Quad Blepharoplasty

Conveniently located to serve the areas of Chicago, IL

Quad blepharoplasty, or four lid blepharoplasty, is a comprehensive approach to rejuvenating the eyes, focusing on both the upper and lower eyelids. This procedure addresses eyelid sagging and under-eye bags by removing excess skin, repositioning fat, and discreetly reshaping each eyelid. Quad eyelid surgery can restore a youthful and bright appearance to the upper and middle third of the face, achieving a harmonious and natural periocular rejuvenation.

Dr. Paul Phelps is a board-certified oculofacial plastic surgeon who specializes in procedures of and around the eyes. Practicing at Chicago Oculofacial Plastic Surgery, he is specifically educated and trained in the art of eyelid surgery, helping his patients achieve a more alert, rejuvenated appearance. If you seek total rejuvenation of the eyes, schedule your private consultation with him today by filling out our contact form or calling our main office at (312) 888 5754

Before and After Photos

Why Choose a Blepharoplasty?

The skin around the eyes is extremely fragile and thin, causing signs of aging to appear earlier than other areas of the face. The upper eyelids lose elasticity and the brows start to sag as we get older, creating unflattering “hoods” of excess skin. Below the lower eyelids, dark circles and fat can accumulate. Quad blepharoplasty addresses the entire eye area at the same time, to achieve smoother, more youthful contours. Dr. Phelps assesses eyelid ptosis (sagging), brow angle, lower eyelid position, and cheek projection to formulate a personalized treatment plan for each patient. (1)

Upper Blepharoplasty

The skin loses elasticity with age, often leading to upper eyelid dermatochalasis (excess eyelid skin) as the skin becomes lax and less supportive. Upper blepharoplasty corrects this by removing excess skin and recessing the fat pad located below the eyebrow ridge. If the upper eyelid starts to sag, the browline commonly follows suit. During upper eyelid lifts, Dr. Phelps carefully measures the excess skin, makes note of how much removal is appropriate, and then safely extracts it. 

Lower Blepharoplasty

To address skin and excess fat underneath the eyes, lower blepharoplasty can be performed in two distinct ways. Much of the eye’s functioning is controlled by the large muscle called the orbicularis oculi that surrounds it. This muscle gets weaker with age, and so do the soft tissues around the lower eyelid. Tissues start to sag and create dark and fatty under-eyes, indicating lower blepharoplasty may be necessary to restore a youthful contour to the eye. (2) There are three main fat pads located just beneath the lower eyelid that can be either excised or repositioned to correct under-eye aging. Dr. Phelps assesses the area to determine what strategy will work best for you.

Benefits of Quad Blepharoplasty

Quad blepharoplasty has many benefits:

  • Restores a youthful eye contour
  • May improve field of vision
  • Addresses multiple concerns in a single procedure
  • Provides complete eye restoration
  • Only one recovery as opposed to two separate healing periods

Ideal Candidates for Quad Blepharoplasty

Quad blepharoplasty is a good option for patients who have cosmetic concerns with both the lower and upper eyelids. Those who have noticed increased folding of the upper eyelid as well as excess fat collection under the lower lid are prime candidates. Some patients seeking quad blepharoplasty have trouble with upper eyelid makeup smearing or completely disappearing when their eyes are open. This may be accompanied by dark circles and puffy under-eyes.

You must be in good health with no existing medical conditions that will impact your healing abilities to undergo surgery. Eyelid lifts are a delicate procedure, so patients must have reasonable and optimistic expectations for their prospective results. You cannot undergo quad eyelid lift surgery if you have any serious eye conditions or injuries. If you smoke, Dr. Phelps recommends that you refrain for one week before your surgery, and for the duration of your recovery so you can heal optimally.

Personal Consultation with Dr. Phelps

Your consultation at Chicago Oculofacial Plastic Surgery will be a private discussion with Dr. Phelps. He will ask you about your medical history, known allergies and medications, and the aesthetic concerns that brought you in. Dr. Phelps then performs a physical examination of the treatment area, making sure to assess your eyebrows as well as your eyelids. He will then create your procedure plan and explain the quad blepharoplasty procedure in detail to prepare you for surgery. After your consultation, a member of our staff will assist you in scheduling your procedure date and follow-up appointments. 


To prepare for quad blepharoplasty, please refrain from consuming:

  • Blood-Thinning Medications
  • Alcohol
  • Tobacco and Nicotine Products
  • Certain Herbal Remedies

Please avoid wearing contact lenses on the day of your surgery and while you are in recovery. Schedule time off of work before your procedure date, and prepare a space in your home for comfortable healing. You should also find a trusted adult who can drive you to the surgery center and back home afterward.

Quad Blepharoplasty Procedure

Quad blepharoplasty typically begins with the upper eyelid lift. After administering the appropriate anesthesia, Dr. Phelps measures and marks the upper eyelids to map out exactly how much skin to remove. After providing protective eyewear, he then makes very shallow incisions in the delicate eyelid skin using a CO2 laser, removing the thin epidermal layer. Once the skin is removed, he addresses the fat pads, removing small amounts until any bulging is reduced. Dr. Phelps then sutures the eyelid very carefully in the natural eye crease.

To address the lower lids, Dr. Phelps typically utilizes the Transconjunctival lower blepharoplasty technique wherein incisions are made inside the eyelid. This conceals your scars and makes for a more precise procedure. He then removes or repositions sections of the three fat pads to reduce the under-eye bags. If you have excess skin that needs addressing, Dr. Phelps can offer chemical peels, CO2 laser, or a surgical incision that he hides along the lash line. To finish the procedure, he sutures the lower lid. Quad blepharoplasty takes around two hours to complete but may take longer if other surgeries like a brow lift are included in your procedure plan.

Brow Lift

Sometimes a patient’s degree of upper lid ptosis (sagging) cannot be fully addressed only using blepharoplasty. In these cases, Dr. Phelps may perform a brow lift to achieve greater lift of the upper third of the face. Typically using the browpexy method, he places a suture connecting the internal tissue to the periosteum of the frontal bone. This action anchors the brow and creates a higher position along the brow bone to correct sagging. It is a convenient method of brow lifting because Dr. Phelps uses the existing upper eyelid incision to make his internal sutures. (3)

Skin Quality

While blepharoplasty may well address sagging or excess tissues, other techniques may be required to improve the quality of the skin around your eyelids. Various options such as chemical peels, CO2 laser resurfacing, and fat grafting may be beneficial to your overall results of your quad blepharoplasty. (4)

Recovery & Results

Your eyes will be swollen and bruised following your procedure. Dr. Phelps provides incision care instructions that you must adhere to for optimal healing. Please minimize your activity levels for the first week and rest as much as you need. We remove your sutures at your one-week follow-up appointment if they have not already dissolved by then. 

The results of quad blepharoplasty are typically visible after your swelling dissipates, and your final results are apparent around your 6th postoperative week. Your eyes will look wider, more youthful, and rejuvenated the more you heal.

How Much Does Quad Blepharoplasty Cost in Chicago?

Quad blepharoplasty is a highly personalized procedure. Your total cost depends on surgery length, personnel, anesthetic used, and other medical expenses. The all-in starting cost for quad blepharoplasty with two hours of anesthesia is $8,750.  To receive a detailed cost estimate, please schedule your private consultation with Dr. Phelps by calling our office at (312) 888-5754.


How do I know if I need both upper and lower blepharoplasty and not one or the other?

Quad blepharoplasty is best suited to patients with both drooping or hooded upper eyelids and excess skin collection or fat on and below the lower eyelids. Consultation with an oculofacial plastic surgeon will help you weigh the risks and possible benefits of the procedure.

Will I have visible scarring after quad blepharoplasty?

Dr. Phelps places his incisions very carefully, leading to well-hidden scars. The upper eyelid sutures lay right along the natural eyelid crease and will not be visible while your eyes are open. Your lower eyelid incisions may be inside the eyelid, rendering them invisible.

How does blepharoplasty address eye bags?

Blepharoplasty can address eye bags by removing excess fat deposits and tightening the skin around the eyes. This results in a more refreshed and youthful look, reducing the appearance of tiredness and puffiness.

Can I get a blepharoplasty if I have monolids?

Asian blepharoplasty is a specialized technique that caters to individuals seeking to create or enhance a supratarsal crease in the upper eyelids. This procedure respects the unique anatomical features of monolids while achieving desired aesthetic outcomes.


  1. Naik M, Honavar S, Das S, Desai S, Dhepe N. Blepharoplasty: An overview. Journal of Cutaneous and Aesthetic Surgery. 2009;2(1):6. doi:https://doi.org/10.4103/0974-2077.53092
  2. Bhattacharjee K, Ghosh S, Ugradar S, Azhdam AM. Lower eyelid blepharoplasty: An overview. Indian Journal of Ophthalmology. 2020;68(10):2075-2083. doi:https://doi.org/10.4103/ijo.IJO_2265_19
  3. Bahmani Kashkouli M, Karimi N, Sianati H, Khademi B. Techniques of Eyebrow Lifting: A Narrative Review. Journal of Ophthalmic and Vision Research. 2020;15(2). doi:https://doi.org/10.18502/jovr.v15i2.6740
  4. Watson AH, Van Brummen A, Somogyi MB, Homer N, Nakra T. Potent Periorbital Fractionated CO2 Laser Resurfacing. Dermatologic Surgery. 2022;48(10):1089-1091. doi:https://doi.org/10.1097/dss.0000000000003533