Medically reviewed by Dr. Shervin Naderi, MD, FACS, double board-certified facial plastic surgeon. Last reviewed October 18, 2026.
Each autumn, many of our patients in Reston and Vienna come to us hoping to soften the lines across their forehead before the holidays. Often, almost in passing, they also mention that their eyes look tired in photographs, or that their eyeshadow has gathered in the crease by midday. Those two concerns are frequently connected, and that connection shapes what we treat first.
Here is your guide to that connection: why heavy, hooded upper eyelids can etch lines into the forehead, why Botox on its own can leave heavy lids feeling heavier, and how upper eyelid surgery in Reston and Chevy Chase is performed at The Naderi Center. Dr. Shervin Naderi, a double board-certified facial plastic surgeon whose practice is devoted to the face and neck, shares how he decides where to begin.
The short answer: should I treat heavy eyelids or forehead lines first?
The short answer: when loose upper eyelid skin is part of the picture, the eyelids usually come first. Extra skin resting on the lid asks the forehead to lift your brows all day, and that constant effort is what draws the horizontal lines. Once the lids are refreshed, the forehead can finally relax, and Botox can do the gentle work it was meant to do.
Why do hooded upper eyelids cause forehead lines?
Hooded eyelids develop when the upper lid skin loses its elasticity and folds softly over the crease. With time we make less collagen, gravity draws on the looser skin, and the tendon of the muscle that raises the upper lid can stretch. Years of rubbing the eyes, and earlier eye surgery such as cataract surgery, can add to the heaviness.
Your brain prefers a clear view, so it quietly recruits the frontalis, the broad muscle across the forehead, to lift the brows and draw the lid skin up and away. Most people never notice. It happens while reading email at a desk in Arlington and again on the drive home, and over the years the creases across the forehead deepen.
“Many people come to me hoping Botox will soften their forehead lines, and as we talk I can see their brows working the entire time to keep the eyelid skin off their lashes,” says Dr. Naderi. “In those cases the lines begin with the eyelids, and that is where I like to begin too.”
Why can Botox make heavy eyelids feel heavier?
Botox relaxes the muscle it is placed in, and in the forehead that is the very muscle supporting your brows. When the lids are already heavy, relaxing it lets the brows settle lower, the extra lid skin loses its support, and the eyes can feel droopier than before.
When someone truly needs an eyelid lift, relaxing the forehead removes the one muscle that was holding their lids open,” Dr. Naderi explains. “Thoughtful injecting begins with knowing when to wait.” Every injection at The Naderi Center is given by a physician who studies the brows, lids and forehead together before any treatment begins. For a closer look at the neuromodulators themselves, our comparison of Botox, Dysport, Xeomin, Jeuveau and Daxxify is a helpful companion.
How can I tell whether I need eyelid surgery or Botox?
A mirror offers a lovely first clue. Relax your forehead completely, close your eyes, then open them without lifting your eyebrows. If skin rests on your lashes or hides the crease where you would place eyeshadow, loose upper lid skin is part of your picture. If your lids look open and the lines appear mainly when you are animated, Botox may be all you need.
Sometimes the brow itself has descended, and the heaviness comes from above the lid. That calls for a different conversation, which we explore in Should You Get a Brow Lift or a Blepharoplasty? Some patients benefit from both, and one of the results below pairs an endoscopic brow lift with upper eyelid surgery. When the concern is fine, crepey texture, laser resurfacing around the eyes is often combined with eyelid surgery.
Excess upper lid skin can also crowd the edges of your vision. If you find yourself tilting your chin to read, or lifting your brows to see the top of a screen at home in Great Falls, please mention it at your consultation. It tells Dr. Naderi how much the skin is asking of you.
What does upper eyelid surgery address?
Upper blepharoplasty removes the excess, softened skin of the upper lid and, when needed, a small amount of fat. The incision rests within the natural crease, where it becomes discreet once healed, and the natural shape of your eye is preserved. It is a refinement of the lid itself, so deeper crow’s feet at the outer corners are better served by other treatments.
“I measure the crease before removing anything,” says Dr. Naderi. “With the upper lid, a precise and gently conservative approach is always kinder than taking too much. I want your friends in McLean to tell you that you look rested, without anyone guessing why.”
How is upper eyelid surgery performed at The Naderi Center?
Dr. Naderi performs upper eyelid surgery in the operating room under general anesthesia, so you rest comfortably throughout. Upper eyelid surgery on its own takes about ninety minutes, and when the upper and lower lids are refreshed together, the procedure takes about two hours.
Preparation begins about two weeks ahead and is simple to follow. Your blepharoplasty instructions include an anti-bruising diet, pausing aspirin, ibuprofen and blood-thinning supplements two weeks before surgery (please check with your prescribing doctor before stopping any prescription blood thinner), and stopping nicotine at least two weeks ahead, ideally four.
What is recovery like after upper eyelid surgery?
The first few days are about rest and gentle care. Swelling, bruising and a little redness in the whites of the eyes are expected, and bruising usually peaks on the second or third day. Cool compresses are soothing for the first three days (never ice directly on the skin), and sleeping with your upper body raised about 45 degrees helps the swelling settle. Vision may be a little blurry for two to three days, partly from the protective ointment.
Sutures are typically removed at about one week, and contact lenses can return then; glasses are fine anytime. Most patients feel ready for work within one to two weeks, and the refreshed look begins to show at two to three weeks. We suggest postponing air travel for seven to ten days, and any remaining bruising continues to fade over about six weeks.
Your instruction sheet asks you to set exercise aside for the first month and to avoid lifting more than 20 pounds, then return gradually to full activity by about three months. The incisions also appreciate protection from direct sun for three months, which is far easier during a Washington DC winter. If you commute from Alexandria or Vienna, plan on a week at home followed by a gentler second week.
Where can I have upper eyelid surgery near McLean, Bethesda or Washington DC?
Dr. Naderi welcomes eyelid patients at both of our offices, and consultations are offered at each. Reston is the easier trip from Great Falls and Vienna, and McLean sits comfortably between the two. Chevy Chase is closer for Bethesda, Potomac and upper Northwest Washington DC, with the office right on Wisconsin Avenue. He has been named to Newsweek’s America’s Best Plastic Surgeons list in 2023, 2024, 2025 and 2026.
Our Reston office is at 1850 Town Center Parkway, Pavillion II, Suite 551, Reston, VA 20190, (703) 481-0002. Our Chevy Chase office is at 5454 Wisconsin Ave, Suite 1655, Chevy Chase, MD 20815, (301) 222-2020. If your schedule is full or you live farther away, you are welcome to begin with a virtual consultation, and you can book an appointment online.
How do eyelid surgery and Botox work together afterward?
Botox still has a graceful place after eyelid surgery. With the extra lid skin gone, the forehead no longer has to hold your brows up all day, so a later treatment can relax it without leaving your lids heavy. “Once the lid skin is out of the way, the forehead finally gets to rest,” Dr. Naderi says. “That is when Botox does what people hoped it would do all along.” Your physician will plan the timing with you at your follow-up visits.
Upper eyelid surgery before and after photos
The results below belong to real patients of The Naderi Center who chose upper eyelid surgery, some alongside other procedures. You will find many more in our blepharoplasty before and after gallery.
Real patients of The Naderi Center. Individual results vary.
When is the best time to schedule upper eyelid surgery?
Late fall and winter suit eyelid surgery beautifully. The holiday weeks give many patients in Arlington, Potomac and Reston the quiet time at home that healing calls for, and the softer winter light makes caring for the incisions easier. We suggest booking your consultation several weeks before the date you have in mind, so there is time for the preparation described above.
“Before you book another round of forehead injections, I would love the chance to look at your eyelids,” says Dr. Naderi. “Sometimes the answer is Botox. Sometimes it is a ninety-minute surgery that brings a lasting change.”
If heavy lids have become part of your reflection, we would be delighted to help. Book a consultation at our Reston or Chevy Chase office, and Dr. Naderi will guide you toward the approach that suits your eyes.
Frequently asked questions
How much does upper eyelid surgery cost at The Naderi Center?
Our menu of services lists upper blepharoplasty at $8,000 to $15,000. Where you fall in that range depends on your plan, and anesthesia and facility fees depend on the length of the procedure. Dr. Naderi will give you a specific quote at your consultation.
How long do upper eyelid surgery results last?
Upper eyelid surgery commonly gives lovely results for 10 years or more. Fat that is removed stays removed, although your eyes will continue to age naturally.
Is upper eyelid surgery painful?
Most patients describe the discomfort after upper eyelid surgery as mild, and many are surprised by how comfortable the first few days feel.
Can I have upper eyelid surgery if I have dry eyes?
Yes. Patients with dry eyes can have upper eyelid surgery; your surgeon simply removes a precisely measured amount of tissue so the eyes continue to close comfortably.