Upper and lower eyelid blepharoplasty surgery by Dr. Kaimana Chow at Veritas Backstage Fredericksburg

Eyelid Surgery

Blepharoplasty

Upper and lower eyelid surgery, performed together or separately, to address the specific structural changes that make the eye area look tired or heavy.

Blepharoplasty addresses two distinct structural changes in the eye area. Upper blepharoplasty removes excess skin — and where appropriate, repositions or reduces herniated fat — from the upper eyelid, correcting the heaviness and hooding that develops as skin loses elasticity over time. Lower blepharoplasty addresses the lower eyelid: herniated fat that produces persistent under-eye bags, loose or crepey skin, and the tear trough hollowing that gives the face a tired appearance regardless of sleep. Both are performed by Dr. Kaimana Chow at our Fredericksburg location.

Neither concern responds fully to non-surgical treatment. Cream, filler, and injectable options can soften the appearance of tear trough hollowing or support upper eyelid position temporarily, but they do not remove excess skin or resolve fat herniation — the structural changes that actually cause both. Surgery is the only approach that addresses the underlying cause directly.

The upper and lower eyelids age as a single unit, and many patients who present for one procedure discover during consultation that their goals are better served by addressing both. Combining upper and lower blepharoplasty in a single surgical session is common — it means one recovery period rather than two, and allows Dr. Chow to balance the correction across the full eye area. Either procedure can also be performed on its own when only one area needs correction.

THE EXPERIENCE

Upper Blepharoplasty

The procedure takes approximately one to two hours and is typically performed under local anesthesia with sedation. The incision is placed within the natural eyelid crease. Mild swelling and bruising are expected for seven to ten days, with sutures removed within the first week. Most patients feel comfortable in social settings within ten to fourteen days, with final results — a fully open, rested eyelid — visible at four to six weeks.

Lower Blepharoplasty

Also performed under local anesthesia with sedation, in one to two hours. Dr. Chow uses either a transconjunctival approach — an incision inside the lower eyelid with no visible scar — or a sub-ciliary incision positioned just below the lash line, depending on anatomy and the degree of skin correction needed. Bruising and swelling peak at 48 to 72 hours and resolve progressively over ten to fourteen days, with most patients comfortable in social settings in that window. Final contour, once any residual swelling has fully resolved, is visible at three to six months.

Combined Procedure

When both are performed together, recovery follows the longer of the two timelines — most patients are comfortable socially within ten to fourteen days, with the upper eyelid fully settled by four to six weeks and the lower eyelid's final contour visible at three to six months. Cold compresses and head elevation in the first 48 hours help manage swelling for both procedures.

What it treats

UPPER EYELID AREA

  • Excess skin causing heaviness and hooding

  • Fat herniation in the upper eyelid

  • Asymmetry in upper eyelid fullness

  • Brow-related heaviness affecting eyelid appearance

  • Peripheral vision obstruction from excess skin fold

LOWER EYELID AREA

  • Under-eye bags from fat herniation or excess fat

  • Tear trough hollowing and depression

  • Loose, crepey lower eyelid skin

  • Asymmetry in lower eyelid contour

IDEAL CANDIDATE

Blepharoplasty is appropriate for adults with excess upper eyelid skin, persistent under-eye bags or fat herniation, or both — particularly patients whose concerns haven't responded to non-surgical treatment. Upper blepharoplasty is appropriate across a wide age range; some patients develop significant hooding in their late thirties or forties, while others become candidates for meaningful correction decades later. Lower blepharoplasty is most appropriate for patients whose bags stem from fat herniation or true skin excess — patients with primarily tear trough hollowing and no fat herniation may find that filler or Sculptra addresses their concern without surgery.

For patients whose excess upper eyelid skin is affecting peripheral vision, a visual field test documents the functional impact and supports insurance pre-authorization, which Dr. Chow's team coordinates on your behalf. A consultation will confirm which procedure — upper, lower, or both — is appropriate for your anatomy and goals.

Results and maintenance

Both procedures produce long-lasting results, since the tissue removed or repositioned does not regenerate. Most patients maintain their improvement for ten years or more, though gradual change can develop over time as aging continues. Ongoing skin quality treatments — IPL, RF microneedling, or laser resurfacing — can help sustain the surface quality of the treated eyelid skin between surgical results.

PAIRS WITH

FACELIFT

A facelift addresses structural change in the mid and lower face — jowling, jawline definition, and neck laxity — through surgical repositioning of the deeper facial tissue.

Blepharoplasty and a facelift address adjacent regions of the same aging process: the eye area and the rest of the face. Patients who have both eyelid changes and midface or jawline laxity often achieve the most cohesive result by addressing both areas, whether in a single combined surgery or a coordinated surgical plan.

Dr. Chow will discuss timing and sequencing during consultation based on your specific anatomy and goals.

FAQ • NEED TO KNOW

QUESTIONS

Upper blepharoplasty removes excess skin from the upper eyelid — and where appropriate, repositions or removes small amounts of herniated fat — through an incision placed within the natural eyelid crease. Lower blepharoplasty addresses fat herniation, loose skin, and tear trough hollowing in the lower eyelid, using either a transconjunctival incision inside the eyelid or a sub-ciliary incision just below the lash line. Both are performed under local anesthesia with sedation and take one to two hours; they can be done individually or in the same surgical session.

For upper blepharoplasty, the incision sits within the natural eyelid crease and fades to a near-invisible fine line as it heals. For lower blepharoplasty, the transconjunctival approach leaves no visible external scar at all; when skin removal requires a sub-ciliary incision, it heals to a fine line just below the lash line. Proper wound care and sun protection during healing support the best possible scar outcome.

Upper blepharoplasty can qualify for insurance coverage when excess eyelid skin is causing a measurable obstruction of the superior visual field. This is documented through a visual field test, and Dr. Chow's team coordinates the pre-authorization process with your insurance provider on your behalf. Lower blepharoplasty is considered cosmetic and is not typically covered.

For upper blepharoplasty, the most visible healing — bruising, swelling, sutures — spans seven to ten days, with full results apparent at four to six weeks. For lower blepharoplasty, bruising and swelling peak at 48 to 72 hours and resolve over ten to fourteen days, with the final contour visible at three to six months once any residual swelling has fully cleared. Most patients feel comfortable in social settings within ten to fourteen days regardless of which procedure they've had. Cold compresses and head elevation in the first 48 hours help manage early swelling for both.

Both procedures produce long-lasting results, since the tissue removed or repositioned does not regenerate significantly. Most patients maintain their improvement for ten years or more, with gradual change developing over time as aging continues. Genetics, skin quality, and sun exposure all influence how long results hold.

Yes — this is one of the most common surgical pairings in facial rejuvenation, since both areas tend to age together. Combining both in a single session means one recovery period, coordinated anesthesia, and a result Dr. Chow can balance across the full eye area. Many patients who initially inquire about just one procedure find during consultation that their goals are better served by addressing both.

**Results may vary. Veritas Backstage is reputable for complete customer satisfaction for completed treatments. Unless otherwise noted, testimonials provided for Backstage are clients who have undergone complete treatment(s.) However, results may vary per client. No treatment is promised to provide permanent results. A guarantee is neither provided nor implied.

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