Upper blepharoplasty removes excess skin and fat from the top eyelid to correct hooding and heaviness, while lower blepharoplasty addresses puffiness and bags beneath the eye by repositioning or removing fat. Some patients need one procedure; others benefit from both procedures performed together. In this blog, Drs. Ron and Alex Caniglia of Caniglia Facial Plastic Surgery in Scottsdale draw on more than three decades of combined, facial-exclusive experience to explain the difference, who's a candidate for each, and what recovery looks like.
What Is Blepharoplasty?
Blepharoplasty is a surgical procedure that removes or repositions excess skin, muscle, and fat around the eyes to create a more alert, rested appearance. It's performed on the upper eyelid, the lower eyelid, or both, depending on where sagging or puffiness occurs.
Patients typically seek blepharoplasty to address:
- Hooded or heavy-looking upper eyelids
- Excess skin that folds over the lash line
- Under-eye bags or persistent puffiness
- A tired or aged appearance around the eyes
- In more advanced cases, upper eyelid skin that hangs low enough to obstruct peripheral vision
Blepharoplasty consistently ranks among the most requested facial procedures nationally. According to the American Academy of Facial Plastic and Reconstructive Surgery's 2024 member survey, blepharoplasty remained one of the top three facial surgical procedures for the fifth consecutive year, alongside rhinoplasty and facelift.
Upper Blepharoplasty: Treating Hooded Eyes and Sagging Lids
Upper blepharoplasty corrects hooded, heavy, or drooping upper eyelids by removing excess skin and, when needed, a small amount of underlying fat. The surgeon places the incision within the eyelid's natural crease, so any resulting scar is well hidden once healed.
Good candidates for upper blepharoplasty are patients whose upper lids have started to fold or sag, sometimes to the point of touching the eyelashes or narrowing the field of vision. Dr. Ron Caniglia, who helped develop and refine laser eyelid surgery techniques and has trained other physicians nationally in the technique, often incorporates laser methods to smooth surrounding skin at the same time.
Lower Blepharoplasty: Treating Under-Eye Bags and Puffiness
Lower blepharoplasty targets the puffiness, bags, and shadowing that develop beneath the eyes as fat pads shift or bulge forward with age. Rather than simply removing this fat, Dr. Alex and Dr. Ron Caniglia typically reposition it to smooth the transition between the lower lid and cheek, which produces a more natural, less hollow result than fat removal alone.
Patients considering lower blepharoplasty are usually bothered by a tired or aged look that persists regardless of sleep or skincare. Because the goal is contour, not just skin tightening, an experienced facial plastic surgeon's judgment about how much fat to reposition versus remove has a significant impact on the outcome.
"Every case has to be judged on its own. What looks natural on one patient's under-eye area can look hollow on another, which is why the surgical plan should always be individualized." - Caniglia Facial Plastic Surgery
Upper vs. Lower Blepharoplasty: Key Differences
The two procedures treat different areas and different concerns, though they're often discussed together because both fall under the blepharoplasty umbrella.
- Area treated: Upper blepharoplasty addresses the eyelid above the lash line; lower blepharoplasty addresses the area beneath the eye down toward the cheek.
- Primary concern: Upper surgery corrects hooding, heaviness, and sometimes obstructed vision; lower surgery corrects bags, puffiness, and shadowing.
- Tissue removed: Upper blepharoplasty removes mostly skin and a limited amount of fat; lower blepharoplasty focuses more on repositioning or removing fat.
- Candidacy signal: Patients considering upper surgery often notice skin resting on the lash line; patients considering lower surgery are bothered by a persistently tired look regardless of rest.
- Combined potential: Many patients qualify for both, since aging affects the upper and lower lid independently but often on a similar timeline.
Can You Combine Upper and Lower Blepharoplasty?
Yes. Many patients have both upper and lower blepharoplasty performed during a single surgical visit, and it's a routine combination at Caniglia Facial Plastic Surgery. Addressing both areas at once means one recovery period instead of two, and it allows Dr. Ron or Dr. Alex Caniglia to balance the upper and lower eyelids for a cohesive, proportional result.
Blepharoplasty is also frequently paired with a brow lift when eyebrow position, rather than eyelid skin alone, is contributing to a heavy upper-lid appearance. Determining whether the brow, the lid, or both need attention is part of the consultation at Caniglia Facial Plastic Surgery.
What to Expect During Recovery
Most blepharoplasty patients experience swelling and bruising that improves substantially within the first one to two weeks. According to the Mayo Clinic, bruising and swelling generally subside within 10 to 14 days, which is typically when patients feel comfortable returning to public activities, though final scar fading can take several months.
During the first few days, patients are advised to keep their head elevated and use cold compresses to manage swelling. Blurred vision immediately after surgery is common and typically resolves within a couple of days. Most patients return to light activities within a week and resume full normal routines within two to four weeks, with the exact timeline depending on whether upper, lower, or both procedures were performed.
Why Choose Caniglia Facial Plastic Surgery for Blepharoplasty in Scottsdale?
Dr. Ron Caniglia is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, with more than three decades focused exclusively on surgery of the face and neck. He helped develop and refine laser eyelid surgery techniques and has served as a national instructor for other physicians in the field, drawing surgeons, residents, and nurses from around the world to observe his technique at The Caniglia Center.
Dr. Alex Caniglia completed a competitive five-year residency in Otolaryngology-Head & Neck Surgery, where he was named Chief Resident, followed by a specialized fellowship in Facial Plastic & Reconstructive Surgery in Indianapolis under Drs. Stephen W. Perkins and Mark Hamilton. He has performed more than 2,000 facial procedures and brings a current, fellowship-refined perspective to eyelid surgery.
Together, this father-son team practices out of The Caniglia Center in Scottsdale, a fully licensed, AAAHC-accredited outpatient facility built specifically for facial plastic surgery since 1993. Because the practice focuses solely on the face, patients considering blepharoplasty in Scottsdale are evaluated by surgeons whose entire careers are built around this one region of the body.
Frequently Asked Questions
How do I know if I need upper, lower, or both types of blepharoplasty? The best way to know is a consultation with a facial plastic surgeon who can evaluate whether hooding, puffiness, or both are present, and whether brow position is contributing to the concern.
Is blepharoplasty covered by insurance? Blepharoplasty may be partially covered when upper eyelid skin obstructs vision and functional impairment can be documented; cosmetic blepharoplasty performed for appearance alone is typically not covered.
What are the risks of blepharoplasty? As with any surgery, risks can include bruising, dry eyes, temporary difficulty closing the eyes, and, rarely, changes in vision. Choosing a facial plastic surgeon with extensive eyelid-specific experience helps minimize these risks.
Questions About Blepharoplasty? Caniglia Facial Plastic Surgery Is Here to Help
Whether hooded upper lids, under-eye bags, or both are affecting how rested you look, Dr. Ron and Dr. Alex Caniglia can help you decide which approach fits your face. Contact Caniglia Facial Plastic Surgery in Scottsdale to schedule a consultation and find out whether upper blepharoplasty, lower blepharoplasty, or a combined approach is right for you.
This information is provided for educational purposes only and does not replace a consultation with a board-certified plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
