Eyelid Surgery Guide

What it is: Blepharoplasty is a plastic surgery procedure meant to address excess fat, wrinkled or drooping skin of the upper eyelids; or bags and puffiness under eyes (lower eyelids). Blepharoplasty surgery is also referred to as Eyelid Surgery.

Inside this Guide
1. Who should consider Blepharoplasty?	6. Recovery
2. Doctor Consultation: what to ask	7. What to expect
3. Getting ready for Blepharoplasty Surgery	8. Side Effects
4. During Blepharoplasty Surgery	9. Cost
5. After Blepharoplasty Surgery	10. Terminology to know

Search terms:  Blepharoplasty Surgery, Eyelid Surgery, Plastic Surgery Blepharoplasty, Eye lift, double eyelid surgery, upper eyelid surgery, lower eyelid surgery, sagging eyelids

Blepharoplasty involves either upper or lower eyelid surgery, or both:

For upper eyelid surgery, generally an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it usually is inconspicuous.

For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. Placement of the incision in natural crease lines allows for the scar to usually heal in an inconspicuous fashion.

In some cases, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.

Additional Considerations:

• If the upper eyelid condition is accompanied by sagging of the eyebrows, a forehead lift may be recommended.
• Smoothing of crow's feet may be accomplished with Botox, chemical peeling or laser resurfacing procedures.
• Circles beneath the eyes caused by dark pigmentation may be treated with fillers such as Hyaluronic Acid or fat as well as bleaching solution or chemical peel.

Who should consider Blepharoplasty?

Any of the following conditions may indicate that you might be a good candidate for Blepharoplasty.

Eyelid surgery can improve:

• Excess skin obscuring the natural fold of the upper eyelids
• Loose skin hanging down from the upper eyelids, perhaps impairing vision
• A puffy appearance to the upper eyelids, making the eyes look tired
• Excess skin and fine, “crepe paper type” wrinkles of the lower eyelids
• Bags and dark circles under the eyes
• Lower eyelid droopiness

Doctor Consultation: what to ask about eyelid surgery

In addition to your surgeon performing a history and physical examination, your doctor consultation is the time to ask questions.

• See the Blepharoplasty consultation checklist
• Read about the experiences of others who've had Blepharoplasty surgery. See real eyelid surgery stories.

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with eyelid surgery.

Your plastic surgeon will want to know if you have allergies, especially if they affect your eyes. He or she may ask whether you have ever tried and were unable to wear contact lenses. It will be necessary for your surgeon to know if you were ever told by an ophthalmologist that you have a condition called "dry eye" or if you have any other problems with your eyes.

Getting ready for Blepharoplasty surgery

If you are a smoker, it is highly recommended to stop smoking well in advance of surgery. Smoking can impair your ability to heal. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Blepharoplasty is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours.

During Blepharoplasty surgery

Your eyelid surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

After Blepharoplasty surgery

You will be taken into a recovery area and a bandage may be wrapped around your face. Sometimes small tubes will be inserted beneath the skin to drain away fluid that might otherwise accumulate. There is surprisingly very little discomfort experienced after facelift surgery. However, any discomfort you may experience will be controlled with pain medication as needed. You may be permitted to go home after a few hours, although some patients may stay overnight in a hospital or surgical facility.

Recovery from Blepharoplasty

It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

The first few days: You should rest quietly with your head elevated. Your surgeon may instruct you to apply cold compresses to your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications. Initially, you may feel a "tight" sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persist for several weeks, while others may see swelling resolve in as little as one week.

Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. Some plastic surgeons recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.

Within 7 to 10 days: Bruising typically disappears within seven to ten days. Within the first week or so, you will be permitted to use makeup, if desired, to conceal any discoloration. Stitches are usually removed within a week of surgery.

Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult. 

Results: what to expect from Blepharoplasty surgery

Eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months usually becoming barely visible.

The results of aesthetic eyelid surgery are usually long-lasting, but they may be affected by heredity and lifestyle factors.

Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along with the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure.

Eyelid surgery side effects

Fortunately, significant complications from aesthetic eyelid surgery are infrequent. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office. The risks in most surgeries are similar.

Potential risks include:

• hematoma (an accumulation of blood under the skin that may require removal)
• infection
• changes in sensation
• scarring, allergic reactions
• damage to underlying structures
• need for revisions
• unsatisfactory results possibly necessitating additional procedures and medical risks

Following the surgery, there can be a feeling of dryness or irritation in the eye that requires treatment. There is a possibility of impaired eyelid function that sometimes may need to be corrected by additional surgery.

You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery. 

Blepharoplasty cost

Eyelid surgery cost can vary widely as reflected in the Blepharoplasty cost data posted on RealSelf.com. A surgeon’s cost for blepharoplasty may vary based on his or her experience, the type of procedure used, as well as geographic office location.

Costs may include:

• Surgeon’s professional fee
• Facility fee
• Anesthesia fee
• Medications
• Surgical garments
• Medical tests

Terminology to know

• Eyelid Surgery: Aesthetic eyelid surgery can brighten the face and restore a more youthful appearance by reducing the fat that causes bags beneath the eyes and removing wrinkled, drooping layers of skin on the eyelids. Blepharoplasty is often performed along with a facelift or with other facial rejuvenation procedures. Incisions follow the natural contour lines in both upper and lower lids, or can be done through the lining of the lower eyelid, providing access to skin and fatty tissue. The thin surgical scars are usually barely visible and blend into the eyes' natural lines and folds.

• Forehead Lift (Brow Lift): The forehead lift is designed to correct or improve skin wrinkling, as well as loss of tone and sagging of the eyebrows that often occurs as part of the aging process. The procedure may also help to smooth horizontal expression lines in the forehead and vertical frown lines between the eyebrows. Incisions are placed behind the hairline above the ear and pass over the top of the head. In some cases, incisions may be placed in front of the hairline. Some patients may have the procedure performed with the use of an endoscope, requiring much shorter incisions. Improvements are made beneath the skin and on the deep muscles; skin and muscle are then tightened to give a fresher, more youthful appearance.

• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Hematoma: Blood pooling beneath the skin.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Tear trough: Deep creases below the lower eyelids.
• Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.

• Transconjunctival Blepharoplasty: Transconjunctival blepharoplasty (eyelid surgery) is performed by making an incision from inside the lower eyelid. It avoids any scarring on the lower lid. It is a useful technique when only fat, and not skin or muscle, needs to be removed from the eyelid area