Understanding When to Combine Upper and Lower Eyelid Blepharoplasty for Optimal Results

Cosmetic eyelid surgery, or blepharoplasty, is one of the most transformative and commonly performed facial rejuvenation procedures. It can significantly improve the appearance of the eyes and, by extension, the entire face—removing signs of aging, fatigue, and stress. While some patients benefit from an upper eyelid lift or a lower eyelid blepharoplasty alone, many achieve the most natural and dramatic results when both procedures are combined.

This comprehensive guide explores the indications, techniques, benefits, and considerations of combining upper and lower eyelid surgery in one session, helping patients and practitioners make informed decisions about timing, safety, and aesthetic outcomes.

Table of Contents

1. What Is Cosmetic Blepharoplasty?

2. Anatomy of the Upper and Lower Eyelids

3. Indications for Upper Eyelid Lift

4. Indications for Lower Eyelid Blepharoplasty

5. Why Combine Upper and Lower Eyelid Surgery?

6. Ideal Candidates for Combined Eyelid Surgery

7. Surgical Techniques for Upper Eyelid Lift

8. Surgical Techniques for Lower Eyelid Blepharoplasty

9. Anesthesia Options: Local vs IV Sedation vs General

10. Benefits of a Combined Procedure

11. Recovery Timeline and Aftercare

12. Risks and Complications

13. Results: Before and After Expectations

14. How to Choose the Right Surgeon

15. Cost of Combined Blepharoplasty

16. Conclusion

1. What Is Cosmetic Blepharoplasty?

Cosmetic blepharoplasty is a surgical procedure designed to rejuvenate the appearance of the upper and/or lower eyelids by removing excess skin, fat, and sometimes muscle. It is not performed to improve vision but to restore a youthful, rested appearance around the eyes.

Patients often seek blepharoplasty to:

• Reduce sagging upper eyelids

• Eliminate under-eye bags or puffiness

• Smooth crepey lower eyelid skin

• Improve symmetry and facial balance

2. Anatomy of the Eyelids

The eyelids are delicate structures that play functional and aesthetic roles. Understanding their anatomy is essential for safe, effective cosmetic surgery.

Upper eyelids consist of:

• Skin

• Orbicularis oculi muscle

• Orbital septum

• Preaponeurotic fat pads

• Levator muscle

Lower eyelids consist of:

• Thin skin and muscle

• Three fat compartments (nasal, central, lateral)

• Supporting structures like the canthal tendons

Surgical techniques must preserve these layers while selectively removing or repositioning tissue.

3. Indications for Upper Eyelid Lift

An upper blepharoplasty is typically indicated when patients experience:

• Loose, redundant upper eyelid skin

• “Hooding” that hides the upper eyelid crease

• Puffiness from bulging fat pads

• A tired or sad appearance despite adequate rest

While insurance may cover functional upper blepharoplasty for vision obstruction, cosmetic upper eyelid surgery focuses on aesthetics.

4. Indications for Lower Eyelid Blepharoplasty

Patients often request lower eyelid surgery for:

• Puffy or baggy lower lids

• Wrinkled or crepey lower eyelid skin

• Shadowing or dark circles

• Hollowing under the eyes (tear troughs)

Lower blepharoplasty can smooth the transition from the lower eyelid to the cheek, rejuvenating the midface in addition to the eyes.

5. Why Combine Upper and Lower Eyelid Surgery?

Combining upper and lower blepharoplasty can yield superior and balanced results for several reasons:

• Harmonized appearance: Rejuvenating both eyelids creates symmetry between the upper and lower halves of the eye area.

• Single downtime: Patients recover from both procedures at once, minimizing total time off work and social activities.

• Cost-effective: Combining surgeries can reduce anesthesia and facility fees.

• More dramatic transformation: A full-eye rejuvenation often provides a more noticeable, yet natural result.

6. Ideal Candidates for Combined Eyelid Surgery

The best candidates typically:

• Are in good general health

• Do not smoke or can quit pre- and post-operatively

• Have realistic expectations

• Have signs of aging in both upper and lower eyelids

• Want a single recovery period

Patients in their 40s to 70s most commonly seek combined eyelid surgery, though younger individuals with genetic puffiness or premature aging may also be candidates.

7. Surgical Techniques: Upper Eyelid Lift

Upper blepharoplasty usually involves:

• A carefully placed incision in the natural eyelid crease

• Removal of excess skin and possibly a small amount of fat

• Precise tailoring to match the patient’s facial anatomy

In some cases, levator advancement or ptosis repair may be performed if drooping is due to muscle dysfunction rather than skin laxity.

8. Surgical Techniques: Lower Eyelid Blepharoplasty

Approaches include:

1. Transconjunctival Approach:

• Incision made inside the lower eyelid

• Fat is removed or repositioned

• Skin left untouched

• Best for younger patients with good skin tone

2. Transcutaneous Approach:

• Incision made just below the lash line

• Skin and muscle can be tightened

• Fat can be removed or repositioned

• Often combined with skin pinch excision or laser resurfacing

A skilled surgeon will evaluate skin quality, fat herniation, and orbicularis muscle tone to select the best technique.

9. Anesthesia Options: Local vs IV Sedation vs General

• Local anesthesia only: Suitable for minor upper eyelid surgery

• Local with IV sedation: Most common and preferred for combined procedures

• General anesthesia: Reserved for complex cases or very anxious patients

Recovery is often smoother with twilight sedation, minimizing grogginess and postoperative nausea.

10. Benefits of a Combined Procedure

• Natural, cohesive rejuvenation

• Fewer scars and incisions (particularly if transconjunctival technique used)

• Single anesthesia session

• Reduced cumulative cost

• More satisfied patients due to synchronized improvements

11. Recovery Timeline and Aftercare

Days 1–3:

• Bruising and swelling peak

• Use cold compresses and sleep with head elevated

• Mild discomfort, tightness, blurry vision

Days 4–7:

• Stitches (if any) removed

• Swelling improves

• Return to non-strenuous work possible

Weeks 2–4:

• Most swelling subsides

• Can resume exercise and social activities

Months 2–3:

• Final results emerge

• Scars continue to fade

Avoid sun exposure during recovery, as UV can darken scars and prolong swelling.

12. Risks and Complications

While rare in experienced hands, possible risks include:

• Dry eye or irritation

• Temporary blurred vision

• Scarring or asymmetry

• Bleeding or hematoma

• Lower lid retraction (if overdone)

• Need for revision (2–3% of cases)

Surgeons trained in oculoplastic or facial plastic surgery typically have lower complication rates due to their specialized knowledge.

13. Results: Before and After Expectations

Patients can expect:

• Brighter, more open eyes

• Reduction in puffiness and tired look

• Smoother lower eyelid contour

• Refreshed, youthful appearance

Results are usually long-lasting:

• 10–15 years for upper lids

• 10+ years for lower lids, especially if fat is repositioned

14. How to Choose the Right Surgeon

For the best outcomes, choose a board-certified surgeon with specific experience in eyelid surgery.

Look for:

• Oculoplastic surgeons (eye + facial surgery)

• Facial plastic surgeons with extensive blepharoplasty portfolios

• Strong online reviews and before/after photos

• An emphasis on natural results and safety

In Denver, Colorado, Dr. Chris Thiagarajah, MD is a well-known oculoplastic surgeon who specializes in both cosmetic and reconstructive eyelid procedures, including complex combined blepharoplasty cases.

15. Cost of Combined Blepharoplasty

While prices vary by region and surgeon, combining upper and lower eyelid surgery typically costs:

• Surgeon fee: $5,500 – $9,500

• Facility fee: $500 – $2,000

• Anesthesia fee: $500 – $1,500

Patients may save 10–20% compared to staging each procedure separately. Insurance rarely covers cosmetic blepharoplasty, though partial coverage may apply if upper lids obstruct vision.

16. Conclusion

Combining upper and lower eyelid blepharoplasty is a highly effective way to rejuvenate the eyes and achieve natural, long-lasting results. With one surgery and one recovery period, patients can enjoy a brighter, more youthful appearance with less downtime.

The key to success lies in patient selection, surgical technique, and choosing the right specialist—ideally someone who understands the art and science of eyelid surgery.

If you’re considering eyelid surgery in Denver or elsewhere, schedule a consultation with a skilled, board-certified surgeon who can tailor a plan to your unique features and aesthetic goals.

Want to learn more about combined eyelid lift surgery or book a consultation? Contact Dr. Chris Thiagarajah, MD, Denver’s trusted oculoplastic surgeon.