Eyelid Surgery (Blepharoplasty)
If you're considering eyelid surgery...
Eyelid surgery (technically called blepharoplasty) is a procedure to remove
fat--usually along with excess skin and muscle from the upper and lower
eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below
your eyes - features that make you look older and more tired than you feel,
and may even interfere with your vision. However, it won't remove crow's
feet or other wrinkles, eliminate dark circles under your eyes, or lift
sagging eyebrows. While it can add an upper eyelid crease to Asian eyes,
it will not erase evidence of your ethnic or racial heritage. Blepharoplasty
can be done alone, or in conjunction with other facial surgery procedures
such as a facelift or browlift.
If you're considering eyelid surgery, this information will give you a basic
understanding of the procedure-when it can help, how it's performed, and
what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.
The best candidates for eyelid surgery
Blepharoplasty can enhance your appearance and your self-confidence, but
it won't necessarily change your looks to match your ideal, or cause other
people to treat you differently. Before you decide to have surgery, think
carefully about your expectations and discuss them with your surgeon.
The best candidates for eyelid surgery are men and women who are physically
healthy, psychologically stable, and realistic in their expectations. Most
are 35 or older, but if droopy, baggy eyelids run in your family, you may
decide to have eyelid surgery at a younger age.
As people age, the eyelid skin stretches,
muscles weaken, and fat accumulates
around the eyes, causing "bags" above
A few medical conditions make blepharoplasty more risky. They include thyroid
problems such as hypothyroidism and Graves' disease, dry eye or lack of
sufficient tears, high blood pressure or other circulatory disorders, cardiovascular
disease, and diabetes. A detached retina or glaucoma is also reason for
caution; check with your ophthalmologist before you have surgery.
All surgery carries some uncertainty and risk
When eyelid surgery is performed by a qualified plastic surgeon, complications
are infrequent and usually minor. Nevertheless, there is always a possibility
of complications, including infection or a reaction to the anesthesia. You
can reduce your risks by closely following your surgeon's instructions both
before and after surgery.
The minor complications that occasionally follow blepharoplasty include
double or blurred vision for a few days; temporary swelling at the corner
of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads
may appear after your stitches are taken out; your surgeon can remove them
easily with a very fine needle.
Following surgery, some patients may have difficulty closing their eyes
when they sleep; in rare cases this condition may be permanent. Another
very rare complication is ectropion, a pulling down of the lower lids. In
this case, further surgery may be required.
Planning your surgery
The initial consultation with your surgeon is very important. The surgeon
will need your complete medical history, so check your own records ahead
of time and be ready to provide this information. Be sure to inform your
surgeon if you have any allergies; if you're taking any vitamins, medications
(prescription or over-the-counter), or other drugs; and if you smoke.
In this consultation, your surgeon or a nurse will test your vision and
assess your tear production. You should also provide any relevant information
from your ophthalmologist or the record of your most recent eye exam. If
you wear glasses or contact lenses, be sure to bring them along.
You and your surgeon should carefully discuss your goals and expectations
for this surgery. You'll need to discuss whether to do all four eyelids
or just the upper or lower ones, whether skin as well as fat will be removed,
and whether any additional procedures are appropriate.
Your surgeon will explain the techniques and anesthesia he or she will use,
the type of facility where the surgery will be performed, and the risks
and costs involved. (Note: Most insurance policies don't cover eyelid surgery,
unless you can prove that drooping upper lids interfere with your vision.
Check with your insurer.)
Don't hesitate to ask your doctor any questions you may have, especially
regarding your expectations and concerns about the results.
The surgeon closes the incisions with
fine sutures, which will leave nearly
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications. Carefully following these instructions
will help your surgery go more smoothly.
While you're making preparations, be sure to arrange for someone to drive
you home after your surgery, and to help you out for a few days if needed.
Where your surgery will be performed
Eyelid surgery may be performed in a surgeon's office-based facility, an
outpatient surgery center, or a hospital. It's usually done on an outpatient
basis; rarely does it require an inpatient stay.
Types of anesthesia
Eyelid surgery is usually performed under local anesthesia--which numbs
the area around your eyes--along with oral or intravenous sedatives. You'll
be awake during the surgery, but relaxed and insensitive to pain. (However,
you may feel some tugging or occasional discomfort.) Some surgeons prefer
to use general anesthesia; in that case, you'll sleep through the operation.
Blepharoplasty usually takes one to three hours, depending on the extent
of the surgery. If you're having all four eyelids done, the surgeon will
probably work on the upper lids first, then the lower ones.
Before surgery, the surgeon marks the
incision sites, following the natural
lines and creases of the upper and
In a typical procedure, the surgeon makes incisions following the natural
lines of your eyelids; in the creases of your upper lids, and just below
the lashes in the lower lids. The incisions may extend into the crow's feet
or laugh lines at the outer corners of your eyes. Working through these
incisions, the surgeon separates the skin from underlying fatty tissue and
muscle, removes excess fat, and often trims sagging skin and muscle. The
incisions are then closed with very fine sutures.
Underlying fat, along with excess skin
and muscle, can be removed during the
If you have a pocket of fat beneath your lower eyelids but don't need to
have any skin removed, your surgeon may perform a transconjunctival blepharoplasty.
In this procedure the incision is made inside your lower eyelid, leaving
no visible scar. It is usually performed on younger patients with thicker,
more elastic skin.
In a transconjunctival blepharoplasty,
a tiny incision is made inside the lower
eyelid and fat is removed with fine forceps.
No skin is removed, and the incision is
closed with dissolving sutures.
After your surgery
After surgery, the surgeon will probably lubricate your eyes with ointment
and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia
wears off, but you can control any discomfort with the pain medication prescribed
by your surgeon. If you feel any severe pain, call your surgeon immediately.
Your surgeon will instruct you to keep your head elevated for several days,
and to use cold compresses to reduce swelling and bruising. (Bruising varies
forn person to person: it reaches its peak during the first week, and generally
lasts anywhere from two weeks to a month.) You'll be shown how to clean
your eyes, which may be gummy for a week or so. Many doctors recommend eyedrops,
since your eyelids may feel dry at first and your eyes may burn or itch.
For the first few weeks you may also experience excessive tearing, sensitivity
to light, and temporary changes in your eyesight, such as blurring or double
Your surgeon will follow your progress very closely for the first week or
two. The stitches will be removed two days to a week after surgery. Once
they're out, the swelling and discoloration around your eyes will gradually
subside, and you'll start to look and feel much better.
Getting back to normal
You should be able to read or watch television after two or three days.
However, you won't be able to wear contact lenses for about two weeks, and
even then they may feel uncomfortable for a while.
Most people feel ready to go out in public (and back to work) in a week
to 10 days. By then, depending on your rate of healing and your doctor's
instructions, you'll probably be able to wear makeup to hide the bruising
that remains. You may be sensitive to sunlight, wind, and other irritants
for several weeks, so you should wear sunglasses and a special sunblock
made for eyelids when you go out.
Your surgeon will probably tell you to keep your activities to a minimum
for three to
five days, and to avoid more strenuous activities for about
three weeks. It's especially important to avoid activities that raise your
blood pressure, including bending, lifting, and rigorous sports. You may
also be told to avoid alcohol, since it causes fluid retention.
Your new look
Healing is a gradual process, and your scars may remain slightly pink for
six months or more after surgery. Eventually, though, they'll fade to a
thin, nearly invisible white line.
After surgery, the upper eyelids no
longer droop and the skin under the
eyes is smooth and firm.
On the other hand, the positive results of your eyelid surgery-the more
alert and youthful look-will last for years. For many people, these results