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Blepharoplasty Overview

What is Upper and Lower Blepharoplasty?

Pronounced “blef-a-ro-plasty,” this is the most commonly performed facial cosmetic procedure in both men and women. As we age, eyelid skin becomes thinner and redundant. The skin excess is medically termed “dermatochalasis.” Blepharoplasty procedure can give the eyes a more rested or rejuvenated look by removing excess skin, and re-positioning bulging fat or lax muscle from the upper or lower eyelids.

Upper Blepharoplasty


The main component of an upper blepharoplasty is removal of excess skin, a condition named dermatochalasis. This will decrease “hooding” of the eye and present more eyelid platform, which women often appreciate as it facilitates the application of eyelid makeup.

If the sagging upper eyelid skin obstructs peripheral vision to a severe enough degree, blepharoplasty may be covered by insurance, and will eliminate the obstruction and expand the visual field.

The excess skin is removed through an incision hidden in the natural eyelid crease, rendering the resultant scar virtually invisible. In years past, upper eyelid fat and muscle were often removed in addition to skin, but we have since recognized that this eventually may lead to a deep upper eyelid “sulcus,” a more hollowed, aged appearance. We now strive to retain as much upper eyelid volume as possible, including muscle. Removing muscle not only can lead to loss of volume, but can also harm the blink strength of the eyelid, potentially leading to dry eye symptoms.

During the evaluation process, careful attention is given to the eyebrow position, as brow descent may give the appearance of excess skin. A browlift may then be indicated in addition to, or instead of, removing eyelid skin.

Lower Blepharoplasty


Lower blepharoplasty is a more complex and potentially risky procedure. In addition to prolapsed fat, stretched-out eyelid muscle and skin may compromise the appearance of the lower eyelids. Furthermore, cheek descent can worsen this appearance by creating a groove below the eyelid, often termed the “tear trough.” Swelling in the cheek/eyelid transition zone, termed “festoons,” can further complicate treatment. These features may require a combination of approaches: fat may need to be removed or repositioned through an incision hidden on the inner surface of the eyelid (transconjunctival), or through an eyelid incision just below the lashes (subciliary) if removing skin and tightening muscle is also planned. If skin creping or festoons are present, laser resurfacing or a chemical peel can be performed to smooth and tighten the lower lid skin

Frequently Asked Questions

Can Upper and Lower Blepharoplasty be done during the same surgery?

Upper and lower blepharoplasty is often performed together and also can be combined with other procedures such as eyebrow or forehead lift, midface lift, face lift, neck lift, or laser skin resurfacing.

What are the risks/complications of Blepharoplasty?

Though with any surgery, there are possible risks and complications, surgery performed by an experienced and knowledgeable surgeon minimizes these risks.

Because of Dr. Amadi’s expertise in this area, many other plastic surgeons refer patients with complications of eyelid surgery to Dr. Amadi for treatment and repair.

The risks/complications of blepharoplasty include dry eye, poor blink, eyelid asymmetry, eyelid retraction, “rounding” of the eyes (loss of “almond shape” of the eye), excess tearing, inability to fully close eyelids, and, extremely rarely, loss of vision.

Will Blepharoplasty be covered by insurance?

Although less severe dermatochalasis (excess eyelid skin) can be a cosmetic concern, more severe forms can compromise visual function, and as such, will be covered by insurance. Formal visual field testing and photography will be required to document the patient’s condition for the insurance company, and prior authorization is often required. It should be noted, that more recently, insurance approval has become increasingly difficult, and sometimes frustrating for both the surgeon and the patient.

Why Should you choose Dr. Amadi to perform your Blepharoplasty?

When choosing a surgeon to perform blepharoplasty, look for a cosmetic and reconstructive facial surgeon who specializes in the face, with extensive experience in eyelid surgery. Dr Amadi’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he is a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, with extensive training in Oculofacial plastic reconstructive and cosmetic surgery.

Dr. Amadi’s practice has been dedicated to this field since 2001. Furthermore, he has trained dozens of other surgeons [residents and fellows] in this area of surgery as Co-Director of the Oculofacial Plastic and Reconstructive Surgery Service and Fellowship at the University of Washington Medical Center and Harborview Medical Center.

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Take the next step to a more youthful and rejuvenated appearance. Schedule a consultation with Dr. Amadi, our board certified Oculofacial Plastic Surgeon today.

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