Eyelid Surgery: What You Need to Know

Eyelid surgery (blepharoplasty) tightens and lifts sagging eyelid skin. In some cases, it may also include the removal or redistribution of herniated fat (also called “fat transposition”) in the lower eyelids.

“For most patients, the goal of eyelid surgery is to look younger and less tired,” says Dr. Mitesh Kapadia, an oculoplastic surgeon in Boston. 

Also known as a lid lift, this surgery can be done on upper lids (an upper blepharoplasty), to remove excess skin and raise hooded or droopy eyelids, and on the lower lids (a lower blepharoplasty), to remove eye bags and tighten loose skin. These procedures can be performed separately or at the same time.

“Frequently, eyelid surgery is performed with other facial rejuvenation procedures, such as a facelift, browlift, or fat transfer,” says Dr. Hessler. It can also be combined with canthoplasty, another type of eye plastic surgery that’s commonly called cat-eye lift surgery. 

If your goal is to create or refine your eyelid crease, learn more about double eyelid surgery. “This specialized upper eyelid surgery is commonly requested by patients of Asian ethnicity,” explainsDr. Vu Ho, a facial plastic surgeon in Plano, Texas, who regularly performs both types of eyelid surgery.

What is it really like to get lower eyelid surgery? Our new video series, In the OR, follows 33-year-old Mariella from her first consultation with board-certified oculoplastic surgeon Dr. Mehryar (Ray) Taban in Beverly Hills, California, to her final result. Watch the first episode below, and then visit the RealSelf News blog to see the rest of the series.

Pros

• A blepharoplasty procedure can make you look refreshed and awake, while giving you a more youthful appearance.
• An upper blepharoplasty, which addresses excess eyelid skin (and occasionally involves eyelid fat removal), has “a great variety of beneficial functional outcomes, including an increased visual field and improvement in headache- and vision-related quality of life,” according to a 2019 survey of 28 studies, published in the Journal of Plastic & Reconstructive Aesthetic Surgery.
• Blepharoplasty surgery is an outpatient procedure that usually takes less than an hour. 
• It can be done under local anesthesia, combined with oral sedation to help keep you relaxed, so the only pain you'll feel during the procedure is from the anesthesia shot.
• Recovery from eyelid surgery is fairly easy, with about one week of sometimes significant swelling and bruising. “Fortunately, patients are often surprised at how little pain is involved,” says Dr. Ho. 
• Because the incisions are made in the natural eyelid crease, they're difficult to detect once healed. 
• An eyelid lift that’s done to correct impaired vision due to extra skin on the eyelid (not just for cosmetic reasons) may be covered by health insurance.

Cons

• You’ll need 4-7 days of downtime, “but most of this is due to the bruising and swelling that keeps patients away from social interactions,” explains Dr. Ho.
• Swelling, bruising, and dry eyes are common side effects. Dry eye or irritation can linger beyond the initial recovery period. Be sure to inform your blepharoplasty surgeon if you have a pre-existing problem with dry eyes, Dr. Ho recommends.
• While results are long-lasting, the natural aging process will continue, so some people will need their eyelids lifted again after many years.
• While blepharoplasty complications are rare, the anatomy around the eye is delicate, and there is a risk of injury to muscles, nerves, and eyelashes.
• If too much eyelid skin is removed from the upper eyelids, the procedure can affect your ability to fully close your eyes.  
• Removing too much skin from your lower eyelids can result in eyelid malposition, pulling down the eyelids.

Removing too much eyelid fat during a lower blepharoplasty can result in premature hollowing and dark circles. This can be improved by a facial fat transfer (a long-lasting solution) or injectable dermal fillers (a temporary fix). “Fat transfer can restore the patients’ natural volume, to subtly enhance and rejuvenate the face,” says Dr. Jill Hessler, a board-certified facial plastic surgeon in Palo Alto, California. However, fat transfer under the eyes is also a delicate procedure, and it's expensive.

• Average Cost:
• $4,675

• Range:
• $75 - $9,300

The price you pay for eye lift surgery will depend on your surgeon’s credentials, their location, the extent of your procedure, and a few other key factors.

Lower eyelid surgery is often more expensive than an upper-lid-only procedure, because it can be more complex and may require general anesthesia.

Related: 7 Women Who Got Eyelid Surgery Share What They Paid and Whether It Was Worth It

Insurance won't cover a cosmetic eye surgery, but if severe ptosis (pronounced TOE-sis) and hooded lids are affecting your field of vision (a common issue for people in their 60s and 70s), your health insurance may cover a portion of the cost for drooping eyelid surgery.

See our complete guide to eyelid surgery costs

Good candidates for eyelid plastic surgery are healthy nonsmokers, with one or more of these eyelid concerns:

For lower eyelid surgery, ideal candidates have:

• under-eye puffiness or eye bags caused by fat pads in the lower eyelid, which can bulge due to hereditary factors or aging 
• signs of aging, such as loose skin, eyelid wrinkles, or crepey skin texture. 

Good candidates for an upper blepharoplasty may have:

• hooded, heavy eyelids
• droopy eyelids (ptosis), typically caused by excess eyelid skin
• asymmetry

To qualify for insurance coverage for upper eyelid surgery, you’ll need to provide documentation that the eye lift is medically necessary due to vision impairment from sagging lids.

Dr. Ho explains, “Oftentimes, there is also the presence of bulging fat pockets on the inner aspect, which can easily be removed at the same time.”

If you want to go this route, start by checking with your insurance provider to see what kind of documentation they require. This may involve a visual field test, along with photos. Also talk with your doctor about whether your impaired vision makes it difficult to drive, read, or perform other normal activities.

Patients with glaucoma or a detached retina will need to consult with an ophthalmologist before considering this procedure.

RealSelf Tip: Dr. Cameron Chesnut, a dermatologic surgeon based in Spokane, Washington, says that "changes in the forehead, eyebrow, and eyelid can all contribute to eyelid hooding, and delineating the exact combination is important before making a plan for correction." He notes that "very rarely does only one portion of this combination need to be addressed," which is why some patients combine upper and lower blepharoplasty with a brow lift or a nonsurgical solution, like injectable fillers, to restore volume and lift the forehead.

Related: Brow Lift or Blepharoplasty? How to Know Which Is Right for You, According to a Plastic Surgeon

Most people interested in upper and lower eyelid surgery are over 40, the age when you typically see changes as the eye skin loses elasticity and begins to droop. However, the surgery is still an option for younger people seeing eye bags or signs of aging sooner—or anyone who’s unhappy with the natural shape of their eyelids or eyelid crease.

Related: 4 Reasons Why Younger Patients Getting Eyelid Surgery

After your consultation—during which you’ll discuss your eyelid concerns and goals and ask your surgeon any questions you may have—your doctor’s team will provide you with very specific pre-op instructions to help prepare you for your blepharoplasty procedure.

You may be asked to:

• See your primary care physician for blood work or a medical evaluation to ensure you’re healthy enough for elective blepharoplasty surgery
• Get an eye exam to assess baseline vision and eye health
• Have standardized “before” photographs taken by your surgeon’s team
• Adjust your medications at least two weeks prior to surgery and stop taking certain drugs or supplements, like aspirin, ibuprofen, and fish oils, that can increase bleeding and bruising
• Stop smoking, vaping, and using nicotine products at least one month before eyelid lift surgery
• Get a COVID-19 test several days before surgery, as determined by your doctor
• Pick up prescription medications that you’ll need directly following your eye lift
• Arrange for a friend or family member to drive you to/from your surgery, stay with you that first night, and take you to your post-op appointment the next day

Upper Blepharoplasty 

For cosmetic surgery on your upper eyelids, you will receive local anesthesia, to numb the area. Markings will be made prior to upper bleph surgery with you sitting up, to determine the exact amount of skin to be removed. 

Once you’re numb, your blepharoplasty surgeon will make an incision along the natural crease in your eyelid and remove any excess skin. Occasionally, a small amount of upper eyelid fat is removed as well. 

“It basically involves cutting and suturing the eyelid back together,” says Dr. Kapadia. “Most of the time, we’re just removing extra eyelid skin, but sometimes we’ll also do a muscle tuck, to make the eye appear more open,” he says.

Both upper and lower eyelid surgeries can be performed with a scalpel or a laser. When used correctly, the two tools yield similar results—it’s a matter of surgeon preference. Doctors who favor a laser say that there’s less bleeding, while others claim that the incisions take longer to heal.

Lower Blepharoplasty 

Lower eyelid surgery can be a bit more uncomfortable for a patient, so Dr. Kapadia performs it under intravenous sedation or general anesthesia. 

This procedure can remove or reposition extra eyelid fat, tone down puffiness, and tighten lax or sagging skin.

If your surgeon will need to remove excess skin, the incision is usually made just below or behind the lower lash line. 

If the goal is to remove or reposition excess fat, incisions are typically made on the inside of the lower eyelid. This internal blepharoplasty technique, called the transconjunctival approach, leaves no visible scar.

Dr. Chesnut uses a transconjunctival technique for the lower eyelids, and he prefers not to remove skin and fat pads because of the danger of creating under-eye hollows. “We know that we tend to lose fat in our face as we age. Taking more out may look good immediately, but it is a bad idea in the long term.” 

Using the transconjunctival approach, Dr. Chesnut says, “the existing fat is repositioned, giving much better long-term results with a more conservative surgical technique that also has lower potential for blepharoplasty complications.”

The support muscles in the lower eyelids may also need to be tightened. “If eyelid laxity is not addressed at the time of eyelid surgery, there is an increased risk of eyelid malposition,” says Dr. Hessler. She often performs a midface lift and eye muscle suspension, or canthopexy, with supporting sutures for patients with eyelid weakness, as a droopy eyelid surgery.

RealSelf Tip: When choosing your doctor, seek out an oculoplastic surgeon who is certified by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) or a facial plastic surgeon certified by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

Related: 8 Things to Know If You're Considering Eyelid Surgery

Upper eyelid surgery can take 30 minutes to an hour, while a lower eyelid surgery takes slightly longer, unless only a transconjunctival approach is used. 

If fat transfer is also performed, this can add about 30 minutes.

Since an eyelid lift is typically done in an outpatient setting, plan to have someone you trust drive you to and from the surgery center or hospital.

Blepharoplasty surgery is considered to be safe, with minimal side effects. However, like any surgical procedure, it comes with risks and possible complications, including a reaction to the anesthesia or infection. 

Risks and side effects associated with both upper and lower blepharoplasty include:

• swelling, including chemosis (swelling of the lining of the eyeball)
• bruising 
• bleeding
• temporarily blurred vision (from a lubricating ointment that’s applied to your eyes), 
• Infection (ask your blepharoplasty surgeon about signs of infection such as pain, redness, pus, warmth, and fever)

You may also have watery eyes, double vision, light sensitivity, or discomfort during your recovery.

According to a 2013 study in the Journal of American Medicine Association Facial Plastic Surgery, dry eye problems can develop or become more noticeable after an eyelid lift. This can be treated with medicated eye drops. 

It's important to have your eyes tested prior to surgery to detect any pre-existing dry eye. This wouldn’t mean you can’t undergo surgery, but you should start using eye drops prior to surgery, and your eyelid surgeon may take a more conservative approach.

One of the most rare but difficult to correct blepharoplasty complications is having too much skin removed, which can make it difficult to fully close your eyes. Going to an experienced surgeon who specializes in eyelid lifts will help minimize this risk. 

To understand all potential risks, talk with your surgeon and disclose any medical conditions you have. “Even in the most experienced hands, surgical complications are possible, though highly unlikely,” explains Dr. Thomas J. Walker, a plastic surgeon in Atlanta.

Eyelid surgery recovery is different for everyone. Dr. Kapadia suggests his patients take a full two weeks of downtime, but he says that many are back to work after just seven days. “For most people, the first 7–10 days are the worst of it,” he says, though most patients don’t experience significant pain during blepharoplasty recovery.

The full healing process can take several months, depending on the extent of your procedure. If minimal eyelid fat is removed, healing could be as rapid as a few days. If you’ve had more extensive muscle dissection, midface lifting, or fat repositioning performed, recovering from eyelid surgery may take longer. It could be many weeks to months until you’re looking your best.

Here’s what you can expect during recovery from blepharoplasty:

• You’ll have the most serious bruising and swelling during the first week after an eyelid lift surgery.
• If your blepharoplasty surgeon didn't use dissolvable sutures, you’ll have a follow-up visit after one week to remove them. Once they're out, you can apply make-up over the incision line to help camouflage the incisions in the eyelid crease. 
• As you heal, you’ll need to ice your eye area or apply cool compresses at least four times a day.
• Sleep upright, propped up with extra pillows, or even in a chair to help minimize swelling. 
• Use any prescribed eye drops or ointments and keep your eyelids clean to reduce your chance of infection. 
• Avoid over-the-counter pain medication like aspirin and ibuprofen, since these can potentially increase bleeding. For pain management, consult with your doctor regarding their preferred methods.
• You’ll be able to resume strenuous activities, including exercise, within one to two weeks.
• If you wear contact lenses, you’ll have to keep them out for at least two weeks after surgery. Touching or pulling on the area near the incisions can increase the risk of infection and cause the incisions to reopen. 
• The American Society of Plastic Surgeons recommends wearing darkly tinted sunglasses until the healing process is fully complete. This can help shield your sensitive eyes and skin, and help conceal bruising, during your eyelid surgery recovery time. “Minimizing direct sunlight exposure on any incisions is important to lessen the risk of scar discoloration,” Dr. Ho explains.
• A majority of the swelling will be gone within two weeks, but it takes up to six months for all the swelling to resolve enough for you to see the final results.
• Blepharoplasty scars in the eyelid crease or just under the lash line on the lower lid should fade within the year, until they’re barely visible.

Related: 4 Signs of a Great Eye Lift: Plastic Surgeons Say These Outcomes Have These Things in Common

Results can last 10 to 15 years, and sometimes longer. 

As your skin continues to age and droop, you may need a second procedure. “We’re not stopping the aging process, just setting it back a bit by making your eyelids look like they did when you were younger,” says Dr. Kapadia. 

Whether or not an eyelid surgery will be worth it for you depends on your aesthetic goals and the severity of your aging eyelids or eye bags. That said, this surgery has a 94% Worth It Rating from RealSelf members, with some reviewers even calling it the "best decision" they've ever made. 

Those who say it was “Not Worth It” cited uneven or otherwise unsatisfactory results. 

For the best eyelid surgery experience possible, choose your surgeon carefully, with a focus on credentials, experience, positive patient reviews, and an impressive gallery of eyelid surgery before and after photos.

For cutting-edge information on eyelid rejuvenation, tune in to this video, where New York City-based, board-certified plastic surgeon Dr. Barry Weintraub explains all about eyelid lifts and answers the all-important question: is an eyelid lift Worth It?

	Laser Resurfacing nonsurgical	Thermage nonsurgical	Botox nonsurgical	Juvéderm nonsurgical
Worth It Rating	88%	67%	96%	90%
Average Cost	$1975	$2450	$550	$750
Downtime	1–12 days of downtime (depending on intensity)	Minimal downtime	No downtime	No downtime
Anesthesia	Topical anesthesia	No anesthesia	No anesthesia	Topical anesthesia

It’s not really possible to get a meaningful nonsurgical eyelid lift, but a few nonsurgical treatments can help to a small extent. Keep in mind, nonsurgical outcomes are never on par with those from a surgical blepharoplasty procedure.

“A resurfacing laser can refresh and rejuvenate the eyes without a scalpel,” says Dr. Hessler. Using an erbium or carbon dioxide (CO2) laser can tighten the skin while smoothing out fine lines and eyelid wrinkles. This skin resurfacing procedure can have a dramatic effect, but it can take 3-7 days for healing. 

Thermage is an FDA-approved skin rejuvenation treatment that uses radiofrequency energy to tighten skin, and it’s safe for use around the eyes. The best candidates have only mild to moderate sagging. 

Sofwave, which firms with ultrasound energy, is newly indicated for eyebrow lifts. Raising the brows by a couple of millimeters can help to subtly lift the upper eyelids. Veteran ultrasound device, Ultherapy, is often used for the same purpose.

Related: 8 Ways to Achieve a More Lifted Eyelid Without Surgery

Injectables are another option. “Droopy eyelids can be improved nonsurgically, with the use of Botox or Dysport, which can raise your eyebrows,” says Dr. Scott Trimas, facial plastic surgeon in Jacksonville Beach, Florida. 

Botox can be injected into the muscles that pull the eyebrows down, temporarily relaxing these muscles allowing the eyebrows to raise naturally. The effect is temporary, lasting 3-6 months, and results aren’t always predictable. “Despite its simplicity, this option has the drawback of sometimes being imprecise, as the amount of change can vary from one treatment to the next,” Dr. Ho explains. 

Other alternatives include fillers, such as Juvéderm or Restylane, strategically placed to elevate the corners of the brows and pull the lids with them.   

In lower eyelids, strategically placed fillers can camouflage puffy or baggy under-eyes: injecting a filler into the indent just below the bag creates the appearance of a smooth surface from upper cheeks to eyes, making minor bags less obvious. 

Ideal candidates for nonsurgical under-eye treatments have tight skin with mild under-eye hollowing or bags. Just be aware that under-eye filler also comes with risks. “Again, it is paramount to seek out providers who are well-experienced and who are capable of handling any potential complications,” Dr. Ho cautions.

Related: 8 Ways to Get Rid of Under-Eye Circles