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Upper vs lower blepharoplasty — which do I need?

Most patients aren't sure whether they want upper bleph, lower bleph, or both. The answer is anatomical, not aesthetic — and you can usually identify which is your dominant issue with a mirror and good lighting.

Doç. Dr. Ayhan Işık Erdal
Doç. Dr. Ayhan Işık Erdal Associate Professor of Plastic Surgery
MD · FACS · FEBOPRAS · Associate Professor
✓ Medically reviewed · Last updated: May 18, 2026

The upper-lid self-check

Stand in good natural light, no makeup, mirror at eye level. Look straight ahead with relaxed face. Then check:

  • Is there a clearly visible crease on each upper lid?
  • Or does the upper lid skin hang over the lash line, covering most of the lid platform?
  • Can you see eyeshadow you applied 30 minutes ago, or has it disappeared under hooded skin?
  • When you look down at a book, does the upper lid skin fall heavily onto your lashes?

"Yes" to the bottom three means upper bleph is likely indicated.

The lower-lid self-check

Same setup. Now:

  • Is there a visible "bag" or puffiness directly under the lash line, distinct from your cheek?
  • Does it persist regardless of sleep — is it there at noon as much as at 7 AM?
  • Is there a hollow groove running from the inner eye corner diagonally toward the cheek?
  • Do photos consistently show shadow under your eyes even in flat lighting?

"Yes" to two or more means lower bleph is likely indicated.

When both are needed

About 40% of patients have meaningful issues in both areas. Quad blepharoplasty addresses both in one operation with one recovery — typically more efficient than two separate procedures.

Frequently asked questions

Can I have just upper now and lower later?

Yes — staged surgery is reasonable. Many patients have upper bleph in their late 40s and add lower bleph in their late 50s as needs emerge. Single-stage is more efficient for those who clearly need both now.

Medical disclaimer: This page provides general information about blepharoplasty and reflects the clinical opinions of Doç. Dr. Erdal. It does not constitute medical advice for any individual patient. Results vary; all surgery carries risk. Blepharoplasty in some cases produces irreversible changes to eyelid anatomy. Suitability is determined only through personal consultation with full medical history disclosure.

Ready to discuss your case?

Doç. Dr. Erdal personally reviews every enquiry. Honest assessment of whether blepharoplasty is right for you, with no pressure to book.

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