One Area, Several Different Decisions
What Is Eyelid Surgery?
Eyelid surgery, or blepharoplasty, may address selected skin, fat, contour, and supporting tissues of the upper eyelids, lower eyelids, or both. Upper- and lower-lid procedures are different decisions, and the visible concern alone does not determine the operation.
A brow lift addresses brow and forehead position rather than removing eyelid tissue. True eyelid ptosis—drooping of the eyelid edge itself—is also different from excess upper-lid skin and may require another evaluation and treatment pathway. Eye health and lower-lid support can further change what is appropriate.
Blepharoplasty does not automatically treat brow descent, dark pigmentation, crow’s-feet, every fine line, cheek descent, or facial-volume loss. Consultation clarifies whether a focused eyelid plan, a different procedure, or observation fits.
Questions an Examination Can Clarify
What Eyelid Concerns Can Blepharoplasty Address?
A consultation identifies the structure involved rather than assigning a procedure from a photograph or symptom label.
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Upper-Lid Skin or Folds
Upper-lid skin may change the visible lid platform or create folds. Brow position and the eyelid edge still need separate evaluation. -
Localized Eyelid Fullness
Selected fat deposits can contribute to upper- or lower-lid fullness. Location, surrounding tissue, and support influence the plan. -
Lower-Lid Bags or Contour
Lower-lid concerns may involve fat, skin, lid position, support, or the lid-cheek relationship rather than one interchangeable problem. -
A Functional Concern
Selected upper-lid tissue can affect the visual field, but brow position, true ptosis, and other conditions may create similar symptoms.
A thoughtful consultation should clarify what surgery may change, which concerns require a different decision, and whether the tradeoffs fit your priorities.
The Examination Comes First
Eyelid Surgery Candidacy and Consultation
It is common for a concern around the eyes not to fit neatly into one label. You do not need to make that distinction before consultation.
Dr. Howarth considers what you notice, what you hope to change, and whether the concern is upper, lower, or both. Examination may include upper-lid skin and fat, the eyelid edge, brow position, lower-lid tone and support, eye closure, asymmetry, skin quality, facial volume, and the lower lid’s relationship to the cheek.
Eye health matters because eyelid surgery can affect closure and the ocular surface. Tell Dr. Howarth about dryness or irritation, contact-lens use, vision changes, eye conditions, prior eye or facial surgery, thyroid or neurologic history, medications, nicotine exposure, and other relevant health factors. Additional records or testing may be useful depending on the history, symptoms, and examination; this is individualized rather than routine.
Alternatives may include Brow Lift when brow position is central, a different pathway for possible ptosis or functional symptoms, selected skin or volume treatment or observation.
When Surgery May Not Be the Right Choice
The purpose of consultation is to identify the most appropriate next step—not to presume that an operation is needed. Dr. Howarth may recommend waiting, further evaluation, a different setting or approach, nonsurgical care, or no surgery when that is the more appropriate recommendation.
PERSONAL DECISIONS. THOUGHTFUL CARE.
Privacy During Facial Surgery Consultation and Care
Questions about facial surgery can feel personal. When you contact us, you can indicate whether you prefer a call or text. Your consultation with Dr. Howarth is a thoughtful conversation about your anatomy, concerns, and goals.
Judgment Around the Eyes
Choosing an Eyelid Surgeon: Why Dr. Howarth
Choosing an eyelid surgeon involves more than comparing an upper- or lower-lid technique. Look for appropriate board certification, careful evaluation of the eyelids, brow position and eye health, balanced counseling about limitations, and a clear plan for follow-up.
Ashley Howarth, MD, FACS, is a board-certified plastic surgeon in Scottsdale, an Instructor in Plastic Surgery at Mayo Clinic, and a Fellow of the American College of Surgeons. Her background includes nine years of surgical training.
Choosing a surgeon for eyelid surgery involves more than selecting a technique. It requires distinguishing eyelid tissue from brow descent or possible ptosis, assessing lower-lid support, respecting eye-health history, and deciding how much change remains appropriate. Dr. Howarth explains the meaningful options and recommends a focused, anatomically appropriate plan.
Her whole-face evaluation keeps the recommendation centered on eyelid anatomy while accounting for the brow, lower-lid support, and eye health.
PLASTIC SURGERY
OF SURGEONS
SCOTTSDALE · MODERN OFFICE SETTING
FROM QUESTIONS TO A CLEAR PLAN
Eyelid Surgery Consultation and Patient Care Coordination
From your first inquiry, your patient care coordinator helps organize the practical next steps. Your coordinator can assist with scheduling, estimates, financing, forms, travel, and follow-up logistics. Dr. Howarth and her clinical team answer medical questions and make all clinical recommendations.
A thoughtful beginning.
Your patient care coordinator can help arrange your consultation and explain what photographs, records, or other information the clinical team would like you to have ready when relevant.
Clear information before you decide.
After Dr. Howarth recommends a plan, your coordinator can review the written estimate, financing information, scheduling requirements, forms, next steps, and practical questions with you.
Practical details, clearly organized.
Once required visits are known, your coordinator can help organize Scottsdale travel and follow-up timing. Dr. Howarth and her clinical team provide individualized medical and recovery guidance.
The Plan Follows the Anatomy
Upper, Lower, or Combined Eyelid Surgery?
Upper Eyelid Surgery
Upper-eyelid planning may address selected skin and fat through an incision often placed within the natural crease. Scar length, tissue handling, and degree of change vary. Removing eyelid skin does not correct brow descent, and possible ptosis requires separate evaluation.
Lower Eyelid Surgery
Lower-eyelid planning may consider bags, skin, fat position, contour, lid tone, and support. Access may be near the lash line or through the lower lid, with fat removed, preserved, or repositioned when appropriate. Examination determines which possibilities fit.
Upper and Lower Eyelids Together
When both areas have distinct concerns, upper and lower eyelid surgery may be discussed together. A combined operation changes the scope, recovery, and risk conversation and is not automatically preferable to a focused procedure for either area alone.
When Another Plan Fits Better
A Brow Lift addresses brow and forehead position. Possible ptosis, pigment, skin texture, crow’s-feet, volume loss, and cheek position may call for another approach or may remain after blepharoplasty. Examination clarifies which concern is actually leading.
A PLAN CONFIRMED BEFORE SURGERY
What Happens on the Day of Eyelid Surgery?
Procedure day follows the upper-lid, lower-lid, or combined plan established in consultation. The team reviews the final plan, relevant health information, setting and anesthesia, transportation, and individualized instructions. Markings may be made as appropriate before surgery.
The operation and early care follow the confirmed scope. Discharge instructions address eye comfort, incision care, activity, and follow-up for the individual plan.
Your plan, confirmed with you.
The team reviews preparation, markings, the selected operation, and remaining questions.
Care matched to your anatomy.
Dr. Howarth performs the operation according to the individualized surgical plan.
Clear instructions and a direct next step.
Written instructions cover medications, activity, support, follow-up, and how to contact the practice.
CLEAR ABOUT WHAT MATTERS
Eyelid Surgery Safety, Risks, and Limitations
General surgical risks include anesthesia complications, bleeding, infection, delayed healing, persistent swelling, unfavorable scarring, asymmetry, contour irregularity, sensation change, and possible additional treatment or revision.
Possible Complications Include
- Bleeding, infection, anesthesia complications, and delayed healing
- Dryness, irritation, tearing, light sensitivity, or temporary vision changes
- Difficulty closing the eyes, lid-position change, or lower-lid retraction
- Visible scarring, asymmetry, contour irregularity, or prolonged swelling
- Injury to the eye or vision loss, which is rare but serious
- An unsatisfactory result or need for additional treatment or revision
What Surgery Cannot Guarantee
- Guarantee exact symmetry between the eyes or eyelids
- Correct every concern caused by brow position, true ptosis, or eye health
- Remove all under-eye pigmentation, texture, or fine lines
- Prevent future aging or tissue change
- Promise a result shown in another patient’s photographs
HEALING IN STAGES
Eyelid Surgery Recovery
Recovery varies with upper versus lower surgery, a combined plan, eye comfort, daily responsibilities, travel, and individual healing. The clinical team’s guidance—not one online date—determines when each activity is appropriate.
A deliberately quiet start
Swelling, bruising, tightness, irritation, light sensitivity, tearing or dryness, and temporary asymmetry may be noticeable. The early appearance is not the final result.
Everyday activities, gradually
Driving, screens, contact lenses, makeup, work, caregiving, and travel resume according to the operation, eye comfort, and how the incisions are healing.
Resume in stages
Exercise, lifting, and other strenuous activities resume after healing has progressed and Dr. Howarth and her clinical team provide guidance for the individual plan.
Healing continues
Swelling changes as tissues settle and scars mature. Final contour and scar visibility become easier to assess over time and vary among patients.
RESULTS WITH CONTEXT
Reviewing Eyelid Surgery Results Thoughtfully
A useful comparison identifies whether the upper lids, lower lids, or both were treated; whether a brow or another procedure was combined; and how long the patient had healed. Brow position, lighting, camera angle, facial expression, makeup, and residual swelling can materially change a photograph.
When authorized eyelid examples are available, a patient care coordinator can arrange a private viewing with context about the procedure and healing stage. A consultation does not need to be scheduled first.
BEFORE & AFTER GALLERIES
Private Eyelid Surgery Before & After Gallery
Eyelid Surgery before-and-after photographs can feel deeply personal. As both a woman and a surgeon, Ashley Howarth, MD, FACS, understands the trust involved in sharing them. Howarth Plastic Surgery in Scottsdale makes galleries of real patient results available by request through private before-and-after reviews.
Keeping eyelid surgery before-and-after galleries off unrestricted public pages helps preserve patient dignity and clinical context while limiting casual viewing, unauthorized reposting, and collection by automated systems or AI agents.
During your private before-and-after review, you can see a range of eyelid surgery results and discuss how starting anatomy, surgical choices, healing, and time influenced each outcome. These photographs can support an informed consultation, but individual results vary, and no image can predict your outcome.
PATIENT CASE SUMMARIES
Selected Eyelid Surgery Case Summaries
These deidentified eyelid surgery case summaries show how Ashley Howarth, MD, FACS, evaluates blepharoplasty at Howarth Plastic Surgery in Scottsdale, Arizona. Each case distinguishes upper-eyelid skin, lower-eyelid bags, brow position, true ptosis, eye-surface health, facial volume, prior treatment, and patient goals before describing the procedure performed or recommendation made. To protect patient privacy, some nonclinical identifying details have been generalized or modified. Anatomy, procedures, healing, and results vary.
Case 01
UPPER-EYELID SKIN
Upper-eyelid skin excess was treated after brow position and eye health were evaluated
Patient presentation
The patient described heaviness at the upper eyelids and difficulty applying eye makeup. She wanted a clearer lid platform without changing the basic shape of her eyes.
Clinical evaluation
Dr. Howarth evaluated upper-eyelid skin and fat, brow position, eyelid crease, true eyelid height, asymmetry, eye closure, dry-eye symptoms, prior surgery, and the amount of tissue that could be removed safely.
Procedure performed
Dr. Howarth performed upper blepharoplasty with conservative skin and tissue treatment based on the examination.
Clinical rationale
The concern was primarily upper-eyelid skin rather than brow descent or true ptosis. The plan preserved sufficient tissue for closure and did not attempt to change unrelated anatomy.
Follow-up
Follow-up addressed bruising, swelling, incision healing, eyelid closure, dryness, asymmetry, scar maturation, and gradual return to contact lenses or eye makeup when appropriate.
Case 02
LOWER-EYELID BAGS
Lower-eyelid bags were treated after support and the eyelid-cheek relationship were assessed
Patient presentation
The patient reported persistent lower-eyelid fullness that remained despite rest. She wanted improvement without creating a hollow or overly tight lower eyelid.
Clinical evaluation
Dr. Howarth evaluated fat prominence, skin, lower-eyelid tone and support, eye position, tear-trough and cheek volume, dry-eye symptoms, asymmetry, prior filler, and the risk of postoperative lid-position change.
Procedure performed
Dr. Howarth performed lower blepharoplasty using a tissue and access plan selected for the lower-eyelid support and contour findings.
Clinical rationale
Lower-eyelid bags can involve fat, skin, support, and the eyelid-cheek transition. The operation was designed to improve the documented source without automatically removing every visible tissue layer.
Follow-up
The patient was followed for swelling, bruising, eye comfort, lid position, vision symptoms, incision or internal healing, and gradual settling of the lower-eyelid contour.
Case 03
UPPER AND LOWER EYELIDS
Upper-eyelid skin and lower-eyelid bags were treated in one coordinated plan
Patient presentation
The patient described both upper-eyelid heaviness and lower-eyelid fullness. She wanted the eyes evaluated as a complete region rather than selecting one eyelid procedure from photographs.
Clinical evaluation
Dr. Howarth assessed upper skin and fat, brow position, eyelid height, lower fat and support, skin quality, eye closure, dry-eye symptoms, facial volume, asymmetry, and the cumulative recovery of treating both eyelids.
Procedure performed
Dr. Howarth performed combined upper and lower blepharoplasty, using separate tissue decisions for each eyelid region.
Clinical rationale
The upper and lower concerns arose from different anatomy. Coordinated treatment allowed both to be addressed without assuming that the same technique or amount of correction applied to each area.
Follow-up
Follow-up included eye comfort, vision symptoms, lid closure and position, bruising, swelling, incision healing, asymmetry, and activity guidance.
Case 04
BROW OR UPPER EYELID
Brow descent, not eyelid skin alone, was the principal source of upper-eye heaviness
Patient presentation
The patient requested upper blepharoplasty for a heavy upper-eye appearance. She noticed that manually lifting the brow changed the concern substantially.
Clinical evaluation
Dr. Howarth evaluated brow position and movement, forehead, hairline, upper-eyelid skin, eyelid crease, true eyelid height, asymmetry, eye closure, and how brow elevation changed the apparent skin excess.
Recommendation
Dr. Howarth recommended brow lift planning rather than isolated upper blepharoplasty, with eyelid treatment considered only if a separate eyelid indication remained.
Clinical rationale
Removing eyelid skin does not correct a descended brow and can create an incomplete or overly aggressive result when the brow is the main contributor.
Follow-up
The patient received a comparison of brow and eyelid procedures, including the areas each could change, scars, recovery, and limitations before choosing a plan.
Case 05
PTOSIS AND EYE-SURFACE HEALTH
True eyelid droop and dry-eye symptoms required ophthalmic evaluation before cosmetic surgery
Patient presentation
The patient described one upper eyelid sitting lower than the other together with eye irritation and dryness. She initially asked whether skin removal would make the eyes match.
Clinical evaluation
Dr. Howarth assessed eyelid height and function, pupil relationship, levator function, brow compensation, skin excess, eye closure, dry-eye history, contact lens use, visual symptoms, and prior eye care.
Recommendation
Dr. Howarth deferred cosmetic blepharoplasty and recommended evaluation by an ophthalmic specialist for ptosis and eye-surface health.
Clinical rationale
True ptosis and dry eye are not corrected by routine skin removal and can affect surgical safety and planning. The functional eye concern needed to be defined first.
Follow-up
No cosmetic operation was scheduled. Reassessment was offered after specialist findings clarified whether plastic surgery had an appropriate role.
Case 06
NO EYELID OPERATION RECOMMENDED
Eyelid surgery was not recommended when the concern arose from normal anatomy and facial volume
Patient presentation
The patient requested upper and lower blepharoplasty for subtle shadows and natural eyelid folds. She wanted a larger change than the examination supported.
Clinical evaluation
Dr. Howarth evaluated eyelid skin and fat, brow position, lid height, support, eye closure, dryness, facial volume, normal anatomic shadowing and facial-volume relationships, asymmetry, and whether a safe amount of removable tissue was present.
Recommendation
Dr. Howarth did not recommend blepharoplasty and explained that tissue removal could create dryness, hollowing, or a changed eye shape without a meaningful benefit.
Clinical rationale
A visible fold or shadow is not automatically a surgical indication. Preserving normal eyelid function and anatomy was more appropriate than operating without a clear target.
Follow-up
No operation was scheduled. Observation and reassessment only if the concern changed were discussed.
PLANNING WITH CLARITY
Eyelid Surgery Cost, Financing, and Travel to Scottsdale
Eyelid Surgery Cost
At Howarth Plastic Surgery in Scottsdale, eyelid surgery typically costs $8,800 to $19,000. Your final fee depends on whether the upper eyelids, lower eyelids, or both are treated, as well as anesthesia, surgical setting, and whether another procedure is included. After consultation with Dr. Howarth, you will receive a personalized written estimate for the plan she recommends.
Financing Options
Howarth Plastic Surgery is a cash-pay practice and does not accept or bill insurance. Your patient care coordinator can review financing through PatientFi and CareCredit, subject to third-party approval.
Planning Care in Scottsdale
If you are traveling from elsewhere in Arizona or out of state, out-of-town patient information can help you plan around consultation, surgery, and follow-up. Required appointment dates, how long to remain nearby, and when travel may resume are individualized. An initial consultation may take place virtually, but an in-person examination is required before the operative plan is finalized.
Clear Answers
Eyelid Surgery Frequently Asked Questions
Upper-eyelid surgery generally addresses selected upper-lid skin and fat. Lower-eyelid surgery may address bags, skin, fat position, contour, and lid support. They use different planning and may be considered separately or together after examination.
It can come from upper-lid skin, brow position, true eyelid ptosis, or more than one factor. Brow position should be assessed before upper-lid skin is removed. Brow Lift explains the separate brow and forehead decision.
No. Blepharoplasty addresses selected eyelid tissues, while true eyelid ptosis involves drooping of the eyelid edge and requires a different evaluation and potentially different treatment. A website or selfie cannot determine which issue is present.
Lower-eyelid surgery may address selected fat, skin, contour, or support contributors. Pigmentation, cheek descent, fluid, skin texture, facial volume, and other anatomy may require another plan or may remain.
Selected upper-lid tissue may contribute to a visual-field concern, but brow position, ptosis, and other conditions can produce similar symptoms. Appropriate evaluation and documentation may be needed. Howarth Plastic Surgery is cash-pay and does not bill insurance or manage authorization, benefits, claims, or reimbursement.
Disclose dryness, irritation, contact-lens use, prior eye surgery, eye conditions, and vision symptoms early. These factors may change candidacy, technique, testing, or whether surgery is recommended. Additional eye evaluation is individualized rather than universal.
Upper-eyelid incisions are often planned within the natural crease. Lower-lid access may be external near the lash line or internal, depending on the operation. Scars and healing vary, and no incision is invisible or scarless.
Swelling, bruising, tightness, irritation, dryness, and temporary asymmetry can occur early. Return to work, driving, screens, contacts, makeup, exercise, and travel varies with the operation and healing.
Surgery may create a durable change in treated tissues, but it does not stop aging. Tissue quality, health, sun exposure, brow position, and time continue to affect the eye area. No universal number of years can be promised.
At Howarth Plastic Surgery in Scottsdale, eyelid surgery typically costs $8,800 to $19,000. Your final fee depends on whether the upper eyelids, lower eyelids, or both are treated, as well as anesthesia, surgical setting, and whether another procedure is included. After consultation with Dr. Howarth, you will receive a personalized written estimate for the plan she recommends.
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