One surgeon wants my upper lids done now and the lowers in a year, the other wants all four in one go. Which is normal?

Some of you will remember me going round the houses about my under eye bags earlier in the year. Well, I have now had two more consultations, both good, both with proper eyelid surgeons, and they have given me two completely different plans and I do not know how to choose between them.

Surgeon one wants to do my upper lids only, under local, in about an hour, and then "see how we go" with the lowers, meaning come back next year if I still want them done. Her reasoning was that my lower lids are a bit lax (this is the third person to say this now) and she would rather not do the whole lot at once. Surgeon two looked at exactly the same face and said do all four together under sedation, one recovery, one bill, and if the lower lids need supporting she would do that at the same time.

So which of these is the NORMAL way round? I had assumed everyone did upper and lower together. Is the first surgeon being careful or being cautious for her own sake? Is the second one being cavalier? And the thing I genuinely cannot work out: if I only do the tops, do the bags underneath end up looking WORSE by comparison. Sorry, long post, I have been chewing on this for a fortnight.

I had all four at once in March and would do it that way again without a second thought. One fortnight of hiding, not two. Though I will say the lower lids were definitely the slower pair, the tops were tidy well before the bottoms stopped being puffy.

Different situation from you but possibly useful. I only ever had my uppers done and I was told at the time that my lower puffiness was not an eyelid problem at all, it was on the cheek, so there was nothing to stage. Point being, "uppers only" is not automatically a half job. Sometimes it is the whole job.

What I would want from surgeon one is the specific reason. "A bit lax, rather not" is a real reason if she thinks the lower lid needs supporting and she is not confident doing that; it is a much weaker reason if she just prefers shorter operations. Ask her straight what she would do differently if you insisted on all four, and whether she does the lid tightening herself. The answer to the second question will tell you a lot.

On the "will the bags look worse" question, yes a bit, in my experience of looking at other people's before and afters. Once the hooding is gone the eye reads as more open and anything sitting underneath it gets more light on it. It does not create a bag that was not there, it just stops hiding it.

kept_blinking said:

Is the first surgeon being careful or being cautious for her own sake? Is the second one being cavalier?

Neither, probably, and that is the frustrating answer, so let me give you the patient side of it and then the reasons a surgeon splits them, because I had exactly the plan surgeon two is describing.

Mine was all four lids together, under local with light sedation, about an hour of surgery, home the same afternoon. The recovery was one stretch rather than two, which mattered more than I expected: one round of drops and ointment, one fortnight of sunglasses, one set of follow ups. What I had not been told, and what RestedAtLast has already said above, is that the lower lids run behind. My upper stitches were out at the end of the first week and the creases looked neat by the second; my lowers were still puffy at six weeks and I was still judging my face by them. So a combined operation is one recovery, but it is the slower pair's recovery. I wrote up the whole decision in upper and lower blepharoplasty at the same time, including what it costs against two separate operations, if you want the longer version.

Now the staging bit, which I can only report rather than judge. The reasons surgeons give for doing one pair first are quite specific: a lower lid that is lax and needs its corner supported, which is exactly what has been said to you three times now; a tear film that is already borderline, because four healing lids at once are harder on a dry eye than two; a brow that needs assessing or lifting before any upper skin comes off; or a health picture where a shorter operation under local is simply the smaller risk. Cost and nerves are legitimate reasons too. What I would take from your two consultations is that they agree on the diagnosis (lax lower lids that need supporting if they are done) and differ only on who does that and when. That is a much smaller disagreement than it feels.

The one thing I would push on before choosing is the question Marguerite has already asked. When I was deciding, the moment that settled it was the surgeon pulling my lower lid down at the mirror, watching it snap back, and telling me it was quick enough to do both pairs together; a slow lid, she said, would either be tightened at the same time or left alone. Ask each surgeon to do that test in front of you and explain what they saw. The wider account of what the lower lid decision hangs on is in lower blepharoplasty. And I am a patient, not a surgeon, so which plan is right for your lids is theirs to say, not mine.

Went back to surgeon two with the snap-back question and she did the test in front of me, twice, and talked me through it. My left lid comes back fine, the right is slower, and she would do a small tightening on that side at the same time as the fat work. She was also completely relaxed about doing the uppers alone if I wanted to, which oddly made me trust her more.

So I am booking all four with her, in October. Surgeon one was not wrong, she just did not want to do the tightening, which is fair enough and I wish she had said so in those words. Thank you all, and Selina, the bit about the lower lids running a week or two behind is going straight into my expectations.