upper blepharoplasty or lower blepharoplasty? The answer depends on your anatomy, concerns, skin quality, and desired outcome.
According to Dr. Costantino Davide, eyelid surgery should always be approached with balance, proportion, and personalised planning. The objective is not to “change the eyes,” but to improve the periocular area while preserving expression and identity.
What Is Blepharoplasty?
Blepharoplasty is a surgical procedure designed to improve the appearance of the upper eyelids, lower eyelids, or both. It can address excess skin, protruding fat pads, lax tissue, and signs of fatigue around the eyes.
Because the eyes are central to facial communication, even subtle improvements can make a significant aesthetic difference. Patients often report looking more awake, refreshed, and less tired after surgery.
Upper Blepharoplasty
Upper eyelid surgery focuses on correcting:
- Excess skin folding over the eyelid
- Hooded or heavy eyelids
- Puffiness caused by fat protrusion
- Reduced eyelid definition
- In some cases, visual obstruction from redundant skin
The incision is typically hidden within the natural eyelid crease, helping scars remain discreet once healed.
Lower Blepharoplasty
Lower eyelid surgery is designed to improve:
- Under-eye bags
- Puffiness caused by fat herniation
- Loose lower eyelid skin
- Wrinkles beneath the eyes
- Hollowing or shadowing in selected cases
Depending on anatomy, the incision may be placed just below the lash line or inside the eyelid (transconjunctival technique), where no visible external scar is created.
Upper or Lower Blepharoplasty: What Is the Difference?
Although both procedures target the eyelids, they treat different ageing patterns and aesthetic concerns. Understanding these distinctions helps patients identify the most appropriate treatment.
When Upper Blepharoplasty Is Usually Best
Upper blepharoplasty is often recommended when the main issue is heaviness above the eye. Many patients feel they look constantly tired or older because excess skin weighs down the upper lid.
Common signs include:
- Makeup transferring onto skin folds
- Difficulty applying eyeliner
- Eyelids that look puffy or sagging
- Brows appearing heavier due to eyelid excess
- A narrowed or hidden eyelid crease
This procedure can create a more open and rested look without altering natural eye shape.
When Lower Blepharoplasty Is Usually Best
Lower blepharoplasty is more suitable when concerns are concentrated beneath the eyes. Under-eye bags often persist despite good sleep, skincare, or healthy habits because they are commonly related to anatomy and tissue ageing.
Typical concerns include:
- Permanent eye bags
- Puffy lower lids in photos
- Dark shadows caused by bulging fat and hollows
- Fine lines with skin laxity
- A fatigued facial expression
By repositioning or removing fat and tightening tissues when necessary, the lower eyelid can appear smoother and more refreshed.
Can Upper and Lower Blepharoplasty Be Combined?
Yes. Many patients benefit most from combined upper and lower blepharoplasty, particularly when ageing signs affect the full eye area.
This combined approach may be ideal when you have:
- Hooded upper lids
- Lower eye bags
- Loose skin above and below the eyes
- Generalised tired appearance
- Desire for comprehensive rejuvenation in one surgical plan
Treating both zones together can create a more balanced result, since rejuvenating only one area may leave the other untreated.
Dr. Costantino Davide emphasises harmony and proportion in facial surgery, meaning treatment should consider the face as a whole rather than isolated features.
How to Know Which Procedure You Need
Choosing between upper or lower blepharoplasty is not based on age alone. Younger patients may need lower eyelid correction due to hereditary bags, while older patients may only need upper lid surgery.
Factors Evaluated During Consultation
A qualified plastic surgeon will assess:
- Skin elasticity
- Fat distribution around the eyes
- Brow position
- Eyelid tone and support
- Tear trough depth
- Facial symmetry
- Overall facial proportions
- Medical history and eye health
This detailed analysis ensures a treatment plan tailored to your anatomy rather than a generic solution.
Why Self-Diagnosis Can Be Misleading
Many people assume dark circles always need lower blepharoplasty, but pigmentation, volume loss, or thin skin may also contribute. Similarly, heavy upper lids can sometimes be influenced by brow descent rather than eyelid skin alone.
For this reason, expert evaluation is essential.
What Is Recovery Like?
Recovery varies depending on whether surgery is upper, lower, or combined, but most patients experience temporary swelling and bruising during the early healing phase.
Typical Recovery Timeline
- First week: swelling, bruising, mild tightness
- 7–14 days: visible improvement increases
- 2–4 weeks: most social downtime passes
- Several months: scars continue to mature and soften
Following post-operative instructions is critical for optimal healing.
Will Scars Be Visible?
Blepharoplasty incisions are carefully positioned in natural folds or discreet locations. Once healed properly, scars are typically minimal and difficult to notice.
Natural Results: The Modern Goal of Eyelid Surgery
Modern blepharoplasty is no longer about aggressive tissue removal. Today, refined surgical technique focuses on:
- Preserving natural expression
- Avoiding hollow or overdone eyes
- Respecting ethnic and anatomical identity
- Restoring youthful contours
- Maintaining eyelid function and safety
The best results usually look subtle: people may say you look rested, not “operated on.”
Is Blepharoplasty Worth It?
For the right candidate, blepharoplasty can offer long-lasting improvement in one of the most expressive areas of the face. Since the eyelids move constantly and attract attention during conversation, even moderate correction can have a strong aesthetic impact.
Patients often seek it because:
- They look tired despite feeling well
- Their eyes appear older than the rest of the face
- Makeup application has become difficult
- Eye bags affect confidence
- They want refreshed, natural rejuvenation
Upper or Lower Blepharoplasty?
If the concern is drooping skin and heaviness above the eyes, upper blepharoplasty may be the better option. If the main issue is bags, puffiness, or laxity under the eyes, lower blepharoplasty may be more appropriate. When both areas are affected, a combined treatment often provides the most harmonious result.
The correct choice always depends on a personalised surgical assessment. Consultation with an experienced specialist such as Dr. Costantino Davide can clarify the most suitable path based on your anatomy and goals.ù
Schedule a consultation with Dr. Costantino Davide.
