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Eyelid Surgery 101: Upper, Lower or Both?

Eyelid surgery can be a helpful option for patients who are bothered by visible signs of aging around the eyes, including loose skin or puffiness. In some cases, excess upper eyelid tissue can also interfere with vision. At Dr. Karol A. Gutowski’s practice, we see patients in Chicago who are interested in learning whether eyelid surgery is right for them.

The type of eyelid surgery that Dr. Gutowski will recommend depends on the concerns you have, the way your eyelids are aging, and what you want to address with surgery. Some patients benefit from upper eyelid surgery, others from lower eyelid surgery, and some from a combination of both. We will review these options in detail so you know what to ask and what to consider when you schedule your consultation.

An Overview of Eyelid Surgery

During eyelid surgery, also called blepharoplasty, Dr. Gutowski removes, tightens or repositions the fat, skin and muscle around the upper or lower eyelids. This surgery addresses changes that can happen because of genetics or aging, especially if they interfere with the appearance or function of the eyelids. Blepharoplasty lifts the eyelids into a position that looks natural with your facial features.

Common Concerns That Your Eyelid Surgery May Address

  • Drooping or hooded upper eyelids: Excess upper eyelid skin can rest on the natural crease of the lid and make it look heavy or folded. In some patients, this tissue may also limit the upper field of vision.
  • Under-eye bags and puffiness: Prominent lower eyelid fullness is often caused by fat that has shifted with age. Eye bag removal can reduce this bulging.
  • Loose or crepey lower eyelid skin: Thinning skin and reduced elasticity can lead to wrinkling beneath the eyes. Eyelid surgery can tighten this area by addressing excess skin.
  • Tired, aged or heavy-looking eyes: When multiple eyelid changes occur together, the eyes may look more tired, but addressing these structural issues can create a more rested look without changing your natural features.

About Upper Eyelid Surgery

What Upper Eyelid Surgery Treats

Upper eyelid surgery focuses on excess skin and tissue along the natural crease of the upper lid. These changes can make the eyes look heavy or cause the skin to rest lower than it used to. The techniques used during this treatment will be based on how much skin is present and how it affects appearance or function.

How the Procedure Works

During surgery, Dr. Gutowski places an incision within the natural upper eyelid crease so it is less noticeable once healed. Excess skin is removed and adjusted to improve lid position and contour, and then the area is sutured closed with the goal of creating a natural shape.

Functional vs. Cosmetic Upper Eyelid Surgery

If you have extra tissue that is interfering with your vision, we may recommend visual field testing to help document these concerns. Then we can perform functional upper eyelid surgery, which can remove and adjust any tissue that is making it harder to see. Cosmetic surgery focuses on aesthetic concerns such as hooding and asymmetry, but both functional and cosmetic concerns can be treated during the same surgery.

What Recovery Looks Like From Upper Eyelid Surgery

Most patients experience swelling and bruising during the first one to two weeks after surgery. Your surgeon will remove stitches within several days, and you can go back to most light activities around the same time. After the initial recovery period, your swelling will continue to go down, and your incisions will become less noticeable.

Not sure what surgery is right for you? Schedule a consultation with Dr. Gutowski!

About Lower Eyelid Surgery

What Lower Eyelid Surgery Treats

Lower eyelid surgery addresses changes beneath the eyes, such as puffiness and loose skin that are either a natural part of your facial features or that have developed with age. Sometimes under-eye bags can be a temporary concern caused by poor quality sleep or allergies, but if they are a permanent feature, they can be corrected by removing the excess fat or tightening the skin. If you have dark circles under the eyes, we may need to combine your surgery with another treatment to address them.

How the Procedure Works

Lower eyelid surgery is performed using either an incision just below the lash line or an incision placed inside the lower eyelid, depending on whether skin removal is needed. The approach is selected based on eyelid structure, skin quality, and the underlying cause of puffiness or laxity. Surgery is usually done under general anesthesia, allowing you to remain comfortable throughout the process.

Fat Removal vs. Fat Repositioning in Lower Eyelid Surgery

Lower eyelid puffiness is often caused by fat that has shifted rather than an actual increase in fat. This fat may be carefully removed or repositioned, depending on your skin quality and the depth of the under-eye hollow. The approach is selected during your consultation based on what will give you the most balanced and natural-looking results.

Recovery and Healing From Lower Eyelid Surgery

Recovery and healing are similar to lower eyelid surgery. You can expect swelling and bruising during the early recovery period that improves over the first couple of weeks. You can return to most activities within several days, but we may have you avoid anything that strains the eyes, such as watching television or reading a book.

Combining Upper and Lower Eyelid Surgery

Sometimes addressing both the upper and lower eyelids during the same surgery can be the right choice for a specific patient. During this surgery, Dr. Gutowski usually performs surgery on the upper eyelids first and then moves to the lower eyelids. Combining both means you only have to go through one recovery period in order to comprehensively treat the lids.

What to Expect During Your Blepharoplasty Consultation

During your blepharoplasty consultation, we begin with a discussion about the concerns you have about your eyelids and what has prompted you to seek surgery. We evaluate your eyelid anatomy, skin quality and fat positioning to determine which areas may benefit from treatment. If you have any vision concerns, we will discuss these during the same appointment. We will also give you complete details about preparing for your surgery and planning for recovery.

Schedule Your Blepharoplasty Consultation Today

Blepharoplasty can address both functional and age-related eyelid concerns by improving excess skin, fat displacement and eyelid positioning. Dr. Karol A. Gutowski focuses on careful surgical planning and clear communication, with years of experience gained from treating patients in Chicago, IL, and the surrounding areas. If you have questions or you want to learn more about your options, call 847-786-5200 or reach out online.

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