The main difference between upper and lower blepharoplasty is location and goal. Upper eyelid surgery removes excess skin and fat that hoods the eye, while lower eyelid surgery smooths undereye bags and puffiness. Many patients at Dr. Ridgway's Bellevue practice benefit from both.
Your eyelids age in two directions. The upper lids tend to droop and hood, while the lower lids develop bags and hollows. Blepharoplasty, or eyelid surgery, corrects both, but the two procedures rely on different techniques. Dr. James M. Ridgway, MD, FACS, a double board-certified facial plastic surgeon in Bellevue, tailors each approach to the individual patient.
Blepharoplasty is a cosmetic surgery that removes or repositions excess skin, muscle, and fat around the eyes. It can treat the upper lids, the lower lids, or both in a single session. The American Society of Plastic Surgeons consistently ranks eyelid surgery among the most requested cosmetic surgical procedures in the country.
Dr. Ridgway performs eyelid surgery under either IV sedation or general anesthesia. During your consultation, he reviews the benefits of each option and helps you decide which is safer and more comfortable for your situation. Both upper and lower blepharoplasty are outpatient procedures, and the surgery usually takes one to three hours.
What Is Upper Blepharoplasty?
Upper blepharoplasty targets the skin and fat above the eye. When the upper lids sag, they can make you look tired and, in more advanced cases, block part of your field of vision.
Upper eyelid surgery addresses several age-related changes, including:
Dr. Ridgway places the incision within the natural crease of the upper eyelid, so the scar stays hidden inside the fold. He then trims excess skin, tightens the underlying muscle, and removes or repositions fat. The incision is closed with fine sutures or medical-grade glue. Most patients notice only mild swelling that fades quickly.
Sometimes. When drooping upper eyelid skin blocks part of your vision, upper blepharoplasty may be considered functional rather than purely cosmetic. In these cases, some insurance plans help cover the procedure after a visual field test confirms the obstruction. Dr. Ridgway's team can walk you through the documentation during your consultation.
Lower blepharoplasty focuses on the delicate skin beneath the eyes. Over time, this area can sag, retain fluid, and form puffy bags that create a tired look, even after a full night of sleep.
Lower eyelid surgery improves common undereye concerns, such as:
Mild hollows alone can sometimes be softened with dermal fillers instead of surgery. Dr. Ridgway will tell you honestly whether a surgical or non-surgical option suits your goals.
Dr. Ridgway uses one of two techniques based on your anatomy. The transconjunctival approach places the incision inside the lower lid to reposition or remove fat, leaving no visible scar and promoting faster healing. The subciliary approach uses a fine incision just below the lash line to remove excess skin, tucked near the natural crease. Your consultation determines which method fits best.
Both procedures refresh the eyes, but they solve different problems. Here is how upper and lower blepharoplasty compare:
Yes. Many patients treat both lids in one outpatient surgery, which addresses the entire eye area at once and consolidates recovery into a single healing period. Dr. Ridgway often pairs eyelid surgery with a brow lift or mid-face lift for a fuller facial rejuvenation.
If your upper lids feel heavy or hooded, upper blepharoplasty is likely the answer. If your main concern is undereye bags or puffiness, lower blepharoplasty is the better fit. Patients with both often choose a combined procedure. Dr. Ridgway evaluates your eyes in person before recommending a plan.
Recovery is similar for both upper and lower blepharoplasty. Most patients return to work and daily routines within ten days, though bruising and swelling can take up to two weeks to settle. Cold compresses and keeping your head elevated help speed healing. Strenuous activity should wait about five weeks.
Dr. Ridgway may recommend lubricating drops to ease dryness while the eyes heal, along with a short series of follow-up visits so he can monitor your progress. Following these aftercare steps closely protects your comfort and supports the cleanest possible result.
Most patients report only mild discomfort after eyelid surgery rather than true pain. Dr. Ridgway provides medication to keep you comfortable during the first few days, and cold compresses ease tenderness. Any soreness usually fades within the first week, and most people find recovery far gentler than they expect for a facial surgery.
Eyelid surgery produces lasting results. Because Dr. Ridgway uses advanced techniques and careful closure, most patients enjoy a refreshed appearance for at least a decade. The natural aging process continues, but the improvement to the treated area holds up well over time. Pairing eyelid surgery with steady sun protection and a consistent skincare routine helps the surrounding skin age more gracefully afterward.
Good candidates for upper or lower eyelid surgery generally:
Most patients are between forty and sixty, though adults as young as eighteen may qualify. The surest way to confirm candidacy is a consultation with Dr. Ridgway.
Dr. James M. Ridgway, MD, FACS, is a double board-certified facial plastic surgeon who focuses exclusively on the face. The eyelids are among the most delicate areas to operate on, and his precise technique protects both function and appearance. He also donates his surgical skill to survivors of domestic violence through the FACE TO FACE program. You can view real patient outcomes in his eyelid surgery gallery.
Still unsure whether upper, lower, or combined eyelid surgery is right for you? Contact Dr. Ridgway's Bellevue practice to schedule a consultation. He will assess your eyes and recommend the approach that delivers the natural, refreshed result you want.
If you are ready to refresh and rejuvenate your look today, we encourage you to schedule a consultation with one of the best plastic surgeons Seattle has to offer: Dr. James M. Ridgway. During your private consultation Dr. Ridgway will carefully evaluate your face and the subtle imperfections that concern you most before providing you with a personalized blend of Bellevue cosmetic surgery procedures that will help you achieve your ideal facial appearance.
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