Upper eyelid hooding is treated with an upper blepharoplasty — removal of the excess, lax eyelid skin (dermatochalasis) through an incision hidden in the natural lid crease. It lifts the heavy, tired look, relieves the brow ache caused by constantly lifting the eyebrows to see, and restores the upper field of vision when hooding has begun to block it. The single most important step is the consultation, because hooding (a skin problem) must be told apart from ptosis (a low lid margin) and brow droop (a descended eyebrow) — the three need different operations and are often combined. UK 2026 self-pay cost is from about £2,800 for both upper lids.
What is upper eyelid hooding (dermatochalasis)?
With age the upper eyelid skin loses elastin and collagen, stretches and sags. The surplus skin — dermatochalasis — folds down over the lid crease and, in more advanced cases, over the lash line and pupil. This is what people describe as hooded or heavy eyelids. The underlying eyelid muscle (orbicularis) can thicken and the small fat pads behind the eyelid (the medial and central orbital fat) can bulge forward, adding to the fullness.
Hooding is usually more than cosmetic. Common functional symptoms include:
- Loss of the upper visual field — the skin curtain blocks the top of your vision, especially when tired or reading.
- Brow ache and forehead furrows — from chronically raising the eyebrows (frontalis overaction) to lift the skin out of the way.
- A tired, aged or asymmetric appearance even when well rested.
- Difficulty with eye make-up as the crease disappears under the fold.
Hooding vs ptosis vs brow droop — why the diagnosis matters
Three different problems all make the eyes look heavy, and the right operation depends on which (or which combination) you have. Getting this right at assessment is the difference between a good and a disappointing result.
Hooding and ptosis frequently coexist, and the same skin-crease incision can be used to correct both in one operation. For a plain-English explainer see the difference between blepharoplasty and ptosis surgery, and our broader blepharoplasty and oculoplastics pages.
Is it skin, lid or brow? A consultant oculoplastic assessment measures your lid height, levator function and brow position and tells you exactly which operation you need.
Book an eyelid assessmentWhat happens during upper blepharoplasty
Upper blepharoplasty is a day-case procedure under local anaesthetic, usually with optional light sedation. Both upper lids take around 45–60 minutes.
- Marking — with you sitting upright, the surgeon marks the precise ellipse of skin to remove, keeping the lower mark in the natural crease and leaving enough skin for normal closure.
- Anaesthetic — local anaesthetic is injected into the lids; the area becomes completely numb.
- Skin removal — the marked strip of excess skin is excised, with a conservative strip of orbicularis muscle if needed.
- Fat adjustment — bulging medial or central fat pads are gently reduced or repositioned for a smooth contour.
- Closure — the incision is closed with fine sutures along the crease line, so the scar is hidden when your eyes are open.
Where ptosis is present, the lid level is corrected through the same incision before closure. Bulky xanthelasma deposits, if present, can also be removed at the same time — see xanthelasma removal.
Recovery week-by-week
Recovery is comfortable for most patients, with bruising and swelling settling over the first one to two weeks and the scar maturing over a few months.
Days 0–2
Mild discomfort, bruising and swelling. Ice packs for 10 minutes hourly while awake. Sleep propped up. Vision is normal.
Days 3–7
Bruising peaks then fades. Sutures removed at day 5–7. Most people feel presentable enough to return to non-public work.
Weeks 2–4
Residual swelling settles; back to normal social life. Resume eye make-up, contact lenses and light exercise around two weeks.
Months 1–3
The crease scar softens and fades to a fine line hidden in the fold. Final result is settled by around three months.
Cost & what is included
Our upper blepharoplasty fees are all-inclusive: consultant oculoplastic assessment, day-case theatre under local anaesthetic, the surgery itself, suture removal and follow-up reviews.
- Upper blepharoplasty (both upper lids): from £2,800, typically £2,800–£4,500 depending on complexity.
- Combined with ptosis correction: more involved — see ptosis surgery cost for combined pricing.
- Four-lid (upper and lower) surgery: quoted individually at consultation.
For the full breakdown of oculoplastic fees see the private blepharoplasty cost guide, the blepharoplasty pricing overview and oculoplastic surgery prices.
Is upper blepharoplasty covered by insurance or the NHS?
Upper blepharoplasty is funded — by the NHS or private medical insurance — only when it is functional rather than cosmetic. That means the hooding must measurably obstruct your upper field of vision, documented with visual field perimetry comparing the lid in its resting position with the skin taped up. Cosmetic-only surgery (to look refreshed, with no field loss) is a self-pay procedure.
- NHS — commissioned where there is documented superior visual field loss from the hooding; thresholds and waits vary by region.
- Private medical insurance — Bupa, AXA Health, Aviva, Vitality and WPA may cover functional cases with pre-authorisation and perimetry evidence; always authorise in writing first.
- Self-pay — the straightforward route for cosmetic hooding or where you simply prefer faster, consultant-chosen care.