Upper Blepharoplasty

Upper Blepharoplasty

The upper eyelid ages in a predictable way. Skin loses elasticity and descends, creating a fold that can drape over the lash line and obscure the natural crease. Fat pads may herniate forward, creating a puffy, heavy appearance. The result is an expression of fatigue, sternness, or simply a heaviness that the patient does not feel reflects who they are.

Upper blepharoplasty — also called an upper eyelid lift — addresses this directly. Dr. Rafizadeh removes the excess skin, trims redundant orbicularis muscle, and precisely contours or removes the herniated fat pads — through an incision placed exactly within the natural eyelid crease. Done well, the scar is invisible within weeks. Done poorly, it can permanently alter the shape of the eye. Precision and restraint are everything. Patients come to his Morristown practice from throughout North Jersey and the greater NYC area for upper eyelid lift surgery.

What Is Removed?

Upper blepharoplasty is not simply about removing skin. Dr. Rafizadeh evaluates each component individually — and first confirms whether the heaviness is true excess skin or a drooping eyelid margin (ptosis vs. blepharoplasty — skin or muscle?), since the two are corrected differently:

Excess skin — The primary target. The amount removed is carefully calculated to avoid the "operated look" while fully correcting the hooding. Removing too much causes lagophthalmos (inability to fully close the eye); too little leaves residual heaviness. The typical amount removed is 5–10 mm of skin, though this varies by anatomy.

Orbicularis muscle — A thin strip of the muscle under the skin may be removed to refine the lid contour and deepen the crease. Whether this is done depends on the individual patient's anatomy.

Herniated fat — The upper lid has two fat compartments (central and nasal). If they have prolapsed forward, Dr. Rafizadeh conservatively removes or repositions them. Aggressive fat removal creates a hollow, skeletonized look that is a hallmark of over-operated eyelids — something he avoids.

The Incision and Crease Position

The incision is placed precisely within the existing eyelid crease, typically 7–10 mm above the lash line in women and slightly lower in men. This placement ensures the scar falls in a natural shadow and is essentially undetectable once healed. The crease position is marked with the patient upright and eyes open — never flat and sedated. This is one reason Dr. Rafizadeh's preference for local anesthesia matters: he can verify crease height symmetry interactively before closing.

Functional vs. Cosmetic Upper Blepharoplasty

When excess upper eyelid skin causes measurable visual field obstruction — particularly in the superior visual field — upper blepharoplasty may qualify as a functional (medical) procedure covered by insurance. This requires:

Documentation of visual field loss by an ophthalmologist, a formal visual field test (Humphrey or Goldmann perimetry) demonstrating ≥30% visual field loss with lids in their natural position, and photographs confirming the excess skin reaches or approaches the pupil line. Dr. Rafizadeh is experienced with the documentation process and can evaluate whether your case has a functional component at your consultation. See also: Functional Blepharoplasty & Insurance Coverage →

Brow Position and Upper Lid Evaluation

One of the most important — and most commonly overlooked — aspects of upper eyelid evaluation is the brow position. A descended brow pushes skin onto the upper lid, creating the appearance of excess eyelid skin that is actually brow ptosis. Operating on the eyelid alone in this situation will produce an unsatisfying result and may cause the brow to descend further as tension is released. Dr. Rafizadeh evaluates the brow position at every upper lid consultation and will recommend a temporal brow lift or endoscopic brow lift if indicated. Learn more about how to distinguish brow ptosis from eyelid excess →

Recovery Timeline

Days 1–3: Mild swelling, bruising, and tightness around the eyelids. Cold compresses and head elevation recommended. Most patients are comfortable at home.
Days 5–7: Sutures removed. Swelling and bruising begin to resolve significantly.
Week 2: Most patients are comfortable returning to desk work, social activities, and light exercise. Residual puffiness is usually camouflaged with makeup.
Months 1–3: Final result becomes visible as the incision fades and the lid settles. In most patients the scar is completely invisible by 3 months.

Cost of Upper Blepharoplasty in New Jersey

Cosmetic upper blepharoplasty in New Jersey typically ranges from $4,000–$7,000 all-inclusive. When functional criteria are met and insurance covers the procedure, out-of-pocket costs are substantially lower. Combining upper and lower blepharoplasty at the same operative session is more cost-efficient than staging them separately. Financing through Prosper Healthcare Lending is available. An exact quote is given at consultation once the technique and extent of surgery have been determined.