In 30 seconds: Blepharoplasty is not one procedure — upper, lower, and Asian (double-eyelid) blepharoplasty treat three different concerns with three different techniques. Upper surgery removes excess skin that hoods the eye; lower surgery addresses under-eye bags and puffiness; Asian blepharoplasty creates or refines a supratarsal crease. Many patients only need one of the three, sometimes combined with a non-surgical option instead. A proper eyelid exam is the only way to know which — if any — applies to you.
Do you actually need blepharoplasty — or is it something else?
Not every tired-looking eye needs surgery. Hollowing under the eyes is often volume loss, which dermal filler can address. Fine crepey skin and mild puffiness sometimes respond to skin tightening or a chemical peel. True blepharoplasty becomes the right answer when there is genuine excess skin (dermatochalasis), herniated fat pads creating visible bags, or — for some patients of East and Southeast Asian descent — the absence of a defined upper eyelid crease. An honest consultation should tell you which category you fall into before surgery is even discussed.
Upper blepharoplasty: heavy, hooded eyelids
Upper eyelid surgery removes excess skin, and sometimes a small amount of muscle or fat, from the eyelid crease. It is the procedure for patients whose upper lids feel heavy, whose eyes look smaller than they used to, or whose skin folds far enough to touch the eyelashes.
- Who it suits: hooded lids, skin resting on the lash line, a tired or sleepy appearance that persists regardless of rest.
- What it does not fix: dark circles, under-eye bags, or brow position — a low brow can mimic hooding and needs a different assessment.
- Incision: hidden within the natural eyelid crease, so the resulting scar is very difficult to see once healed.
Lower blepharoplasty: under-eye bags and puffiness
Lower eyelid surgery targets the fat pads that herniate forward with age or genetics, creating a permanent puffy or tired look that concealer cannot fully hide. Depending on the case, fat is removed or repositioned to smooth the transition between the lower lid and the cheek.
- Who it suits: visible under-eye bags present even when well-rested, a defined shadow or groove below the bag (tear-trough hollowing).
- Technique choice matters: a transconjunctival approach (through the inside of the eyelid, no visible scar) suits fat repositioning without excess skin; an external incision is reserved for patients who also have loose skin to remove.
- Often paired with: a small amount of filler or fat grafting to blend the lid-cheek junction, planned at the same consultation.
Asian blepharoplasty: creating or defining a double eyelid
Asian, or double-eyelid, blepharoplasty is a distinct procedure with a different goal: creating, deepening, or making more symmetrical the supratarsal crease in eyelids that are naturally single-lidded or have a low, uneven fold. This is not a Westernisation of the eye — the aim is a natural, ethnically appropriate crease that suits the patient’s own anatomy, at a height and shape the patient chooses.
- Two main techniques: an incisional method (a fine incision defines a permanent crease, and can address excess skin or fat at the same time) or a suture method (small internal stitches create the fold without an external incision, best suited to thinner eyelids with minimal excess skin).
- Planning is individual: crease height, shape (parallel vs. tapered), and symmetry are discussed and marked with the patient before surgery — there is no single “standard” result.
- Can be combined with epicanthoplasty in some cases, when the inner corner of the eye is also part of the desired change.
Comparing the three at a glance
| Type | Main concern treated | Where the incision is | Typical recovery |
|---|---|---|---|
| Upper blepharoplasty | Hooded, heavy upper lids | Hidden in the natural eyelid crease | Bruising and swelling settle over 1–2 weeks |
| Lower blepharoplasty | Under-eye bags, puffiness | Inside the lid (transconjunctival) or just below the lash line | Bruising and swelling settle over 1–2 weeks |
| Asian (double-eyelid) blepharoplasty | Absent or low, uneven eyelid crease | Within the planned crease line, or internal sutures | Initial swelling softens over 2–3 weeks; final crease settles over months |
Many patients qualify for more than one at once — hooded upper lids and puffy lower lids are frequently addressed in the same session, since both are assessed during the same eyelid exam.
Why eyelid surgery needs a surgeon’s precision
The eyelid is one of the thinnest, most mechanically active pieces of skin on the body, sitting directly over the eyeball and the muscles that open and close it. A few millimetres of difference in how much skin or fat is removed is the difference between a natural result and a lid that sits wrong, closes incompletely, or looks asymmetric — and unlike most facial procedures, complications here can affect how the eye itself functions, not just how it looks.
This is why blepharoplasty is planned and performed as facial surgery, not a standalone cosmetic add-on. A maxillofacial or oculoplastic surgical background means the anatomy of the orbit, the eyelid muscles, and the surrounding facial structures is understood as a whole — useful when a “simple” eyelid concern turns out to involve brow position, fat compartments, or asymmetry that needs correcting elsewhere in the assessment. The procedure that looks the most minor on the surface is, anatomically, one of the least forgiving to get wrong.
The approach used at the practice
- Eyelid and facial assessment: examining skin excess, fat pad position, brow height, and eyelid function to identify which of the three procedures — if any — actually applies, and whether a non-surgical option would be more appropriate.
- Individual planning: for Asian blepharoplasty in particular, crease height and shape are discussed and marked together with the patient before any decision is made.
- Procedure under local or general anaesthesia, chosen based on the extent of surgery and the patient’s preference.
- Structured follow-up to monitor healing and confirm the eyelid is functioning and closing normally as swelling resolves.
Frequently asked questions
Q: Can I have upper and lower blepharoplasty at the same time?
A: Yes — it is common to address both in a single session when both are indicated, which also means a single recovery period instead of two.
Q: Will Asian blepharoplasty change the shape of my eyes to look less natural?
A: The goal is a crease that suits your own eyelid anatomy, not a fixed “Western” look. Crease height, shape, and depth are planned individually, and many patients choose a subtle, natural result.
Q: How long do the results last?
A: Upper and lower blepharoplasty results are long-lasting, though the skin continues to age naturally afterward. The eyelid crease created in Asian blepharoplasty is generally permanent once fully healed.
Q: Is blepharoplasty painful?
A: Most patients describe tightness and swelling rather than significant pain, managed with simple pain relief in the days after surgery.
Q: When can I wear makeup or contact lenses again?
A: Typically after about a week, once swelling has settled and any stitches are removed or dissolved — this is confirmed at your follow-up visit rather than a fixed date for everyone.
Q: I just have dark circles, not bags — do I need surgery?
A: Often not. Dark circles are frequently a pigmentation or thin-skin issue rather than excess fat, and may respond better to non-surgical treatment. This is exactly what the initial assessment is for.
Q: Should a dentist or general practitioner perform eyelid surgery?
A: Blepharoplasty involves the eyelid, orbital fat, and muscles that control eye closure, so it should be performed by a surgeon trained in facial and periorbital anatomy. Even experienced non-surgical injectors are not equipped to safely alter eyelid tissue itself.
About the author
Dr Marc-Kevin Le Roux is a French board-certified Oral and Maxillofacial Surgeon practising in Dubai. Trained in France’s top university hospitals with international fellowships in Asia. 1,500+ facial procedures performed. Bilingual English and French.
Not sure which type of blepharoplasty applies to you?
An eyelid and facial assessment is the only reliable way to know whether upper, lower, or Asian blepharoplasty — or a non-surgical alternative — is the right fit for your eyes.
Related: Upper Blepharoplasty · Lower Blepharoplasty in Dubai · Asian Blepharoplasty
