Understanding Cosmetic Upper Eyelid Blepharoplasty, Part II

Posted on: December 9th, 2025 by Our Team

We are fortunate, both as patients and surgeons, to live in the age of social media and the internet. For patients, the internet and social media are sources of readily available information about prospective surgeons. Patients can easily find and verify a surgeon’s credentials and see before-and-after photos of their results. Researching a surgeon wasn’t always this easy, and in the realm of cosmetic surgery, it was significantly more difficult to objectively assess surgical results prior to the internet. (One could visit several surgeons and review physical books of their photos, but this required a significant expenditure of time and money, especially if one was considering a surgeon outside her or his locale).

For surgeons, the internet and social media allow us to reach substantially more patients than we would with traditional marketing and word-of-mouth recommendations. I am eternally grateful that I can post an upper eyelid blepharoplasty before-and-after photo on Instagram or my website, and a patient in Philadelphia can see the photo just as easily as a patient in Phoenix. The internet is always open, and interested patients can send a consultation request via my website at 1am. They don’t have to wait until 9am the following day to call and speak with a member of our reception staff. Overall, I feel that the internet and social media has been an effective tool for both patients and surgeons.

That being said, not everything about the internet and social media is ideal. A discussion on the ethics of using social medial to promote cosmetic surgery and aesthetic medicine is beyond the scope of this post. The spectrum of ethics amongst providers using social media to advertise their services is broad, to say the least.

So, how does one best evaluate a surgeon’s before-and-after photos of cosmetic upper eyelid blepharoplasty patients?

Fortunately for patients, upper eyelid blepharoplasty before-and-after photos are less easy to manipulate than lower eyelid blepharoplasty (eyelid bag removal) photos. In lower eyelid blepharoplasty, if indirect lighting (i.e., no flash or flash pointed at ceiling to maximize shadows) is used in the “before” photo and direct lighting (i.e., flash pointed directly at patient to minimize shadows) is used in the “after” photo, the improvement will appear more dramatic and the surgical results will likely appear better in the “after” photo than they do in real life. In upper eyelid blepharoplasty, even lighting tricks won’t lessen the appearance of eyelid crease asymmetry or make an under corrected patient appear to have less redundant eyelid skin.

When I evaluate other surgeons’ cosmetic upper eyelid blepharoplasty before-and-after photos, I look at a few aspects:

1. Is the lighting consistent? If a surgeon has obviously used a flash in the “after” photo but not the “before”, I question their result, even if it’s just an upper eyelid blepharoplasty. That being said, we can’t get lighting exactly the same all the time, especially those of us who travel to multiple different clinics where each exam room has a different configuration of lights. Subtle changes in lighting/backgrounds (walls are painted different colors in different clinics) are probably okay, but beware of obvious lighting changes.
2. Are the upper eyelid creases symmetric (or very close to it)? The upper eyelid crease is the fold of skin that exists several millimeters above the eyelash line. The space between the eyelid crease and the lash line is called the “tarsal platform.” This is where eyeliner is applied. As eyelid surgeons, we do our best to avoid situations where one eyelid crease is substantially higher than the other.
3. Has enough skin been removed? Under correction is common in cosmetic upper eyelid blepharoplasty, as the alternative (over correction), can have significant negative consequences. If redundant hooding is present, is this due to brow position? Not all patients want to undergo brow lift surgery, and thus patients who have declined brow lift surgery may also appear to have residual hooding even after a perfectly performed upper eyelid blepharoplasty surgery. (see item #5 below for more discussion on brow position).
4. Does the patient look natural? Creating an unnatural appearance with only upper eyelid blepharoplasty is rare. It is much more common with brow lifts, as patients can often appear surprised if their brows are too high.
5. Are the eyebrows in good position? My favorite analogy for eyebrows and eyelids is that of a curtain rod and a curtain. Eyebrows are similar to curtain rods, and eyelids are similar to curtains. Their appearances are intimately related. Raising the curtain rod raises the curtain. A surgeon can remove a substantial amount of upper eyelid skin as part of an upper eyelid blepharoplasty, but if a patient has low eyebrows, the eyelids will continue to appear low, not to mention, the distance between the eyelashes and eyebrows will decrease. This can create an unnatural appearance.
6. Has upper eyelid ptosis been addressed if present? Ptosis is the medical term for an eyelid that droops due to an issue with the levator muscle (i.e., the muscle that raises the eyelid). In patients with ptosis, a surgeon can remove a substantial portion of the upper eyelid skin, but the upper eyelid will still appear low if ptosis has not been corrected. For most patients, we aim for the eyelid margin to be 2-3 millimeters above the border of the pupil.
7. Has the surgeon provided an explanation for anything in the photo that appears off or under-corrected to you? Surgeons are humans, too. Sometimes, the lighting or coloration in our “after” photos is slightly inconsistent for some of the factors noted above (i.e., different clinic rooms, etc) or our patients opt out of procedures we’ve recommended (i.e., declined a brow lift although it was suggested). In situations like these, many surgeons often provide a short explanation. For example, a few years ago, I started using a new camera, and the coloration was different in my “after” photos for several months. I explained this in my social media posts so patients would understand why my patients’ skin tones appeared differently after surgery. In other instances, I’ve explained that patients were not bothered by an easily visualized cosmetic issue (i.e., lower eyelid bags), and thus we did not perform a procedure (i.e., lower eyelid blepharoplasty) to address the area. Even if I feel that I can improve an aspect of a patient’s face, I don’t address the area unless the patient requests my assessment.

Once you’ve examined a surgeon’s cosmetic upper eyelid blepharoplasty before-and-after photos and found them to be outstanding using the tips above, there are a few other factors to consider prior to making your choice.

First and foremost, how many upper eyelid blepharoplasties has the surgeon performed over the course of their career and how many do they perform on a weekly basis? As a frame of reference, I have performed about 5000 upper eyelid blepharoplasties over the course of my training and the last 7 years of my career in private practice. I do about 7-10 per week on average. These are not all cosmetic cases, as I still perform some functional surgery (i.e., blepharoplasty surgery for older patients with obstructed peripheral vision). Although the goals of cosmetic and functional upper eyelid blepharoplasty surgery are different, improved cosmetic appearance vs. improved peripheral vision, the steps of surgery are the same.

My numbers are on the higher end of the spectrum, but that being said, there are many surgeons who perform 3-4 upper eyelid blepharoplasty surgeries per week who are also outstanding. If you are considering cosmetic upper eyelid blepharoplasty, I recommend seeking a surgeon who consistently performs at least 3 upper eyelid blepharoplasty surgeries per week (12 per month) on a regular basis and has performed at least 500 upper eyelid blepharoplasty surgeries in their career.

Other than that, there are many phenomenal upper eyelid blepharoplasty surgeons. Many of us are fellowship-trained oculofacial plastic surgeons and members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. I also know many facial plastic surgeons (most of whom completed ear, nose, and throat [ENT] residencies) who are outstanding upper eyelid blepharoplasty surgeons.

I highly recommend choosing a surgeon who devoted a large portion of their residency and fellowship surgical training to eyelid and facial plastic surgery, as there are many surgeons who perform upper eyelid blepharoplasty surgery despite having very little training around the eyelids and face. I sometimes joke that you would not want me to do your foot surgery or deliver your baby, nor do I try perform these procedures as I have not undergone adequate training to perform them. As noted above, Google is a great tool for researching surgeons. You’ll be able to find patient reviews and additional information about prospective surgeons’ residency and fellowship training. Most of us are very proud of our residency and fellowship training (it took years!), and it is usually prominently displayed in the biography sections of our websites.

Thanks so much for reading this blog post. I hope Parts 1 and 2 of the Understanding Cosmetic Upper Eyelid Blepharoplasty series have been helpful. If you’d like to see me for a consult, please follow the link below. I look forward to meeting you soon!