Am I a Candidate for Eyelid Surgery? Upper vs. Lower Blepharoplasty

“Am I even a candidate for eyelid surgery?” is one of the first things patients want to know, and it comes up again and again on Dr. Farhad Rafizadeh’s RealSelf Q&A page. People notice heavy, hooded upper lids or puffy bags under their eyes, wonder whether surgery is the answer, and then get tangled in a second question they didn’t expect: is this an upper eyelid problem, a lower one, or both?

It is exactly the right thing to ask, because “eyelid surgery” is not one operation. Upper and lower blepharoplasty solve different problems, and being a good candidate for one does not automatically mean you need the other. Sorting out who you are — and which lid is actually driving the tired look — is the whole point of an evaluation.

Dr. Rafizadeh’s Short Answer

Most people who are bothered by heavy upper lids or under-eye bags and are in good general health are candidates for eyelid surgery — it is one of the safest, best-tolerated facial procedures, and there is no real upper age limit. The more useful question is which eyelid surgery you need. Hooding and a curtained, tired upper lid point to upper blepharoplasty; puffy bags and loose skin below the eye point to the lower lid. Many patients need only one. Some need both, and those can be done together. The exam sorts out who is a candidate and for what.

In other words, candidacy has two layers: are you medically a good candidate at all, and then which specific operation fits your eyes. Let’s take them in turn.

The Two Halves of Eyelid Surgery

“Blepharoplasty” simply means eyelid surgery, and it comes in an upper and a lower version that address opposite ends of the eye.

Upper Blepharoplasty — the Hood

With age the thin skin of the upper eyelid loses elasticity and becomes redundant, and the fat behind it can bulge forward. The result is a fold of loose skin — a hood — that hangs over the lid, makes the eyes look tired and smaller, and in heavier cases rests on the lashes or clips the outer edge of your vision. Upper eyelid surgery removes that redundant skin, and conservatively any bulging fat, through an incision hidden in the natural crease of the lid. It is the operation for the person who says their upper lids feel heavy or that they look exhausted even when they’re rested.

Lower Blepharoplasty — the Bags

The lower lid is a different problem. Here the complaint is usually puffy bags — small pads of fat that push forward and cast a shadow — sometimes with crepey or loose skin along the lid. Lower blepharoplasty softens or repositions that fat, and addresses skin when needed, so the under-eye area looks smooth and rested rather than tired and puffy. It is a more nuanced operation than the upper lid, because the lower lid’s position and support have to be respected, which is exactly why matching the technique to the patient matters.

Are You Medically a Good Candidate?

The bar for being a candidate is reassuringly reasonable. In general, you’re a good candidate if you:

• Are an adult in reasonable general health;
• Are genuinely bothered by heavy upper lids, under-eye bags, or a tired appearance;
• Have realistic expectations — refreshed and rested, not a different face;
• Don’t smoke, or are willing to stop well before and after surgery;
• Have healthy eyes with an adequate tear film and no untreated eye condition.

The situations that make someone a poor candidate, or a “not yet,” are mostly about eye health: significant untreated dry eye, uncontrolled glaucoma, thyroid eye disease, or a recent retinal problem all deserve attention first. A very low, heavy brow is another one — if the brow is what’s pushing everything down, eyelid surgery alone will disappoint, and a brow lift may be the real answer. This is why Dr. Rafizadeh examines the brow, the lid, and the eye itself before ever recommending surgery.

Upper, Lower, or Both?

Once you know you’re a candidate, the practical decision is which lids to treat. The honest way to decide is to name what actually bothers you when you look in the mirror:

• Heavy, hooded upper lids; skin resting on the lashes; a tired, curtained look → upper blepharoplasty.
• Puffy bags, shadows, or loose skin below the eye → lower blepharoplasty.
• Both an upper hood and lower bags → a combined upper and lower procedure, done in one sitting.

Combining upper and lower when both are truly present is efficient — one anesthesia, one recovery, and a balanced result where the top and bottom of the eye match. What a careful surgeon will not do is talk you into a lower blepharoplasty you don’t need just because you’re already having the uppers done. Each lid earns its place on the plan because the exam supports it.

What About My Age?

Age is the concern patients raise most and the one that matters least. Eyelid surgery is gentle enough — especially when performed, as Dr. Rafizadeh does, under local anesthesia with light sedation rather than general anesthesia — that healthy patients in their seventies and eighties do very well. Most cosmetic candidates happen to be 35 or older simply because that is when hooding and bags become noticeable, but there is no ceiling. What decides candidacy is the health of your eyes and your overall medical fitness, not your birth year.

Do You Actually Need Surgery? Non-Surgical Alternatives

Not every tired-looking eye needs an operation. A younger patient whose under-eye “bags” are really a hollow — a shadowed groove rather than a fat bulge — can often be improved with a small amount of hyaluronic-acid filler in the tear trough. But filler has limits: a true herniated fat bag that bulges more when you look up is structural, and adding volume around it can make it look worse, not better. Similarly, mild upper-lid heaviness in someone with good skin tone might be watched rather than operated on. Part of an honest consultation is telling patients when they don’t need surgery yet.

Recovery and Scars

Recovery is one of the reasons eyelid surgery is so well liked. Most patients are presentable in public within a week to ten days; bruising and swelling peak in the first couple of days and are eased with cold compresses and keeping the head elevated. Upper-lid sutures come out around five to seven days, and the incision fades into the natural crease. On the lower lid, when only fat needs work, the approach is often through the inside of the lid and leaves no external scar at all. Eyelid skin is thin and heals beautifully, which is why blepharoplasty scars are among the most inconspicuous in facial surgery.

Cost and Insurance in North Jersey

Cosmetic eyelid surgery in Northern New Jersey generally falls in the several-thousand-dollar range, varying with whether one lid or both are treated and whether it is combined with a brow lift or facelift. Purely cosmetic work — done to look more rested — is out of pocket. However, when a heavy upper lid is severe enough to block your vision and that is documented, the functional portion of an upper blepharoplasty may be covered by insurance. Carriers look for objective evidence: a visual-field test that improves when the lid is taped up, straight-gaze photographs, and a low lid-margin measurement. Lower-lid (bag) surgery is essentially always cosmetic. Dr. Rafizadeh gives exact pricing after an in-person evaluation and helps eligible patients assemble the documentation an insurer requires.

The Morristown Setting

Dr. Rafizadeh performs upper and lower blepharoplasty in a fully accredited outpatient surgical facility in Morristown, NJ, under local anesthesia with light sedation — often combined with a brow lift or a facelift under the same anesthesia for patients seeking broader rejuvenation. Patients who travel from Manhattan, Westchester, Bergen County, Hoboken, or Jersey City can read about the practice’s arrangements on the out-of-town patient page.

Questions to Ask Any Plastic Surgeon About Eyelid Surgery in North Jersey

If you are interviewing surgeons in Morristown, Summit, Chatham, Madison, Short Hills, Bernardsville, or anywhere across Northern New Jersey, useful questions include:

• Based on my exam, am I a candidate for upper eyelid surgery, lower, or both — and why?
• Is my tired look coming from the eyelids or from a low brow that should be addressed instead?
• Are my eyes healthy enough — is my tear film adequate — for this surgery?
• If I have a heavy upper lid, could any part of this be covered by insurance, and will your office document it?
• Do you perform this under local anesthesia with sedation, and how do you avoid removing too much skin?
• For my lower lids, will you use an approach that leaves no external scar?

Frequently Asked Questions

Eyelid Surgery Candidacy — Upper vs. Lower Blepharoplasty

Who is a good candidate for eyelid surgery?

A good candidate is an adult in general good health who is bothered by heavy, hooded upper eyelids or puffy under-eye bags, has realistic expectations, does not smoke, and has no active eye condition — such as severe dry eye, uncontrolled glaucoma, or a recent retinal problem — that would make surgery risky. There is no strict upper age limit; Dr. Rafizadeh operates on healthy patients in their sixties, seventies, and beyond. What matters far more than age is that the eyes are healthy, the tear film is adequate, and the concern is genuinely coming from the eyelids rather than from a low brow or a medical cause that needs treating first.

What is the difference between upper and lower eyelid surgery?

Upper eyelid surgery (upper blepharoplasty) removes the redundant, hooding skin — and sometimes a little fat — from the upper lid, opening up a tired, heavy eye and, when the hood is severe, clearing the outer field of vision. Lower eyelid surgery (lower blepharoplasty) addresses the puffy bags and, in some patients, loose skin beneath the eye, usually by repositioning or conservatively removing the fat that creates the bulge. They treat different problems, take different amounts of time, and carry different considerations; many patients need only one, while others benefit from both.

Should I get upper eyelid surgery, lower, or both?

It depends entirely on what bothers you and what the exam shows. If your complaint is a heavy, hooded upper lid or a tired look with skin resting on your lashes, upper blepharoplasty is the answer. If it is puffy bags or dark shadowed hollows under the eyes, that is the lower lid. Patients who have both an upper hood and lower bags can have both corrected in one operation and one recovery, which many find more efficient than staging them. Dr. Rafizadeh maps out exactly which lids are driving the appearance you dislike before recommending upper, lower, or a combined approach.

Is there an age limit for eyelid surgery?

No. Eyelid surgery is one of the safest facial procedures and is routinely performed on healthy patients well into their seventies and eighties. Because Dr. Rafizadeh performs it under local anesthesia with light sedation rather than general anesthesia, it is gentle enough that advanced age alone is rarely a barrier. The deciding factors are the health of the eye and the patient's overall medical fitness, not the number on a birth certificate. Most cosmetic patients are 35 and older, simply because that is when upper-lid hooding and under-eye bags become noticeable.

How long is recovery after eyelid surgery?

Most patients look presentable in public in about a week to ten days. Bruising and swelling are the main nuisances and peak in the first two or three days, helped by cold compresses and keeping the head elevated. Fine sutures on the upper lid are typically removed at about five to seven days, and any incision heals into a line hidden in the natural eyelid crease. Eye makeup can usually resume around two weeks, and the last traces of swelling settle over the following weeks. It is a well-tolerated recovery compared with most facial surgery.

Can under-eye bags be treated without surgery?

Sometimes. Mild lower-lid hollows and shadows can be softened with a small amount of hyaluronic-acid filler placed in the tear trough, which is a good option for younger patients whose skin is still tight and whose 'bags' are really a hollow. But true herniated fat bags — the ones that bulge more when you look up — are a structural problem that filler cannot remove; adding volume around them can even make them look worse. For those, lower blepharoplasty is the definitive fix. An honest exam is what separates a filler candidate from a surgical one.

Does eyelid surgery leave visible scars?

For upper eyelid surgery, the incision is placed in the natural crease of the lid, so once healed it is hidden when the eyes are open and typically becomes very difficult to see. For lower eyelid surgery, when only fat needs adjusting Dr. Rafizadeh often works through the inside of the lid (a transconjunctival approach) that leaves no external scar at all; when skin must also be removed, the incision sits just beneath the lash line. Eyelid skin is thin and heals exceptionally well, which is a large part of why blepharoplasty scars are among the most inconspicuous in facial surgery.

Can eyelid surgery be combined with a facelift or brow lift?

Yes, and it commonly is. The eyes, brow, and midface age together, and combining procedures under the same anesthesia often gives a more harmonious result and a single recovery. A low, heavy brow can masquerade as excess upper-eyelid skin, so Dr. Rafizadeh evaluates brow position before deciding whether a brow lift, an eyelid surgery, or both will actually address the complaint. Eyelid surgery also pairs naturally with a facelift for patients seeking overall facial rejuvenation. What is combined is tailored to each patient rather than sold as a package.

People Also Ask

Common Questions Patients Search About Eyelid Surgery

Who is not a good candidate for blepharoplasty?

Blepharoplasty is best avoided, or delayed, in people with certain eye and health issues: significant untreated dry eye, uncontrolled glaucoma, a recent or active retinal problem, poorly controlled diabetes or thyroid eye disease, or unrealistic expectations. Active smokers heal less reliably and are usually asked to stop beforehand. A very low brow can also mean that eyelid surgery alone would not fix the problem — a brow lift may be needed instead. This is why a proper eye and eyelid evaluation comes before any decision to operate.

What is the regret rate for blepharoplasty?

Blepharoplasty has one of the highest satisfaction rates in facial surgery, and serious regret is uncommon. When it does happen, it usually traces to two avoidable causes: an inaccurate diagnosis — for example, treating skin when the real problem was a droopy lid muscle or a low brow — or removing too much skin, which can leave the eyes feeling tight, dry, or unable to close fully. Both are prevented by careful measurement and conservative surgery. Choosing an experienced surgeon who diagnoses the eyelid precisely is the best protection against regret.

Is it better to do upper and lower blepharoplasty together?

For patients who genuinely have both an upper hood and lower-lid bags, doing them together is usually the better choice: one anesthesia, one recovery, and a balanced result where the upper and lower lids match. There is no meaningful added risk to combining them when both are truly indicated. What Dr. Rafizadeh does not do is add a lower blepharoplasty a patient does not need simply because they are already having the upper lids done — each lid is treated because the exam supports it, not to round out a package.

Is upper and lower eyelid surgery worth it?

For the right candidate, it is one of the most rewarding facial procedures — a relatively quick, well-tolerated surgery that can take years off a tired appearance and, in the case of a heavy upper hood, can even improve the field of vision. Satisfaction is consistently high. 'Worth it' hinges on an accurate diagnosis and a conservative, natural result rather than an overdone one. Patients who are bothered by their heavy or puffy eyes, and who are treated by a surgeon who removes just enough, tend to be very glad they did it.

What do I say to get eyelid surgery covered by insurance?

You do not need a script — you need documentation. Insurance considers upper eyelid surgery medically necessary only when the drooping is severe enough to block your vision, so coverage rests on objective findings: a visual-field test showing improvement when the lid is taped up, photographs in straight-ahead gaze, and a low lid-margin measurement. Describe the real functional problems you have — difficulty reading, driving, or a sensation of having to raise your brows to see — and let the testing support it. Lower-lid (bag) surgery is essentially always cosmetic and is not covered. The office helps assemble what a carrier requires.

What are the downsides of eyelid surgery?

The common downsides are temporary: bruising, swelling, watery or dry eyes, and blurred vision for a few days. Less common issues include asymmetry, over- or under-correction, difficulty fully closing the eyes if too much skin is removed, and, very rarely, changes in the lower-lid position. As with any surgery there is a small risk of bleeding or infection, and an extremely rare risk to vision. Choosing an experienced surgeon, being conservative with skin removal, and following aftercare keep the risk profile low — which is why blepharoplasty is considered one of the safer facial operations.

Sources & References

1. American Society of Plastic Surgeons. “Eyelid Surgery: Candidates & Procedure Details.” plasticsurgery.org
2. American Society of Plastic Surgeons. “Eyelid Surgery (Blepharoplasty) Cost.” plasticsurgery.org
3. Cleveland Clinic. “Blepharoplasty (Eyelid Surgery): Details & Recovery.” clevelandclinic.org
4. Naik MN, Honavar SG, et al. “Blepharoplasty: An Overview.” Journal of Cutaneous and Aesthetic Surgery. 2009;2(1):6–11. PubMed Central
5. American Academy of Ophthalmology. “Blepharoplasty (Eyelid Surgery).” aao.org
6. Dr. Farhad Rafizadeh, RealSelf Q&A. realself.com

Related Reading From Dr. Rafizadeh’s Blog

Patients researching eyelid, brow, and upper-face rejuvenation in Northern New Jersey may find these articles useful:

• Ptosis vs. Blepharoplasty: Is My Droopy Upper Eyelid Skin or Muscle?
• Blepharoplasty vs. Brow Lift: Which Do I Need?
• Lower Eyelid Blepharoplasty: Transconjunctival vs. Subciliary
• Festoons & Malar Bags vs. True Eye Bags — What Surgery Actually Fixes
• Eyelid Surgery (Blepharoplasty) in Morristown — What to Expect

Bottom Line

“Am I a candidate for eyelid surgery?” almost always has a yes hiding inside it, because most healthy adults bothered by heavy upper lids or under-eye bags qualify — there is no meaningful age limit, and it is one of the gentlest facial operations. The sharper question is which eyelid surgery you need: upper blepharoplasty for a hooded, tired upper lid, lower blepharoplasty for puffy bags, or both when both are present. The wrong answer is treating a lid that isn’t the problem, or missing a low brow that is. Get the diagnosis right, and the operation — and the result — follows naturally.

If you are considering eyelid surgery, a brow lift, or a fuller facial rejuvenation in Morristown, Summit, Chatham, Madison, Short Hills, or anywhere across Northern New Jersey, Dr. Rafizadeh is happy to examine your eyes, tell you honestly whether you’re a candidate, and recommend the upper, lower, or combined approach that fits.