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Blepharoplasty

Eyelid Surgery (Blepharoplasty)

Eyelids age and lose elasticity, causing drooping of upper lids and bagginess under eyes. Blepharoplasty is a surgery to remove excess skin, muscle and fatty tissue. It is mainly cosmetic but can be helpful in improving vision.

What is blepharoplasty (eyelid surgery)?

Blepharoplasty is a surgical procedure that reduces bagginess from lower eyelids and improves hooding of the upper eyelids. Upper blepharoplasty is a distinct surgery from upper eyelid ptosis repair, which raises drooping upper eyelids. Blepharoplasty often calls for the removal of excess skin, muscle, and underlying fatty tissue, but sometimes tissues can be repositioned rather than removed. While it is primarily a cosmetic procedure, blepharoplasty is also an effective method for improving sight in patients whose sagging upper eyelids obstruct their vision as determined by an ophthalmologist or oculoplastic surgeon.

Blepharoplasty with fat removal does not eliminate dark circles under the eyes or remove crow’s feet or other facial wrinkles. Other blepharoplasty techniques that employ fat repositioning or cheek lifting can improve dark circles. Blepharoplasty can be performed in conjunction with other facial surgery procedures, such as laser resurfacing or brow lifts.

How does aging affect eyelids?

As skin ages, it gradually loses its elasticity. A lack of elasticity, combined with the relentless pull from gravity, causes excessive skin to collect in the upper and lower eyelids. Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin forms that can hang over the eyelashes and obstruct vision. Bulges on the upper and lower eyelids can also be caused by the fat that cushions the eyeball from the eye socket. The thin membrane that holds the fat in place weakens with age, allowing the fat to protrude into the lids.

Who is a good candidate for blepharoplasty (eyelid surgery)?

The best candidates for blepharoplasty are individuals generally 30 years old or older who are in good health and who have no other eye conditions. Tell your doctor if you have any of the following conditions:

  • Eye disease, such as glaucoma, dry eye, or a detached retina
  • Thyroid disorders, such as Graves’ disease and under or overactive thyroid
  • Cardiovascular disease, high blood pressure, or other circulatory disorders
  • Diabetes

Be realistic about the expectations you have for blepharoplasty. Eyelid surgery can enhance your appearance and help build your confidence. However, you should not expect the surgery to drastically change your look. Many people have eyes that are not perfectly aligned or that appear to be different sizes. Asymmetrical features occur during the early stages of development. Blepharoplasty will not alter your facial structure. It is important to know your face well before you decide to have surgery. Think carefully about your expectations and discuss them with your surgeon.

What can I expect from blepharoplasty (eyelid surgery)?

Blepharoplasty takes 1-2 hours if both upper and lower eyelids are done at the same time, depending on whether fat is repositioned or if there is additional work to lift cheeks. There will be a stitch in both upper lids that will remain for about a week. The lower lids do not require sutures if the incision is made on the inside of the lid. It is common for swelling and bruising to occur in the upper and lower lids. Within one to two weeks the upper eyelids will look good. Upper lids show the incision line and take a bit longer than lower lids to look great. Expect to stay home from work and limit your activities for several days after surgery to allow your eyelids to heal. Some patients experience dry eyes after surgery, but the condition rarely lasts more than two weeks. If you have dry eyes for more than two weeks, contact your doctor.

Are the changes with blepharoplasty (eyelid surgery) permanent?

Blepharoplasty will not stop your eyes from aging. However, the results usually last a long time. Upper-eyelid surgery can last anywhere from 5 to 7 years to an entire lifetime, while lower-eyelid surgery rarely needs to be done more than once.

Caring for Yourself After Your Surgery

Follow these guidelines to care for yourself after your surgery.

  • Wear dark sunglasses during your trip home. You may be sensitive to light.
  • The ointment used during your surgery may make your vision blurry. This is temporary and usually goes away within 24 hours.
  • Don’t wear contact lenses until at least 2 weeks after your surgery. You can wear eyeglasses.
  • Do not drive until you have stopped taking pain medication and no longer have blurry vision. Make sure that you can safely and comfortably drive a car. This is usually about 5 to 10 days after surgery. 
  • It’s important to get quiet, peaceful rest during the first 3 to 4 days after your surgery. To do this:
  • Avoid activities such as heavy lifting and exercise.
  • Let your healthcare provider know if you’re having nausea (feeling like you’re going to throw up) or cold symptoms. It’s important for you to avoid sneezing, coughing, and vomiting (throwing up), as much as you can. These can raise your blood pressure and cause bleeding at your surgical sites.
  • Avoid bending at the waist or lifting items heavier than 5 pounds (2.3 kilograms) for 4 to 6 weeks after your surgery. Talk with your surgeon before going back to your usual activities, such as lifting and exercise.
  • Rest and sleep with your head raised on 2 to 3 pillows for 2 weeks or as directed by your surgeon. This will help prevent swelling at your surgical sites.
  • Your eyes may look swollen and bruised after your surgery. The eyelid swelling is usually worse early in the morning and will get better during the day as you sit or walk around.
  • You may also have swelling on your cheeks and jawline. This will start to get better 2 to 3 weeks after your surgery.