Blepharoplasty: Compare practices from our network

Blepharoplasty is surgery on the eyelids. Upper blepharoplasty removes excess skin, and sometimes a small amount of muscle or fat, from the upper lid. Lower blepharoplasty addresses puffiness and bags beneath the eye by removing or repositioning fat and, where needed, tightening skin.

The two are often performed together, and either can be combined with brow or facial surgery.

The two treatments address different concerns:

• Upper blepharoplasty removes hooded skin that can make the eyes look tired and, in more advanced cases, obstruct the upper field of vision. The incision sits in the natural lid crease.
• Lower blepharoplasty reduces or repositions the fat causing under-eye bags. The incision may be just below the lash line or, in some techniques, inside the lid with no external scar.

Eyelid surgery suits people in good health troubled by hooding, puffiness, or obstructed vision. Your surgeon may advise caution if you:

• Have significant dry eye or reduced tear function
• Have a thyroid or eye condition affecting the lids
• Have had recent laser eye surgery
• Are actually troubled by brow descent rather than lid skin
• Smoke, which impairs healing of delicate lid tissue

1. Consultation. Your surgeon assesses lid skin, fat, muscle tone, brow position, and tear function, and may arrange a visual field test where vision is obstructed.
2. Preparations. Medication adjustments, stopping smoking, and arranging for a week of visible bruising and swelling.
3. Anesthesia. Frequently local anesthetic with sedation, particularly for upper lids alone. General anesthesia may be used for combined or more extensive surgery.
4. Upper lid work. An incision in the natural crease allows conservative removal of excess skin, and fat or muscle where appropriate.
5. Lower lid work. Fat is removed or repositioned to smooth the under-eye hollow, with skin tightened only as much as lid support allows.
6. Closing. Very fine sutures close the incisions, sitting in the lid crease or below the lash line where they become difficult to see.

Bruising and swelling around the eyes are expected and most noticeable in the first week. Sutures are usually removed within a week.

• Use cold compresses in the first days to limit swelling
• Sleep with your head elevated
• Use prescribed lubricating drops or ointment as directed
• Avoid contact lenses, eye makeup, and strenuous activity until cleared
• Wear sunglasses outdoors, as healing lids are sensitive to light and wind

Most patients feel presentable at one to two weeks. Fine swelling and scar redness continue to settle over two to three months.

Eyelid surgery is generally safe, but the tissue is delicate and specific risks apply:

• Dry or irritated eyes, common temporarily, and more likely if dryness pre-existed.
• Difficulty fully closing the eye, usually temporary, and a consequence of removing too much skin if persistent.
• Changes in lower lid position or shape, where lid support is not adequately respected.
• Asymmetry between the two sides, as eyes are rarely identical to begin with.
• Visible scarring, uncommon, as incisions sit in natural creases.
• Vision changes, very rare but serious, which is why any change in vision needs urgent review.

When to seek medical attention

• Any change in vision, or loss of vision
• Severe or increasing pain behind the eye
• Rapidly increasing swelling or bleeding
• Fever, or increasing redness and discharge from an incision

Contact your surgeon's practice directly, or seek emergency care, if you experience any of the above.