A large number of patients say things like “my friend had her upper lids done” and the implication is that all upper lid surgery is the same. Of course, that is not the case. I routinely perform a dozen different upper lid surgeries, with numerous variations on each.
Upper blepharoplasty at it’s core means removing or redistributing tissue from the upper lids. It can include brow release and stabilization. It can include fat transfer between the medial and central fat pockets. The construction of the incision and lid crease is individualized based on the patient’s natural lid folds, ethnicity, and desires; it varies according to the concomitant brow treatment as well. The lash line can be manipulated and rotated, if it points downward. The excision can incorporate preexisting pigment abnormalities, lumps, or bumps, so as to facilitate their removal. The tissue handling can be biased on one side so as to mask an inherent asymmetry between the right and left sides.
The reality is that a good upper blepharoplasty surgery is guided by certain principles, and no two surgeries should be the same. The cookie-cutter approach to eyelid surgery does not achieve individualized maximal outcomes, and for this reason it makes good sense to get a surgical consult with a surgeon with an intimate knowledge of eyelid structure and function.