Eyelid Surgery: Upper vs. Lower Blepharoplasty Bengtson Center for Aesthetics & Plastic Surgery

Posted On: June 11, 2026

---

"You look tired. Are you feeling ok?"

You slept eight hours. You feel fine. But there it is again — that comment, that feeling that your reflection doesn't match how you feel or how you want to be perceived.

Interest in eyelid surgery (blepharoplasty) has grown in recent years. The American Society of Plastic Surgeons reports that blepharoplasty was the fifth most performed cosmetic surgical procedure in the United States in 2024, its third consecutive year in the top five, and according to the International Society of Aesthetic Plastic Surgery, eyelid surgery was the world's most popular surgical procedure in 2024.

More people than ever are exploring their options and asking the same questions you may be asking now: How can you tell if you need eyelid surgery? Are there different types of eyelid surgery? Which type of eyelid surgery do I need? Can I combine the different types of eyelid surgery?

The answers to these questions all start with what you see when you look in the mirror. Let's begin there.

What Do You See When You Look in the Mirror?

At the Bengtson Center for Aesthetics & Plastic Surgery in Grand Rapids, Michigan, our surgeons hear a wide range of concerns about the eye area. In most cases, a patient doesn't walk in and say "I need an upper blepharoplasty." Instead, they describe what they see and how it makes them feel.

Signs You Might Need Upper Eyelid Surgery

You might benefit from an upper blepharoplasty if you've caught yourself thinking…

• "My eyelids feel so heavy."
• "My eyes are too hooded."
• "I feel like my eyes look smaller than they used to."
• "I have difficulty applying eye makeup because there's no space."
• "I sometimes have trouble seeing in my peripheral field of vision."
• "I am constantly lifting my eyebrows to try to open up my eyes more."

These are classic upper eyelid issues. As we get older, the skin of our upper eyelids loses elasticity and begins to fold down over the crease. In mild cases, it creates a hooded appearance and shrinks the visible space of the mobile lid. In more pronounced cases, the excess skin can sink so far that it rests on the lashes and limits peripheral vision.

Except…

Sometimes what looks like an upper lid problem is actually a brow position problem. The brow also descends with age, and as it does, it pushes extra skin down onto the upper eyelid. During your consultation, our surgeons evaluate the entire brow-to-lid relationship to determine whether upper blepharoplasty, a brow lift or a combination of the two will address your concerns most effectively.

Signs You Might Need Lower Eyelid Surgery

You might benefit from a lower blepharoplasty if any of these complaints sound familiar…

• "I always look exhausted and underslept."
• "People often ask if I'm feeling unwell, even when I'm fine."
• "I have bags or puffiness under my eyes that never go away."
• "My tear troughs have become such deep hollows."
• "The skin beneath my eyes looks loose and crepey."

These concerns point to the lower lids. The culprit is usually fat pads that have shifted forward from behind the eye socket, and thinning skin that makes those pads more visible, or volume loss that deepens the hollow between the lower lid and cheek. Lower blepharoplasty addresses this anatomy.

Except…

Crow's feet are primarily caused by muscle movement, not changing fat volume or loss of skin elasticity, so they are not targeted effectively by lower blepharoplasty. If crow's feet are one of your concerns, your surgeon may recommend treating them with a neurotoxin (BOTOX®, DAXXIFY®, Dysport®).

It's All of the Above — Can I Fix Everything at Once?

Yes, and many patients do. Aging doesn't limit itself to one part of the eye, so your surgical plan doesn't need to either. Addressing the upper and lower lids in a single procedure means one visit to our AAASF/QUAD A–accredited on-site surgical center, one round of anesthesia with our board-certified anesthesiologists and one recovery period. Our surgeons use VECTRA® 3D imaging to help you visualize potential outcomes before surgery, so you can see how addressing both areas together creates a more balanced, cohesive look.

Upper Blepharoplasty: What It Does And Doesn't Do

Upper blepharoplasty involves removing excess skin, and sometimes small amounts of fat, from the upper eyelid. The incision is placed within the natural crease of the lid, so the resulting scar is difficult to detect once it heals.

What upper blepharoplasty corrects: Excess or drooping upper eyelid skin, a hooded appearance where skin folds over the crease, difficulty applying eye makeup due to excess skin, and in some cases, peripheral vision obstruction from significant skin overhang.

What upper blepharoplasty does not correct: Under-eye bags or puffiness (that's a lower lid concern), crow's feet or fine lines around the eyes (nonsurgical treatments at Symmetry Med Spa by Bengtson Center can address those), or a low brow position (which may require a brow lift rather than, or in addition to, upper eyelid surgery).

Upper blepharoplasty isn't always a purely cosmetic procedure. If excess upper eyelid skin significantly impairs your visual field or causes you discomfort such as frequent headaches or skin irritation, the procedure may be considered medically necessary. Our surgeons can help you determine whether this applies to your situation during your consultation.

Lower Blepharoplasty: What It Does And Doesn't Do

Lower blepharoplasty addresses bags, puffiness and hollowing beneath the eyes. The procedure may involve repositioning or removing fat pads that have bulged forward, tightening loose skin and smoothing the transition between the lower lid and cheek.

What lower blepharoplasty corrects: Under-eye bags and puffiness caused by fat pad herniation, hollowing in the tear trough area (through fat repositioning), and loose, crepey skin of the lower eyelid.

What lower blepharoplasty does not correct: Hooded or heavy upper eyelids (that requires upper blepharoplasty), dark circles caused by pigmentation rather than shadowing from volume loss (chemical peels or laser treatments may be more effective), or wrinkles in the surrounding area (which may benefit from laser resurfacing or injectables as a complementary treatment).

Our surgeons use two techniques for lower eyelid surgery. One is the subciliary approach, in which the incision is placed just under the lower lash line. The other is the transconjunctival approach, sometimes called "scarless" lower blepharoplasty, in which the incision is placed inside the lower eyelid so there is no external scar.

Upper vs. Lower Blepharoplasty: A Quick Comparison

This side-by-side overview highlights the key differences between upper and lower eyelid surgery. Keep in mind that many patients benefit from combining both procedures for the most complete result.

What Our Patients Say About Their Eyelid Surgeries

Reading about techniques is one thing. Hearing from people who've been through the process is another. Here's what our patients have to say about their blepharoplasty experiences at the Bengtson Center:

"I had an upper blepharoplasty and brow lift done by Dr. Alfonso and couldn't be happier with the results. I've already had people (who don't know I've had the procedure done) commenting that I look well rested. Those that know I had eyelid surgery are so impressed they are now interested in scheduling a consult for themselves! I highly recommend the Bengtson Center and Dr. Alfonso." — Kristy M.

"I have been an aesthetic patient of the Bengtson Center for years. After much thought, I decided to consult about an upper eyelid blepharoplasty. Dr. Bengtson explained with great detail my expected results and I scheduled the procedure. I'm 6 days post-op and had my stitches removed today. I have minimal swelling and bruising and literally zero pain. I truly believe that Dr. B's cutting edge surgical methods made my experience and results amazing. I'm thrilled!" — Laurie C.

"Just Wow!!! From the moment I walked into the facility until I left after my first surgery follow up visit, I was beyond impressed and thankful. A+ report card!!! My results of eyelid surgery and breast implant exchange are amazing. And like Dr. Alfonso promised—ZERO pain!! Like no pain at all!! Woo!!!!!!” — Susan M.

You can browse our before-and-after gallery to see the natural-looking blepharoplasty results our surgeons achieve.

See What's Possible for You

Ready to explore your eyelid surgery options with surgeons who have the experience and expertise to guide you well? The Bengtson Center for Aesthetics & Plastic Surgery has been South Michigan's trusted destination for plastic surgery for more than 30 years. Call us at 616-202-5640 or request a consultation online to get started.