Upper Eyelids alone or should I also do the lower eyelids at the same time? Pitfalls to avoid when d



Often when I give consultations for eyelid surgery in my office in Denver, there are many myths that I have to dispel that patients have. These are things that are told to them by friends, family members or rarely even other doctors. Often, patients come in because their upper eyelids bother them or their lower eyelids bother them and they are not sure if they should do all four eyelids. The decision to have your upper, lower or all four eyelids done is based on what bothers you about the appearance, nothing more or less. Here are common myths about adding upper or lower eyelid blepharoplasty.

Well since we are there, we might as well do the lower eyelids

Deciding to get the upper eyelids done and then deciding to add the lower eyelids “just cos you are there” makes as much sense as going in for cataract surgery in one eye and then getting the other eye done “just cos you are there”. The lower eyelids should be added because there is puffiness from excess fat that is prominent. If one doesn’t have puffiness of the lower eyelid, a blepharoplasty is generally not going to help them. Just because you are there, is not a good reason to have a surgical procedure done..for anything.

It will lift up your cheek when we tighten the skin on the lower eyelid

When lower eyelid surgery is done, the cheek is not lifted at all. Sometimes patients have festoons which is swelling of the cheek. This area of swelling will not be improved by a blepharoplasty. Festoons of the cheek can be treated with filler, laser or surgery directed at the festoons. A lower eyelid blepharoplasty will not help this surgery.

If you do it now you won’t have to have a blepharoplasty later

Having a blepharoplasty when you don’t need it, does not prevent you from needing one in the future. Having a blepharoplasty when you do need it does not prevent you from needing one in the future. The aging process continues whether surgery is done or not. Having cosmetic eyelid surgery does not slow down or stop the aging process. Period.

Most people do upper and lower eyelid surgery at the same time

That is a true statement but because most people get upper and lower blepharoplasty does not mean that you should. Remember, each person is different. Their cosmetic needs are different and whether they need upper and lower eyelid surgery or just upper or just lower is based on their appearance and their needs. What most people do is irrelevant.

You should do all four because it is a really good deal

Financial incentives to perfom any cosmetic facial surgery is only a good deal if the limiting reagent for a patient getting a procedure is purely cost. Getting procedures or surgeries done solely because they are low cost or there is a great savings is not beneficial to the patient. It would be like buying a TV and then purchasing a VCR because it is on sale as well for cheap despite not owning any VHS tapes. Even though you got a good deal, it was not a good idea. The same applies to going for procedures regardless of need because they are “good deals”.

Any decision to have surgery on the eyelids or face is something that should be discussed with your ASOPRS oculoplastic surgeon. As an eyelid specialist, I have encouraged patients to not have surgery if they don’t need it and not have lower or upper eyelid surgery if it is unnecessary. In my Denver office, I counsel patients on procedures that I feel that would be helpful to them based on what cosmetically bothers them alone. Hopefull this guide helps avoid some of the pitfalls when deciding to do upper or lower eyelid surgery.


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