Upper and Lower Eyelid Surgery: Key Differences

Doctor examining a patient's upper eyelid drooping and lower eyelid bags.

The eyes are the focal point of our face; they are the first place to reveal our mood, energy, and age. However, over time, unwanted changes occur in our eyelids due to genetic factors and gravity. Skin piles up on the upper eyelids, dropping over the eye, while fat pads known as "under-eye bags" become prominent on the lower eyelids, and wrinkles form on the skin. This situation projects a tired, sleepless, sad, and older expression to the outside world, regardless of how rested and energetic you actually feel.

Patients usually come to our clinic saying, "I want eyelid surgery." However, Blepharoplasty (eyelid surgery) is not a single standard procedure. Upper Eyelid Surgery and Lower Eyelid Surgery are two distinct worlds, targeting completely different problems, performed with different techniques, and involving different recovery processes.

In this comprehensive guide, under the guidance of Assoc. Prof. Dr. Yalçın Bayram, a Specialist in Plastic, Reconstructive, and Aesthetic Surgery, we will examine in detail the critical differences between these two procedures, which problem (excess skin or fat herniation?) is solved by which surgery, and which planning is correct for your face.

Why Does the Eye Area Age? An Anatomical Perspective

To understand the right treatment, we must first get to the source of the problem. The skin around the eyes is the thinnest in our body. This delicate structure reflects even the slightest changes in the underlying muscle and fat tissue.

The aging process proceeds on two different fronts around the eyes:

  1. On the Upper Lid: Gravity and loss of elasticity are dominant. As the forehead and brows descend, the upper eyelid skin also loosens and folds over, piling up on the eyelashes.

  2. On the Lower Lid: Connective tissue weakness is dominant. The membrane called the septum, which holds the fat pads (orbital fat) protecting the eyeball in place, weakens over time. As a result of this weakening, the fat herniates forward, creating the puffiness we call "under-eye bags."

1. Upper Eyelid Surgery (Upper Blepharoplasty)

Upper eyelid surgery is fundamentally a "clearing and lightening" procedure. The main goal is to remove the weight from the eye.

Targeted Problems: "Heaviness and Excess Skin"

The main complaints in patients considering this surgery are:

  • Skin Piling (Dermatochalasis): The skin on the eyelid becoming loose, folding over, and touching the eyelashes.

  • "Hooded" Look: The colored part of the eye (iris) and the lash line being covered by skin.

  • Makeup Difficulty: Difficulty applying eyeshadow or eyeliner, with makeup getting lost in skin folds or smudging.

  • Visual Field Restriction (Functional Issue): In advanced cases, the sagging skin is so excessive that it blocks the upper and lateral parts of the patient's field of vision. The patient has to constantly raise their eyebrows to see, which increases forehead wrinkles.

Surgical Technique: Where is the Scar Hidden?

Upper blepharoplasty is one of the most elegant and best-concealed procedures in aesthetic surgery.

  • Incision: Assoc. Prof. Dr. Yalçın Bayram places the incision with millimetric precision exactly in the natural crease of the upper eyelid.

  • Procedure: Through this incision, the pre-measured excess skin and (if necessary) a thin strip of muscle underneath are removed. If there is fat herniation in the inner corner, this fat pad is also reduced.

  • Result and Scar: When your eyes are open, the surgical scar remains completely inside the fold and is absolutely invisible. When your eyes are closed, it becomes a very thin line that fades to skin tone over time.

Anesthesia and Process

The biggest advantage of this surgery is that it can be performed under local anesthesia (numbing only the area, like in a dentist's chair). The procedure takes an average of 45 minutes to 1 hour. The patient is awake during the procedure, can talk to their doctor, and can return home immediately after it is finished.

2. Lower Eyelid Surgery (Lower Blepharoplasty)

Lower eyelid surgery is a technically more complex and sophisticated "reshaping" procedure compared to the upper lid. The main goal is not just to remove skin, but to correct the play of light and shadow to erase the tired expression.

Targeted Problems: "Bags and Hollowing"

Problems in the lower lid are usually related to "volume" rather than just "skin":

  • Under-Eye Bags: Puffiness caused by the fat surrounding the eye protruding forward.

  • Tear Trough Deformity: A deep hollow or groove formed right below the bags, where the cheek meets the eye. This hollow deepens the shadow of the bag, making the person look "sick" or "sleepless."

  • Dark Circles: A shadowy appearance caused by hollowing and skin thinning.

  • Skin Laxity: Fine wrinkles forming on the skin (crepey skin).

Surgical Techniques: The Modern Approach is "Fat Preservation"

In the past, lower eyelid surgeries involved simply removing and discarding the fat. However, this could lead to a hollowing of the under-eye (a skeletal look) over time.

Assoc. Prof. Dr. Yalçın Bayram applies modern "Fat Preserving" or "Fat Transposition" techniques:

  • Fat Transposition: The herniated (bag-forming) fat is not cut out and thrown away; instead, it is spread downwards to fill the "tear trough" hollow immediately below it. Thus, both the bag is eliminated, and the hollow is filled, ensuring a smooth transition to the cheek.

Incision Sites (Two Options):

  1. Transconjunctival (Scarless) Technique: Preferred in young patients if there is no excess skin and only bags. The incision is made inside the eyelid (through the pink mucosa). There are no external stitches or scars.

  2. Subciliary (Under Lash) Technique: Preferred in patients with excess skin and sagging. The incision is made just 1-2 mm below the lower lashes. This allows for the removal of excess skin as well. The scar is perfectly hidden in the lash line.

Anesthesia and Process

Since lower blepharoplasty involves intervention in deeper tissues, it is generally performed under sedation (light sleep) or general anesthesia. The duration can reach 1.5 - 2 hours.

Combined Approach: "Quad Blepharoplasty"

Aging does not stop in one area of the face and continue in another. Usually, sagging in the upper lid is accompanied by bags in the lower lid. Therefore, to obtain the most natural and harmonious result, Upper and Lower Eyelid Surgery are frequently performed in the same session.

This is called "Quad Blepharoplasty." A rejuvenation of 10-15 years around the eyes is achieved with a single anesthesia and a single recovery period.

Furthermore, periorbital aesthetics is not just about the lids. Assoc. Prof. Dr. Yalçın Bayram frequently combines this surgery with the following procedures for a holistic result:

  • Brow Lift: To improve the upper lid result by lifting low brows.

  • Almond Eye Surgery: To pull the outer corner of the eye upwards, giving it a more attractive form.

  • Mid-Face Lift: To lift the cheek tissue upwards, perfecting the transition between the lower lid and the cheek.

Recovery Process Comparison

Feature Upper Eyelid Lower Eyelid
Surgery Time 45 mins - 1 hour 1.5 - 2 hours
Anesthesia Local (Usually) Sedation / General
Pain Level Minimal Mild - Moderate
Bruising and Swelling Mild Moderate (Can descend to cheeks)
Suture Removal Day 5-7 Day 5-7 (If applicable)
Return to Social Life 3-5 Days 7-10 Days

General Recovery Tips:

  • Applying cold compresses (ice) for the first 72 hours is the golden rule for reducing swelling.

  • Keeping the head elevated (sleeping with double pillows) accelerates the drainage of edema.

  • Watering, stinging, or dryness in the eyes is normal in the first week; drops provided by your doctor will relieve these complaints.

Alternatives: Are Non-Surgical Solutions Possible?

Devices like Plasma Energy (Plexr) or Lasers promising "non-surgical eyelid aesthetics" exist on the market.

  • For Upper Lid: These devices can only provide minimal tightening in very mild skin laxity. However, if there is a distinct skin fold or fat herniation, no method other than surgery can remove this excess tissue.

  • For Lower Lid: There is no cream or device that can melt or eliminate under-eye bags (fat hernias). Only Under-Eye Light Filler can camouflage (hide) the bags by filling the hollow beneath them, but it does not treat them.

For a real, permanent, and dramatic change, surgical blepharoplasty is the "gold standard."

Conclusion: Which Surgery is For You?

When you look in the mirror;

  • If your world brightens, your gaze lightens, and your makeup becomes visible when you lift your upper eyelid with your finger; you are a candidate for Upper Blepharoplasty.

  • If the bags and hollows under your eyes do not go away no matter how much you sleep and make you look tired; you are a candidate for Lower Blepharoplasty.

Often, it is a combination of these two problems. The correct planning for you will be determined by a consultation with an expert who evaluates your anatomical structure and expectations.

In this guide, we have examined the two fundamental surgical procedures used in periorbital rejuvenation, their differences, and which problem is solved by which method.

If you want to permanently get rid of the tiredness in your gaze but are unsure which procedure (or combination) is right for you, you can find technical details and pricing factors on our main Eyelid Surgery (Blepharoplasty) service page.

If you have low brows accompanying your eyelid issues, we recommend reviewing our Brow Lift options that complement this procedure; or if you desire a more slanted and exotic eye shape, our Almond Eye Surgery page.