Upper Blepharoplasty

Upper blepharoplasty, also known as upper eyelid surgery, is a surgical procedure that removes or reshapes excess upper eyelid skin and, when appropriate, addresses underlying fat or muscle to improve eyelid contour and function.

As we age, the delicate tissues of the upper eyelids gradually lose elasticity. The skin stretches, the supporting muscles weaken, and fat pockets may become more prominent. This combination can create hooded eyelids, a tired appearance, or even a sensation of heaviness around the eyes. While skincare products may improve skin quality, they cannot remove excess skin or reposition underlying tissues. Upper blepharoplasty directly addresses these anatomical changes, providing long-lasting improvement with scars that are typically well hidden within the natural eyelid crease.

The goal is to restore a more youthful, refreshed appearance while improving the natural contour of the eyes. In some patients, the surgery may also improve vision by removing loose eyelid skin that hangs over the eyelashes and obstructs the upper field of vision.

An ideal candidate for upper blepharoplasty is someone with excess upper eyelid skin, eyelid fullness, or hooding that creates a heavy or tired appearance and, in some cases, interferes with the upper field of vision. Candidates should generally be in good overall health, have realistic expectations, and understand that the cause of heavy-looking eyelids must be assessed before deciding whether upper blepharoplasty is the appropriate procedure.

However, not every patient with heavy upper eyelids needs Upper Blepharoplasty . Eyebrow ptosis, forehead ptosis, eyelid ptosis or changes in the eyelid muscle function can also contribute to a heavy appearance and may require a different or additional procedure.

My approach to upper blepharoplasty begins with identifying the underlying cause of heavy or hooded upper eyelids rather than simply removing excess skin. I assess the upper eyelid skin, eyelid fat, brow position, forehead, eyelid muscle function, and overall facial proportions to determine which procedure—or combination of procedures—will provide the most appropriate and natural result.

Sometimes, what appears to be "heavy eyelids" is not caused by excess eyelid skin alone. It may be related to eyebrow ptosis, forehead ptosis, eyelid ptosis, or weakness of the eyelid muscles. Previous eyelid surgery or other facial procedures can also affect the anatomy and influence which technique is safest and most appropriate.

Whole-face assessment is important because treating only the visible problem may not address its underlying cause.

I do not simply remove excess skin because a patient asks for it. Instead, I first determine what is actually causing the concern and whether Upper Blepharoplasty is the right procedure.

• Upper Blepharoplasty: Appropriate when there is excess upper eyelid skin and the eyebrow position is satisfactory.
• Upper Blepharoplasty with Double Eyelid Creation: Considered when a patient wants a more defined or higher eyelid crease.
• Subbrow Eyelid Lift: May be an option for selected patients who have had previous Upper Blepharoplasty and still have excess skin, provided the eyebrow position is appropriate.
• Eyebrow Lift or Forehead Lift: May be necessary when eyebrow or forehead descent contributes significantly to the heavy appearance of the upper eyelids.
• Ptosis Surgery: May be needed when the eyelid itself is drooping because of weakness or dysfunction of the eyelid-lifting muscle.

In some patients, more than one condition is present, so combining procedures may provide a more balanced and natural result.

Before surgery, I carefully take measurements and perform detailed preoperative markings to determine the appropriate amount and location of skin to be removed. I also assess the upper eyelid fat and eyelid muscle before and during surgery.

When necessary, the eyelid crease and its relationship with the eyelid muscle may need to be carefully adjusted. The goal is not simply to remove tissue, but to preserve or restore the proper anatomy of the eyelid while creating a natural and harmonious appearance.

My background in Plastic and Reconstructive Surgery has taught me to look beyond the surface. Patients with aging or drooping upper eyelids may have several contributing factors, including eyelid ptosis, eyebrow ptosis, forehead ptosis, excess skin, changes in eyelid fat, or complications from previous blepharoplasty.

Understanding these different problems allows me to choose a treatment that addresses the underlying anatomy rather than simply removing skin.

Postoperative monitoring is an important part of successful eyelid surgery. I closely monitor my patients during recovery and maintain communication throughout the healing process. This allows potential problems to be recognized early and managed appropriately, while also helping patients understand what is normal during recovery.

By Dr. Aicee Bernal (officially licensed as Ma. Concepcion M. Bernal MD)

Board-Certified Plastic and Reconstructive Surgeon

Manila, Philippines

Before surgery: 

Your medications and supplements will be reviewed during consultation. If you take anticoagulants, antiplatelet medications, or other medicines that may increase bleeding, you will be given individualized instructions regarding whether and when they should be adjusted.

Anesthesia: 

Local anesthesia is preferred for upper blepharoplasty because it provides excellent pain control while allowing the patient to open and close their eyes during surgery, enabling the surgeon to assess eyelid height, crease symmetry, and the amount of skin that can be safely removed. It also avoids the risks and longer recovery associated with IV sedation or general anesthesia, allowing most patients to go home shortly after the procedure with minimal downtime. For these reasons, upper blepharoplasty performed under local anesthesia is often safer, more precise, and more efficient than the same procedure under sedation.

Procedure: 

Upper blepharoplasty is performed through an incision placed within the natural crease of the upper eyelid. The amount of skin removed is carefully determined based on the patient's eyelid anatomy, brow position, eyelid function, and degree of skin excess. When appropriate, underlying fat or muscle may also be addressed to improve eyelid contour while preserving natural eyelid function.  Suturing is done using non-absorbable sutures which will be removed after a week. 

• Post-op Medications: I usually prescribe oral antibiotics and pain reliever after surgery.  

• Suture Removal: sutures are removed after 6-7 days
   
• Downtime: Mild discomfort, swelling, and bruising are expected after upper blepharoplasty. Cold compresses and keeping the head elevated can help reduce swelling during the early recovery period.

• Scarring:  scars are usually visible for 1-3 months and will gradually fade over 6-12 months
   
• Results: The eyelids may remain mildly swollen or firm for several months as the tissues heal. The appearance continues to refine over time, with scar and tissue maturation continuing for up to a year.  Recovery varies from patient to patient and may be influenced by the amount of tissue treated, individual healing, previous eyelid surgery, and whether another procedure is performed at the same time.  Many patients are able to return to work within about 7–14 days, depending on the amount of swelling and bruising and the nature of their work.

The cost of upper blepharoplasty in the Philippines varies depending on the surgical setting, anesthesia, complexity of the procedure, and what is included in the surgical and hospital fees.  For patients considering upper eyelid surgery in Manila, the total cost depends on whether the procedure is performed under local anesthesia in the clinic or in a hospital with anesthesia services.

Cost of Upper Blepharoplasty for uncomplicated cases 

Upper Blepharoplasty Under Local Anesthesia: P45,000*

     *When performed in the clinic under local anesthesia. Postoperative medications are not included.

Upper Blepharoplasty Under Sedation in a Hospital: P120,000-160,000*

    *Hospital-based surgery with a board-certified anesthesiologist. This estimate excludes preoperative laboratory 

      tests, medical clearance, and postoperative medications.

The difference in cost primarily reflects the surgical setting, anesthesia, hospital and operating-room fees, and anesthesia services rather than simply the surgical procedure itself.  These prices are provided as a general guide and may change depending on the patient's individual surgical plan and the facilities or services required. A final quotation is provided after consultation and treatment planning.

Upper blepharoplasty is generally a safe procedure when carefully planned and performed, but like any surgery, it carries potential risks and complications. During consultation, I discuss these risks, the expected benefits, alternatives, and the measures taken to minimize complications.

• Bleeding or hematoma
• Infection
• Wound separation (dehiscence)
• Prominent or hypertrophic scars
• Persistent swelling
• Asymmetry
• Dry Eyes or Eye Irritation
• Difficulty closing the eyes
• Eyelid Ptosis

Upper blepharoplasty requires more than determining how much skin to remove. A thorough assessment of eyelid anatomy, eyebrow position, forehead position, eyelid function, facial proportions, and previous surgery helps determine which procedure is most appropriate. My training in Plastic and Reconstructive Surgery informs this individualized approach to eyelid surgery.