This will be determined on a case-by-case basis. Dr. Parakh will examine your eyes and decide which procedure would be most beneficial to you. If the main issue is loose skin on the upper eyelid, an upper blepharoplasty will likely be needed. In extreme cases, the skin will fold down and rest against the eyelashes, causing discomfort. Sometimes it can even impair the field of vision and cause other health problems. A lower blepharoplasty would be performed in cases where there are fat pockets or bulges on the lower eyelid. This is usually genetically linked and often makes the eye appear overly tired and swollen.