Comparing Upper and Lower Eyelid Procedures


Blepharoplasty is one of the most common facial cosmetic surgeries performed on patients today. It can be used to correct or improve physical symptoms that result from aging, disease, injury, or genetic defect. A patient could undergo blepharoplasty to remove dark circles under his or her eyes or to fix a drooping eye and improve his or her vision dramatically. The upper and lower lid of the eye serve individual functions and, as such, require different procedures.

The upper eyelid provides support and protection for the eye. When assessing the upper eyelid for a potential surgery, the doctor will examine the skin for elasticity and support. As a person ages, the collagen and elastin fibers within the skin become fewer in number and reduce functionality. This can cause sagging or loose skin around the eye. This condition in the upper eye can cause a drooping eyelid or simply create extra folds of skin that can impair a person’s vision. An excess of preseptal fat in the lower part of the upper eyelid can also increase the thickness and heaviness of the eyelid. This can contribute to an aged appearance around the eyes.

The lower eyelid is assessed for the amount of fat in the medial, central, and lower fat pads of the eye. Excessive fat in these pads can be more prominent when looking upward as opposed to looking downward. Excessive skin in the lower eyelid can also contribute to a sagging and aged appearance. Another important part of the lower eyelid assessment is the position of the canthus in the eye. The canthus refers to the corners of the eye where the upper and lower lids meet. If the canthus is displaced, particularly the outer canthus, the eye can appear hollow or sunken. These are referred to as prominent or deep-set eyes.

The overall symmetry of the upper and lower eyelids, as well as the brow position, are also considered during a consultation.

For both the upper and lower eyelids, simple procedures, such as fat or skin excising, can be performed under local anesthesia. More invasive procedures will require general anesthesia. Procedures conducted on the upper eyelid typically involve small incisions made in the upper corner of the brow, from which excess fat and skin can be easily removed and the fat pads can be repositioned.

Lower eyelid procedures can be slightly more complex than upper eyelid procedures, depending on the desired results. The surgeries can also be conducted by small incisions, but can involve small amounts of pressure being put on the eyeball. This pressure makes it easier for the surgeon to isolate and identify the fat pads surrounding the lower part of the eye. Electrosurgery can be used to remove excess fat by running electrical current through the target area. The surgeon must also be more mindful of the muscles surrounding the eyeball when performing lower lid procedures.

Meeting Your Doctor

Both procedures are generally minimally invasive. During your consultation, Dr. Hobgood will discuss the least invasive method for accomplishing your desired results.

When considering complications, lower eyelid surgery has more significant risks than upper eyelid surgery. These include a loss of vision from hemorrhage or injection, eyelid retraction, persistence of dark circles, temporary skin irregularities, and restricted eye motility. Upper eyelid surgery complications are primarily eyelid retraction. It should be noted, however, that these complications are extremely rare in post-operative patients. Most patients are able to recover within 72 hours after surgery and can return to full, normal activity within eight days.

To schedule a consultation for eyelift surgery, call (480) 214-9955. Dr. Hobgood’s office has full operating and admitting privileges at seven different hospitals and medical centers in the Greater Phoenix area.

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