Upper blepharoplasty — it removes sagging upper eyelid skin, and it is not double-eyelid surgery

Upper blepharoplasty removes stretched skin from the upper eyelid. Some fat and muscle are dealt with too, where needed.

This is where names get mixed up more than anywhere in this layer. Three things get called by one word in consultations.

• double-eyelid surgery — creates a crease that was not there. It changes shape
• ptosis correction — works on the muscle that opens the eye, when the lift is weak
• upper blepharoplasty — removes skin that has dropped, when there is skin to spare

They are three different operations, and the answer depends on what has dropped.

That distinction is the most important thing on this page.

There are three reasons an upper lid looks heavy.

• the skin has stretched — this is where upper blepharoplasty belongs
• the muscle that opens the eye has weakened — that is ptosis correction. Removing skin alone leaves the lift unchanged
• the brow has come down — that is a brow lift. Remove only eyelid skin here and the brow can come down further

They often coexist. Which is why the examination is almost everything in this operation. This site cannot tell you which is yours. But you can ask about all three in a consultation.

This operation has a non-cosmetic side to it.

When skin droops a great deal it blocks the upper field of vision. A habit of lifting with the forehead develops, and that leads to forehead lines and tired eyes. That judgement belongs in a consultation, and this site does not make it for you.

About the scar. The incision goes where the lid folds when the eye is open. So with the eye open it is hard to see. But with the eye closed the line shows. This site writes 'absent' and 'hidden' as different words.

This site does not deal in prices, clinics or reviews.

The two sides will not come out identical. Differences in droop and in lift between the two lids are very common to begin with, and a difference you had not noticed before can become visible afterwards.

Eyes can become dry. The tear film is unstable for a while afterwards, the more so if dry eye was already there. If you have dry eye, say so at the consultation.

There can be a period when the eyes do not close fully, from swelling and tightness; it usually settles. Remove too much skin and it stays.

There will be a scar — in the crease. It shows when the eye is closed and takes months to fade. In some people it stays red or thickened.

The brow can come down. That is what happens when only eyelid skin is removed from a brow that had already dropped. The option there is a brow lift, not this operation.

The shape of the crease can change. If you had one, its position and depth shift. Whether you want that has to be said beforehand.

There will be bruising and swelling. The eye area swells particularly readily. See the bruising page alongside.

Rarely, complications involving vision have been reported. Sudden pain, a change in vision, or one side swelling hard after surgery are not things to wait out. Make contact immediately.

It droops again. Skin keeps changing with age. This operation does not stop that.

Ask about all three separately. Ask whether it is the skin that has dropped, the lift that is weak, or the brow that has come down. It is the most useful question in this operation. If all three are mixed, ask which comes first.

Mention dry eye first. Say if you use artificial tears, and say if you have had LASIK or LASEK. It changes the extent of the surgery.

Ask how much skin will be removed and how that is decided. Taking more looks more open, but it moves towards not closing, or feeling tight. They are traded against each other.

Be explicit about the crease. Whether your current crease stays, whether its position changes, whether a new one appears — ask to see it drawn.

If your field of vision feels blocked, say so. Whether looking up is awkward, whether you are lifting with your forehead, whether your eyes feel heavy in the evening — that information changes the plan.

Report blood-thinning drugs and supplements. The eye area bruises easily. Do not stop anything on your own; discuss it with whoever prescribed it.

Not smoking helps. It takes part in healing.

Follow the instructions on cold compresses and head position for the first days. They act directly on how much it swells.

Ask in advance when the result should be judged. Swelling settling and the crease setting take months. Do not judge from how it looks after a month.

It cannot be undone. Removed skin does not come back. The commonest regret in this operation is on the side of 'too much was taken'.

What the problem is chooses the operation. If you take one sentence from this page, that is it. Skin, muscle and brow are three different operations. It is better not to decide from one clinic saying 'an upper blepharoplasty will do it'.

If functional reasons are part of it, make them explicit. If the field of vision and forehead lifting are both there, the plan can change. But this site does not make that judgement for you.

It droops again with age. This operation sets things once.

The impression of the eye changes. Removing skin makes the eye look larger, but the question is whether you can accept it looking different from before — particularly when the crease changes with it.

If you have dry eye, think about that side first. Surgery can move things towards more dryness.

Whether to have it is decided in consultation, and it is better not to decide from one clinic's account.