Find all kinds of information about facial plastic surgery to make your decision easier.

What Is Blepharoplasty?

Blepharoplasty is the term for any corrective or cosmetic surgery to the eyelids. In cosmetic surgery, it is a procedure to correct sagging or drooping of the eyelids, to remove excess fat, skin and atrophied muscle, or even some of the fat that is pocketed around the eye area.
As we get older, most people will start to see changes around their eyes. They will see more loose skin and bags below and above the eye. In some cases, loose skin and extra fat above the eye can make the upper lid seem to disappear. You start to have an older, more tired looking face. Blepharoplasty can correct these problems and give you a more youthful appearance.

If you are considering surgery to your eyelids, you should give serious thought to who will perform your surgery. It should be performed by a surgeon who is skilled and experienced with numerous types of faces and eyes. As with every surgery, there are risks. If your procedure is performed by a surgeon who is not experienced in cosmetic eye surgery, it could prove disastrous to your looks and even to the health of your eyes.

First, you have to understand what blepharoplasty cannot do. Blepharoplasty will not get rid of wrinkles around the eye—in what is called the periobital area. This includes crow's feet or wrinkles at the corners of the eye. It will not eliminate dark circles or lift your eyebrows. If you are concerned about dark circles under your eyes, see our Dark Under Eye Circles Section. If you are looking for a lift to your eyebrows, a Brow Lift will probably be a better choice. If you want to reduce or eliminate wrinkles, you could look into Laser Resurfacing in addition to blepharoplasty.

Cosmetic eyelid surgery can enhance your appearance and give your face a refreshed and more wide-awake look. can rid your eyes of its excess baggage and allow you to look as good as you feel.

In some cases, plastic surgery to the eyelids can be used to correct vision problems if they are caused by excess skin blocking the vision or an upper lid that hangs lower than it should. In such cases, your health insurance may cover the costs of the surgery. However, you should consult with your insurer about coverage before any surgery

Excess skin and fat can be removed with blepharoplasty for a more youthful, refreshed look

Understanding the Anatomy Around the Eye

The eye and the area around it are a complex structure made up of the eyeball, the muscles that control the eye’s movements, and the upper and lower lids and the muscles that control their movements. In addition, there are pads of fat around the eye that cushion it. These are all set into the orbit, which is the bony pocket in the skull that the eye sits in. All of this is then draped with skin. Above the eye, sitting on the bony ridge above the orbit, are the eyebrows.

As the years pass, the skin and fat around the eye start to show the effects of time and sun exposure. The skin can start to stretch and form bags under the eye and hang loosely above the eye. Genetics also play a role in this. The pads of fat may start to sag out of place, a process that is called fat herniation. (Hernia is medicalese for displaced or protruding.) This herniation may be due to weakening of the orbital septum, which is a thin sheet of fibrous tissue that hangs from the upper ridge of the orbit and keeps the orbital fat in its normal position.

In standard cosmetic blepharoplasty procedures, excess fat and skin are removed and, in some cases, the muscles around the eye that control the lids may be adjusted or rearranged. At one time, surgeons removed more fat around the eye than they do now, especially under the eye. Surgeons now lean toward repositioning the fat pads rather than aggressively removing fat, especially in the lower eyelid area. Too much fat removal can make the eyes look too hollow or unusually round and cause complications such as an eyelid that folds in (ectropion) or droops outward (entropion), either of which can cause eye irritation or infections.

Are You a Candidate for Blepharoplasty?

If you have loose, sagging eyelids, you may be a good candidate for cosmetic eye surgery if you are in good health, have no uncontrolled preexisting diseases or medical conditions, are mentally and emotionally stable, and have realistic expectations of what the surgery can do. Most individuals start to think about having blepharoplasty when they are in their late thirties to mid-forties, but there is no upper limit to the age at which you can have the surgery, assuming you are in good health.

You are probably not a good candidate for blepharoplasty if you suffer from hyperthyroidism. Hyperthyroidism is a result of an overactive thyroid gland, which can lead to myxedema, where you have edema (swelling from fluid retention) around your eyes. This swelling can look like excess or herniated fat, but it is not. Surgery will not help this condition. Hyperthyroidism can also lead to Graves’ disease, where the eyes can look swollen, but are being pushed forward by swelling behind the eyes. For these eye conditions, you need to consult with either an ophthalmologist or an endocrinologist, or both.

Please read about the risks, complications and contraindications of blepharoplasty, further down this page.

What to Expect at Your Consultation

You should collect the names of a few surgeons who specialize in cosmetic surgery to the eye. These surgeons should be board-certified and can be either board-certified plastic surgeons or board-certified ophthalmologists. An ophthalmologist is a medical doctor who specializes in care of the eye and surrounding structures.

After checking on the backgrounds and credentials of a few surgeons, make an appointment for a consultation with a few of them. A consultation is a chance for you to meet with a surgeon and discuss your goals for how you want to look.

During the consultation, you must disclose all information regarding your health including past illnesses and surgeries, and what medications you take. This is called your medical history. You may be asked to fill out a questionnaire about your medical history before the surgeon sees you. It is a good idea to go over your medical records to refresh your memory before meeting with the surgeon. Be sure to disclose:

Any allergies that you may have
All past illnesses of a serious nature
Any conditions such as asthma, diabetes, lung conditions, and any problems with circulation, including blood pressure
Whether you smoke
All medications that you take, including vitamins, herbal supplements, and over-the-counter medications.
Any past eye problems and whether you have had LASIK surgery on your eyes.

Your surgeon will explain the technique or methods that may be most appropriate for you and should discuss the risks associated with blepharoplasty with you, as well. He or she should also discuss whether your expectations are realistic and what other options you may have instead of surgery.

You need to make sure that you understand what blepharoplasty can do for you and what it cannot do. It can make someone look younger and well-rested, but it cannot make a 50-year-old look like a 20-year-old. Blepharoplasty can change how your eyes look, but will change nothing else about your life.

He or she will examine you and recommend whether you need surgery on all four lids, or just the upper or lower eyelids to give you the look you desire. You will discuss the placement of incisions.

You will also discuss what type of anesthesia will be used for your procedure. Most blepharoplasty procedures are performed under light sleep sedation or general anesthesia. There are risks to anesthesia that you must understand in order to make a fully informed decision to have surgery. Please read our All About Anesthesia Page. Your surgeon will also tell you whether the anesthesia will be administered by an anesthesiologist (a physician) or an anesthetist (a nurse or physician’s assistant).

During the consultation, you also need to discuss where the surgery will be performed and whether you need to stay overnight afterward. Cosmetic eye surgery can be performed in a hospital, in a free-standing surgical clinic, or in the surgeon’s office. Most patients having blepharoplasties can go home the same day as your surgery, but there are exceptions to this. In addition, ask about how many postoperative visits will be needed and whether these visits will be included in the surgeon’s fee.

You will discuss fees, medication costs and any "hidden" costs that may arise. Discuss with your surgeon your vision problems, if any, and tell him if you wear contacts or glasses and if you have ever had LASIK or other surgery to correct vision. If your eyelids interfere with your vision or if there are other problems with your eyes, the surgery may be covered by your health insurance.

At the consultation, you can look at photos of other people who have had surgery with the same surgeon. Although looking at photos of past work is no guarantee of your own outcome, it can help you determine your surgeon's idea of what is aesthetically pleasing and see if it matches yours.

For more information on consultations and a list of sample questions to ask your surgeon, visit the Consultation Help Page.

If you decide to book or reserve a surgery date, you will usually give a deposit to hold that date. Usually, this deposit is not refundable if you cancel a few days before your surgery, so if you have to cancel, do so well in advance.

The next step is to schedule a preoperative appointment.

Your Preoperative Appointment

The preoperative appointment is a second chance to ask questions you may not have thought to ask at the consultation. It is also another chance to make sure your surgeon is aware of what you desire from your procedure and for your surgeon to make sure you know what it realistically possible from this procedure.

You will also go over your preoperative instructions and what to expect during recovery and the months ahead. You will also be instructed on how to clean your eyes postoperatively. You may be given or asked to purchase icepacks, gel masks, or other products to use directly after surgery. Some surgeons instruct you to wear eye guards while you sleep for a few days after surgery so that your eyes are not accidentally rubbed or disturbed.

At this appointment, you will probably be given prescriptions for antibiotics and pain relievers so that you can fill the prescriptions and have the medications on hand when you get home after surgery.

Please do not hesitate to ask any questions or voice any concerns that you may have during this appointment. If you remember something when you get home or the next day, don't be afraid to call the surgeon and ask.

Preparing for Your Surgery

The information packet you received at the preoperative appointment should explain everything you should do and know before your surgery date. The packet should include a list of all the medications you should avoid taking for at least 2 weeks before your surgery. The most common products on this list will be anything containing aspirin or ibuprofen, which can promote bleeding. We have a list of medications that you may be told to avoid here, however you should have already told your surgeon all the medications that you commonly take, including vitamins and herbal products.

You will probably need to have blood tests done. The surgeon’s office may do this, or you may be sent to your regular physician to have the blood drawn. Blood tests are usually an extra out-of-pocket expense, but they are necessary to check for various health conditions, including infections, anemia, and clotting disorders. If you are a woman, you may be asked to have a pregnancy test.

Some surgeons ask that you have a complete physical exam before your surgery, especially if you have any underlying conditions such as diabetes or asthma. This will be another out-of-pocket expense.

We have a Preparing For SurgeryPage with more information.

How a Blepharoplasty Is Performed

A blepharoplasty usually takes between 1 and 3 hours to perform. If you are having upper and lower blepharoplasty, surgery will last closer to 3 hours. Generally, upper blepharoplasty will be performed first. Larger amounts of skin are excised for upper blepharoplasty and the swelling is more intense than with the lower lids. The exception is when unusually large bags under the eyes are to be removed.

First, you will undress and be given a hospital gown to wear. The anesthetist or anesthesiologist may meet with you briefly to ask a few questions discuss the anesthesia. You may be given an oral sedative or Valium to reduce any anxiety.

Once you are on the operating table, you will be connected to gear that will monitor your blood pressure, breathing, blood oxygen levels, and other vital signs. In most cases, you will have an intravenous (IV) line started. This will be used to administer fluids and medications. A bag of saline fluid will be attached to the IV line.

You will then be marked with a surgical marker to show where the incisions will go, although this marking is sometimes done before you are sedated. You may be injected with a solution of lidocaine and epinephrine. Lidocaine is a local anesthetic and epinephrine is a vasoconstrictor, which means that it narrows the blood vessels and helps decrease the risk of excessive bleeding.

For blepharoplasty, incisions can be made on the outside of the eyelids or inside the lower lid. If the incisions are outside the lids, your surgeon will usually use incisions that follow the natural lines and creases of the lids. On the lower lid, the incision may be made just below the line of the eyelashes, where it will usually be hidden. In some cases, the incisions may extend into the crow's feet area at the outer corners of your eyes. Your surgeon will make every attempt to ensure that any scars are as inconspicuous as possible.

Incisions for upper and lower blepharoplasty are placed within the
natural folds of the eyelids, where they will be hidden after they heal.

For some patient, those with bags beneath the eyes, but who have skin with a lot of elasticity, the surgeon may choose a transconjunctival incision. The incision is made on the inside of the lower lid, through the membrane called the conjunctiva. With this procedure, fat is removed through this incision with no visible scarring.

After the incisions are made, the surgeon will separate the skin from underlying tissue and muscle and remove excess fat if needed. Sometimes muscle tissue is removed as well. The surgeon then trims excess sagging skin, if necessary. During the surgery, your eyeball will be protected with a special guard that looks similar to a large contact lens.

The incisions are then closed with very fine sutures, which will be left in from 2 to 5 days. The surgeon will then lubricate your eyes with an ointment and will perhaps apply a dressing.

You are then awakened and brought into the recovery room where a staff member will monitor you until you are ready to be released. This is dependent upon the individual but may take 2 hours or more. As the anesthesia wears off, your eyes may feel tight, hot, and tender. If you are in any pain, you can ask for a pain reliever.

The experience of coming out of anesthesia varies from person to person. You may feel emotional or upset or may experience rigors or shivering. You can ask for a warm blanket and some facilities offer their patients a heat lamp.

If you had general anesthesia, you may feel a little sick or nauseated as you come awake. Tell a staff member if you think you are going to throw up. You can ask for cool water to sip, which can help settle your stomach.

You must be driven home by your spouse, a family member, or a friend. You will not be able to drive yourself home and will not be allowed to in any event. You will be groggy and it is unlikely you will be able to see clearly for at least a day or so.

Your prescribed pain medication should alleviate any pain. However, if you are in a great deal of pain once you get home, call your surgeon or the on-call staff immediately.

The Road to Recovery

When you get home, you still may be groggy from the anesthetic. You will have to take it easy for the first 7 to 14 days. You will be instructed to keep your head elevated even while sleeping for several days. Two to three medium-sized pillows should do the trick or you can get one of those inclined foam wedges.

You must take your temperature regularly. An elevated temperature could mean an infection. Take your antibiotics on time and take them as prescribed. If your surgeon prescribed 7 days of antibiotics, don’t stop taking them on day 5 because you feel fine. Doing that leads to antibiotic-resistant infections.

Women, if you are taking birth control pills, don't forget that some antibiotics can interfere with them so in the event that you have sex, use another form of birth control.

You will probably be told to use cold compresses on your face and eyes to keep swelling and bruising to a minimum. You can buy cold compresses at a pharmacy or online. Buy at least two so that one is in the freezer while you are using the other.

In the first 3 days, you will notice that your eyes will look even more swollen than they did on day 1. For the first few days, you will probably not look good. But, as the days go by, the swelling will slowly dissipate. You may have moderate bruising and you may have a pair of black eyes. The amount of bruising varies with the individual. This too will go away. The eye area is delicate and it bruises and swells easily. Make a mental note to yourself that you will look very bruised or you might be shocked into a depression.

You should begin cleaning your eyes and the area around them as you were shown at the preoperative visit. Your surgeon may recommend using eye drops or a wetting solution to help keep your eyes lubricated. It is possible that your tear glands will not be able to produce enough tears to lubricate your eyes properly for the first few days or even weeks. The opposite, excessive tearing, can also happen. You may also experience light sensitivity and blurred or double vision. You may be instructed to wear a special eye mask over your eyes while sleeping to keep you from accidentally applying pressure or rubbing your eyes while you sleep.

Your sutures will be removed generally about 3 days after surgery. Swelling will begin to subside at the end of a week, although it may take up to 3 weeks to resolve.

If you wear contact lenses, you will be instructed not to wear them for a period of time after your surgery. Even after that time, your contacts may not feel comfortable for a while. You may experience excessive tearing or dryness from lack of tears until the healing process is complete. Things should return to normal after a few weeks.

Most patients can return to work 7 to 10 days after surgery, although swelling and bruising will usually still be present to some degree. You should limit your sun exposure because your eyes will be sensitive to bright light. Protect your incisions with a strong sun block, but make sure the sun block is safe for eyes and will not irritate them and avoid getting sun block in your eye. If this should happen, rinse your eyes thoroughly and apply your wetting drops to soothe any irritation.

Avoid too much eye movement for the first 5 days or so after surgery. Even if you are feeling better, you should take it easy while you are recovering. Do not participate is strenuous activates for at least 3 weeks. And absolutely no contact sports until your surgeon gives you permission!

Your bruising will subside within a few weeks. After your surgeon gives you the go ahead, you can begin wearing cosmetics to hide residual bruising and redness. But never apply cosmetics while you have sutures in place or if your incision lines are not fully closed as this could cause an infection. Only apply cosmetics after your surgeon gives you the go ahead.

You may feel sad or depressed during your recovery. Although this is rare, it does happen due to a combination of the lack of activity, medications, the swelling and bruising, and a natural period of let down post-operatively. See our Postoperative Depression Section for more information.

Risks and Complications Associated with Blepharoplasty

Please read this section carefully. Many people think of cosmetic surgery as minor surgery. Surgery is surgery and there will always be risks. There are also risks to anesthesia.

To reduce your risks, make sure your surgeon knows your complete medical history and that both the surgeon and anesthesiologist have a list of all medications you take.

Certain people are at greater risk of complications if they have eye surgery. If you have thyroid problems (hypothyroidism or Graves' disease) or insufficient tearing (dry eyes), circulatory disorders or high blood pressure, having blepharoplasty may be more risky for you than an individual without such disorders. Other disorders that may increase your risks are myasthenia gravis, diabetes, a detached retina or glaucoma (high pressure within the eye), and poor skin elasticity.

Minor complications that are associated with blepharoplasty include double or blurry vision for a few days, temporary swelling at the corners of the eyelids, and tiny whiteheads on the eyelids. It is possible to develop asymmetry of the eyes during healing, since your eyes may not heal at the same rate. This asymmetry may be permanent, however. There is also the risk of excessive scarring.

A more serious complication is difficulty blinking or in keeping your eyes closed while sleeping. In rare instances this condition may be permanent and lead to problems associated with dryness of the eyes. Another risk is ectropion, a condition where your lower lids pull down or gape postoperatively. Similarly, the edges of your lids may pull inward, a condition called entropion, which can cause your eyelashes to rub against your eyeball. For either ectropion or entropion, you may need further surgery to correct the problem, which could lead to more risks and more cost to you.

Sometimes the lids will not heal correctly and you may have to have additional surgery to correct the problem. Many surgeons do not charge additional fees if another surgery is necessary. Ask your surgeon about his or her policies on revision surgery and costs before you commit to your surgery. Get this in writing.

There is also the risk your doctor may remove all or too much of the fat pads under your eyes, a practice most surgeons are discontinuing. Patients can end up with sunken eyes, hollowness under the eyes, and a tired, aged look. This sometimes can be corrected with fat grafting or using injectable fillers, but it is better to avoid this situation. It can also result in smaller, rounder eyes or eyes that do not close properly. This will change the appearance of your eyes rather than rejuvenating them. Again, you may end up needing another surgery.

There is also the risk that you will not like the results of your surgery. In other words, nothing is medically wrong, but you just don’t like how you look. You can reduce this risk by carefully choosing your surgeon and by talking frankly with him or her about what you want out of blepharoplasty.