Upper Blepharoplasty & Sunken Eyelids FAQ

Upper blepharoplasty is surgery that uses an incision along the double eyelid crease to remove sagging upper eyelid skin and trim loose muscle and thick fat, and it is mainly performed when the eyelids have drooped with age. It is considered when sagging skin covers the lashes and makes vision feel blocked, or when the eyes look small and sleepy (hooded eyes), and a natural double eyelid crease is created where the skin was removed. If the eye-opening muscle is weak, ptosis correction may be done at the same time.

Upper blepharoplasty is like double eyelid surgery in that it creates a crease through an incision along the crease line, but it removes more skin than double eyelid surgery. Also, middle-aged eyelids have reduced skin elasticity, so the crease can loosen or sagging skin can cover the crease again, and the crease must be fixed more carefully so that it settles in a natural shape. The more skin is removed, the more your look changes, so a double eyelid crease for middle-aged eyelids is often planned low and natural, taking the sagging skin into account.

Drooping eyelids mainly develop as skin elasticity decreases with age and the muscles and supporting tissues around the eyes loosen. Ptosis, in which the eye-opening muscle weakens, or drooping of the eyebrow itself can also be the cause, and long-term contact lens wear or a habit of rubbing the eyes can contribute. Depending on the cause, the right option may be upper blepharoplasty, a sub-brow lift, ptosis correction, or an endoscopic brow lift.

Droopy eyelids are difficult to improve with exercise or massage. Stretched skin and loosened tissue do not shrink with exercise, and frequently rubbing around the eyes can actually irritate the skin. If the drooping blocks your vision or makes your eyes look sleepy, the cause is checked and surgical correction is considered.

Returning to daily life after upper blepharoplasty usually takes about 1 week, and stitches are removed 7 days after surgery. Swelling and bruising peak on days 2–3, and most of the major swelling is expected to go down in about 4–6 weeks. Face washing is OK from the day after stitch removal, makeup on the incision area and contact lenses from 4 weeks, and alcohol, smoking, saunas, and strenuous exercise are also best avoided for 4 weeks.

Besides temporary swelling, bruising, a feeling that the eyes do not close completely, and dryness, upper blepharoplasty can rarely cause asymmetry, a crease that looks high or thick, scarring, or difficulty closing the eyes due to excessive skin removal. Early symptoms often improve as the swelling subsides, but if they persist, additional correction may be needed. It is important to plan the amount of skin removal accurately before surgery.

Upper blepharoplasty and ptosis correction can be done together. In middle age, skin drooping is often accompanied by ptosis from weakened eye-opening muscles, so removing only skin may leave the eyes still looking sleepy. We check eye-opening strength before surgery and, if needed, perform ptosis correction through the same incision.

The cost of upper blepharoplasty depends on the extent of skin removal, whether combined procedures such as fat contouring or ptosis correction are included, and whether it is a revision. The scope of surgery differs depending on your eyelid condition, so an exact cost can be provided after a consultation.

Sunken upper eyelids mainly develop as upper eyelid fat decreases and retracts with age. They can also occur when there is little eyelid fat to begin with, the eye sockets are naturally deep, or a lot of fat was removed during double eyelid surgery or upper blepharoplasty. Sunken eyelids can make you look tired and older, and the crease may fold into multiple layers or the eyes may look as if they struggle to open. In severe cases, opening the eyes can feel heavy and stiff.

Sunken eyelids are mainly corrected by restoring volume with a fat graft. Fat harvested from the abdomen or thigh is purified and injected in small portions into the hollow area, and if the eyelids look sunken because the eye-opening muscle is weak, ptosis correction may be done at the same time. When incisional double eyelid surgery or upper blepharoplasty is done at the same time, fat repositioning is also considered.

After a sunken eyelid fat graft, part of the fat is absorbed and the rest, once settled, can last a long time, though the survival rate varies by individual. The remaining fat usually settles after about 1–2 months, and if absorption is high and volume is lacking, an additional graft can be considered. The upper eyelid skin is thin, so overfilling can look lumpy or puffy, and it is important to inject an appropriate amount in divided portions.

Double eyelid surgery is possible even with sunken upper eyelids, but the hollowing can make the line look deep and folded into multiple creases, so it is often corrected at the same time. Fat is grafted into the hollow area, or ptosis correction is added if eye-opening strength is weak, so that the line settles naturally. For eyes that naturally have little fat, it is important to preserve the fat rather than remove it during double eyelid surgery.

If excess upper eyelid fat makes the eyelids look thick and puffy, an appropriate amount of fat can be removed during double eyelid surgery or upper blepharoplasty. Removing too much fat can make the eyelids look sunken later, so it is important to check whether the thickness comes from fat or from skin or muscle and remove only as much as needed.

Sunken eyelids can be filled with filler, but the upper eyelid skin is thin and moves a lot, so filler may show through or look lumpy. A bigger concern is that filler may migrate to unintended areas. For this reason, a fat graft is recommended over filler for sunken eyelids.