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To compare preoperative incision design markings between both eyelids in upper blepharoplasty.This retrospective study examined 22 patients who underwent bilateral upper blepharoplasty surgery resulting from senile dermatochalasis and/or blepharoptosis. The initial preoperative incision design markings were drawn with the patient sitting upright. Then, with the patient in a supine position, preoperative design photographs were taken. The authors measured medial canthal excision angle, maximal lid excision height, maximal lid excision width, peak point angle, and peak point distance and compared measurements between both upper eyelids designs using Image J software.The mean medial canthal excision angle, maximal lid excision height, and maximal lid excision width for the right side (30.68° ± 10.16°, 1.17 ± 0.24 cm, and 0.72 ± 0.19 cm) were significantly different from those for the left side (35.39° ± 13.82°; P < 0.001, 1.24 ± 0.25 cm; P = 0.002, and 0.77 ± 0.21 cm; P = 0.011). The mean peak point angle and peak point distance for the right side (15.67° ± 5.09°, 2.41° ± 0.31°) were significantly different from those for the left side (18.11° ± 5.49°; P = 0.001, 2.22 ± 0.28 cm; P = 0.001).In upper blepharoplasty, the preoperative incision marking design measurements of the left side were significantly greater than those of the right side. The symmetry can therefore be maximized by including the asymmetries in the preoperative design.