Upper Eyelid Lift

Upper blepharoplasty removes the excess skin that folds over the upper eyelid and makes the eyes look tired or hooded. It takes about 30 minutes, and most patients return to work in 4 to 5 days. The important thing to establish first is what is actually causing the hooding — excess eyelid skin, a drooping lid margin (ptosis), or a descended brow are three different problems with three different operations. Sam Naficy, MD, FACS performs 120 to 140 upper eyelid procedures each year in Bellevue, Washington.

What is upper blepharoplasty?

Upper blepharoplasty — also called an upper eyelid lift or eyelid surgery — removes excess skin, and sometimes a small amount of muscle or fat, from the upper eyelid. The incision sits in the natural crease of the lid, where it becomes very difficult to see once healed.

It is one of the highest-yield procedures in facial surgery: a short operation, a quick recovery, a well-hidden scar, and a change people notice without being able to identify. The eyes look open and rested rather than altered.

Ptosis, excess skin, or brow descent? Telling them apart

This is the most important distinction on this page, and the one most often got wrong. Three different problems produce a heavy, hooded upper eye, and each needs a different operation. Treating the wrong one is the single most common reason an upper eyelid surgery under-delivers.

	Eyelid ptosis	Excess upper eyelid skin	Brow descent
What has changed	The levator muscle or its tendon has stretched or detached, so the lid margin itself sits low	The skin of the upper lid has stretched and folds over the lash line (dermatochalasis)	The eyebrow has descended, pushing forehead tissue down onto the lid
Where the problem sits	At the lid margin	In the lid skin	Above the lid entirely
How it looks	The lid edge covers part of the pupil; the eye looks smaller or sleepy; often noticeably asymmetric between sides	A fold of skin rests on or hangs over the lashes, while the lid margin sits at a normal height	Heavy, hooded, tired appearance; the distance from brow to lashes is shortened
Self-check in a mirror	Compare where each lid edge crosses the pupil. One eye often looks smaller than the other	Lift only the fold of skin. If that clears the hooding, skin is the problem	Lift the outer end of the brow with a fingertip. If that clears it, the brow is contributing
Other clues	Raising the eyebrows or tilting the chin up to see; worse when tired; sometimes present since childhood	Vision blocked from above by skin rather than by the lid edge; skin may touch the lashes	Deep horizontal forehead lines from constantly raising the brows to compensate
Treatment	Ptosis repair (levator advancement), performed at our practice by Dr. Bryan Sires	Upper blepharoplasty	Brow lift

These frequently coexist. Many patients have two of the three, and some have all three. Removing eyelid skin when the lid margin is low leaves the eye still looking sleepy. Removing eyelid skin when the brow has descended pulls the brow down further. Establishing which components are present — and in what proportion — is the substance of the consultation, and it is why the assessment matters more than the operation.

Upper blepharoplasty, Lower blepharoplasty, and Fat grafting by Sam Naficy, MD * Individual results may vary.

How do the eyes age?

The eyes are usually the first area to show age, and often the area people notice about themselves before anything else. The common changes:

1. Heavy, droopy, or hooded eyebrows
2. Excess folds of skin on the upper eyelid
3. Loss of the natural upper eyelid crease
4. Fullness or puffiness of the upper lid from prominent fat
5. Hollowing of the upper lid in some patients, giving a skeletal look
6. A low-sitting lid margin from stretching of the levator muscle
7. Fine wrinkling and crepe-like texture of the eyelid skin
8. Bags and dark shadows of the lower lids
9. Descent of the upper cheek, which deepens the shadow beneath the eye

These do not progress at the same rate, which is why two patients of the same age can need entirely different operations.

What can upper blepharoplasty achieve?

After upper eyelid surgery the eyes look more open and rested. The incision lies within the natural crease of the lid and typically heals quickly and inconspicuously — eyelid skin heals better than skin almost anywhere else on the body.

The result is characteristically difficult to attribute. Friends and colleagues comment that you look well without identifying what changed. As with all facial surgery, a good result is as much about what is not noticeable as what is.

What it does not do: upper blepharoplasty does not lift the brow, does not correct a low lid margin, does not remove crow's feet, and does not treat lower eyelid bags. Each of those needs its own procedure, and several are commonly combined in the same anesthetic.

Who is a good candidate for upper blepharoplasty?

• Excess upper eyelid skin folding over the lash line or resting on the lashes
• A tired or heavy appearance that does not reflect how you feel
• Difficulty applying make-up to the upper lid because the fold obscures it
• A normal lid margin position and a reasonable brow position — or a plan to address those at the same time
• Good general health, no uncontrolled dry eye, and realistic expectations

Who is not a good candidate?

• The problem is brow descent, not eyelid skin. Removing lid skin in this situation under-corrects and can pull the brow lower. A brow lift is the right operation.
• The problem is ptosis. If the lid margin sits low, removing skin above it does not raise it. Ptosis repair is a different procedure.
• Significant untreated dry eye. Eyelid surgery can worsen dry eye symptoms; this needs evaluating first.
• Thyroid eye disease or other active orbital conditions, which need to be stable before elective surgery.
• Uncontrolled hypertension, poorly controlled diabetes, or a bleeding disorder.

How is upper blepharoplasty performed?

Upper blepharoplasty takes approximately 30 minutes and is usually performed under IV sedation or local anesthesia, though general anesthesia is used when it is combined with longer procedures.

1. The excess skin is marked with the patient sitting upright, since lid position changes when lying down.
2. The incision is placed within the natural upper eyelid crease, and extends laterally into a smile line where more skin needs removing.
3. The measured strip of excess skin is removed, along with a small amount of muscle where indicated.
4. Prominent fat in the inner corner is conservatively reduced — conservatively, because over-removal produces a hollow, skeletal upper lid that is difficult to correct later.
5. The incision is closed with very fine sutures, which are removed within about a week.

The most important judgement in the operation is how much skin to leave. Enough must remain for the lid to close completely and comfortably. Taking too much is the error that cannot be undone.

What is upper blepharoplasty recovery like?

Most patients return to work in 4 to 5 days. Discomfort is minimal — typically compared to having an irritated eye rather than to pain.

Time after surgery	What to expect
Days 1–2	Swelling and bruising around the eyes, peaking early. Cool compresses and head elevation. Vision may be blurry from ointment. Discomfort is usually managed with acetaminophen.
Days 3–5	Swelling begins to settle noticeably. Most patients return to work at the end of this window, with make-up used to cover residual bruising once the incisions have sealed.
Around day 7	Fine sutures removed. The incision is pink but sits within the lid crease.
Weeks 2–4	Bruising resolved. Light to moderate exercise resumes with clearance. The lid crease still looks slightly tight or high — this settles.
Weeks 6–8	Full activity cleared. Incision continues to fade.
Months 3–12	The scar matures into the crease and becomes difficult to identify. Final result assessed at one year.

Patients travelling from out of the area should plan to remain locally until sutures are removed. See Out of Town Patients.

Upper blepharoplasty by Sam Naficy, MD.  * Individual results may vary.

Does insurance cover upper eyelid surgery?

Usually not. Upper blepharoplasty performed to improve appearance is a cosmetic procedure and is not covered.

On rare occasions insurance will cover it — but only where the extent of visual obstruction is severe. The threshold is genuinely high: the excess skin has to be obstructing the upper visual field to a degree that is documented objectively, typically with formal visual field testing performed with the lid taped and untaped, along with photographs. Mild hooding, feeling that your eyes look tired, or difficulty with eye make-up do not meet it.

Where a patient's obstruction may be severe enough to qualify, we refer those cases to Dr. Bryan Sires, who handles the functional and insurance side of eyelid surgery at our practice, including ptosis repair.

If you are unsure which category you fall into, raise it at consultation rather than assuming either way.

Can a brow lift be combined with blepharoplasty?

Yes, and it is one of the most common combinations — because the two problems so often occur together.

The judgement is proportional. When the brow has descended, some of what looks like excess eyelid skin is actually forehead tissue that has been pushed down. Lifting the brow first reveals how much lid skin genuinely needs removing, which is usually less than it appeared. Doing both in one anesthetic allows that judgement to be made with the brow already in its final position, rather than estimating.

Correcting only the eyelid when the brow is the dominant problem produces a result that looks incomplete, and can leave the brow sitting lower than before.

Upper blepharoplasty and Brow lift by Sam Naficy, MD.  * Individual results may vary.

Upper blepharoplasty and Endoscopic Brow lift in a male patient by Sam Naficy, MD.  * Individual results may vary.

Can fat grafting be combined with blepharoplasty?

Yes. Upper blepharoplasty removes tissue; fat grafting replaces volume that has been lost. Ageing around the eye involves both: skin becomes excessive while the surrounding structures — the temple, the brow, and the upper cheek — deflate.

Removing skin without restoring that volume can produce an eye that looks tidier but still hollow or skeletal. Adding volume around the eye at the same time gives a fuller, rested appearance rather than a merely tightened one.

Upper blepharoplasty and Fat grafting by Sam Naficy, MD.  * Individual results may vary.

Can laser skin resurfacing be combined with blepharoplasty?

Yes. Eyelid surgery repositions and removes tissue; it does not change skin quality. Laser resurfacing treats the fine crepe-like wrinkling of the eyelid skin and the lines at the outer corner that surgery leaves untouched.

Combining them extends recovery somewhat compared with blepharoplasty alone, and that should be factored into planning.

Upper and Lower blepharoplasty, Fat grafting, and  laser resurfacing of full face by Sam Naficy, MD.  * Individual results may vary.

How is upper blepharoplasty different in men?

Upper eyelid surgery is popular among men, and the aesthetic target differs. The male upper lid carries a lower, fuller crease and less visible lid platform than the female eyelid. Creating a high, well-defined crease — often desirable in women — feminizes a man's eye.

The approach in men is therefore more conservative: less skin removed, minimal fat reduction, and the crease left low. Men also more often have a heavy brow contributing to the hooding, so brow position needs assessing carefully before deciding how much lid skin to take.

Upper blepharoplasty in a male patient by Sam Naficy, MD * Individual results may vary.

Upper blepharoplasty, Lower blepharoplasty, and Fat grafting in a male patient by Sam Naficy, MD * Individual results may vary.

What are the risks of upper blepharoplasty?

More common, and usually temporary: swelling and bruising, dryness or grittiness of the eye, blurred vision from ointment, mild asymmetry in swelling between sides, and temporary difficulty closing the eyes fully at night.

Less common:

• Asymmetry. Eyelids and brows are asymmetric in most people before surgery and some difference persists after.
• Dry eye that persists or is unmasked by surgery, more likely in patients with pre-existing dryness.
• Over-resection of skin, leaving the lid unable to close fully. This is the error that is hardest to correct, and the reason a conservative amount is removed.
• Over-resection of fat, producing a hollow, skeletal upper lid.
• Crease asymmetry or a crease set higher or lower than intended.
• Visible scarring or a widened scar, more likely in smokers.
• Residual hooding where brow descent or ptosis was the dominant problem and was not addressed.

Rare: infection, hematoma, and vision change. Loss of vision after blepharoplasty is extremely rare but is the reason post-operative bleeding is treated urgently rather than expectantly.

How much does upper blepharoplasty cost?

At Naficy Plastic Surgery, upper blepharoplasty is approximately $7,000. Combining it with lower eyelid surgery, a brow lift, fat grafting, or laser resurfacing increases the total, though combining generally costs less than staging the procedures separately because anesthesia and facility time are shared.

Fees are itemized in writing at consultation, covering surgeon, anesthesia, facility, and follow-up care. Financing is available through PatientFi. Where visual obstruction is severe enough that insurance may apply, those cases are referred to Dr. Sires — see above.

Fees & payment policies · Financing

Why choose a facial plastic surgeon for eyelid surgery?

Upper blepharoplasty looks like a simple operation and is not. The difficulty is not the technique; it is the assessment — deciding how much of the hooding is skin, how much is brow, how much is lid margin, and how much skin can safely be removed without compromising lid closure.

Dr. Naficy performs 120 to 140 upper eyelid procedures each year. His practice has been devoted exclusively to facial plastic surgery since 2000. He is certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS), graduated first in his class from the University of Washington School of Medicine, and completed both his residency and fellowship at the University of Michigan. Dr. Naficy has been recognized in Seattle Magazine's Top Doctors list.

Our practice also includes Dr. Bryan Sires, who performs ptosis repair and handles functional eyelid cases — so if your assessment turns out to involve the lid margin rather than the skin, the right operation is available under the same roof.

About Dr. Sam Naficy, MD, FACS

What type of anesthesia is used?

Upper blepharoplasty is typically performed under IV sedation or local anesthesia, and under general anesthesia when combined with longer procedures. Your anesthesia provider will discuss which is appropriate for your health status and the planned procedure, and monitors heart rate, blood pressure, breathing, and oxygen levels continuously.

Surgery is performed in our on-site surgery center, which is Medicare-certified and Washington State–accredited. Our anesthesia team has more than 50 years of combined experience, and all providers also hold appointments at the University of Washington or other regional medical centers.

Anesthesia guidelines [21kb PDF] · Post-operative care instructions [12kb PDF]

Eyelid surgery before and after photos

Representative before and after images of eyelid procedures performed by Dr. Sam Naficy. Some patients had more than one procedure; the caption accompanying each photograph describes the details.

* Individual results may vary.

Frequently asked questions

Do I need an upper eyelid lift or a brow lift?

Lift the outer end of your brow gently with a fingertip in a mirror. If that removes the heaviness, the brow is contributing and eyelid surgery alone will under-correct. If the hooding persists with the brow lifted, the skin is the problem. Many patients need both.

How do I know if I have ptosis?

Look at where each upper lid edge crosses the pupil. In ptosis the lid margin itself sits low and often covers part of the pupil, and one side is frequently lower than the other. Removing skin above a low lid does not raise it — that requires ptosis repair.

Will the scar show?

The incision sits inside the natural crease of the upper lid. Once healed it is difficult to find, and it is invisible with the eyes open.

How long until I look presentable?

Most patients return to work at 4 to 5 days, using make-up over any residual bruising once the incisions have sealed.

Will I be able to close my eyes normally?

Yes. Temporary difficulty closing fully at night is common in the early weeks. Permanent difficulty results from removing too much skin, which is why a conservative amount is taken.

Does insurance cover it?

Rarely, and only where visual obstruction is severe and objectively documented. Most upper blepharoplasty is cosmetic and not covered. Cases that may qualify are referred to Dr. Sires.

How long do the results last?

Upper blepharoplasty is long lasting; many patients never need it repeated. Skin continues to age, so some patients seek a touch-up after 10 to 15 years.

Can it be combined with a facelift?

Yes. A facelift treats the lower face and neck and does nothing for the eyes, so the two are frequently performed together.

Will it get rid of my crow's feet?

No. Those are treated with Botox or laser resurfacing, which can be combined with surgery.

What about the bags under my eyes?

Those are a separate problem requiring lower eyelid surgery.

I am interested. What do I do next?

If you are considering upper eyelid surgery, we encourage you to complete the Surgical Consultation Intake Form. Dr. Naficy will assess how much of the hooding is eyelid skin, how much is brow position, and whether the lid margin is involved, then recommend the procedure or combination that fits — and inform you of the potential risks. You will also have the opportunity to view before and after albums of patients with similar features.

Naficy Plastic Surgery & Rejuvenation Center — 1110 112th Ave. NE, Suite 150, Bellevue, WA 98004 · (425) 450-0880. Serving Bellevue, Seattle, Kirkland, Redmond, Medina, Mercer Island, and the greater Puget Sound region.

This page is for general education and does not constitute medical advice. Individual results vary. Written and medically reviewed by Sam Naficy, MD, FACS. Last reviewed August 2026.