Eyelid Surgery

Blepharoplasty or eyelid surgery is a surgical procedure that is performed to remove the excess skin from the eyelids and may include removing fat from them or adding fat to them (less common). Eyelid surgery is done to improve the appearance of the upper or lower eyelids, or both, to give the patient more youthful eyes and facial appearance in general.

Blepharoplasty is considered a cosmetic procedure that is typically done for aesthetic reasons. However, it can also be used for medical reasons when the droopy eyelids cover a portion of the pupil, limiting a person’s visual field. The main reasons to undergo blepharoplasty are:

• To remove excess skin from around the eyes to have a more youthful look
• To get rid of a tired look caused by droopy eyelids and not an actual feeling of tiredness
• To treat eye bags and puffiness in the lower or upper eyelids
• To improve the eyesight if the sagging is affecting the vision
• To achieve facial symmetry if one of the eyelids shows signs of aging more than the other
• To reduce dark circles around the eyes
• To help you put makeup more easily around the eyes

You can be a candidate for blepharoplasty if you are unhappy with the appearance of your eyelids, have sagging eyelids, wrinkles in your eyelids, or baggy eyes. But to be a good candidate for blepharoplasty you should:

• Be a non-smoker or can stop smoking for a few weeks before the surgery
• Have realistic expectations about the results
• Have no serious eye conditions such as chronic dry-eye
• Have good health without any condition that may prevent healing after the surgery like hypertension, circulation disorders, and thyroid disorders

Although blepharoplasty is more common for patients in their late 30s or older, younger patients may undergo the surgery to improve early aging signs or sagging eyelids due to genetic reasons. However, you need to consult with your doctor before you choose to have the surgery to make sure your eyelid problems can be improved with blepharoplasty. 

There are 3 main types of eyelid surgery:

• Upper blepharoplasty: used to address problems of the upper eyelids, usually sagging eyelids.
• Lower blepharoplasty: used to address lower eyelids problems, usually bags under the eyes
• Asian blepharoplasty (double eyelid surgery): used to create a crease in the upper lids for people who don’t have a natural one (such eyelids are known as monolids)

Before undergoing blepharoplasty, you may need to have some lab tests and follow some pre-op instructions given by your surgeon. You may want to ask your doctor questions about the surgery and the recovery, including what type of anesthesia is going to be used, what you should expect from the surgery, and how long the recovery takes.

You should try your best to stay in a good state physically and mentally to reduce risks and have a safe surgery. To do so, the doctor will give you some guidelines that include:

• Stopping blood thinners (aspirin, ibuprofen, and warfarin) for two weeks before the surgery
• Protecting the skin around the eyes from the sun by using a good sunscreen
• Quitting smoking for at least 4 weeks before the surgery
• Avoiding alcohol for about two weeks before the surgery
• Telling your doctor about any medicines and/or herbal supplements you are taking and stopping them if you need to do so
• Arranging for someone to help you with housework for a few days after the surgery
• Avoiding eating or drinking 12 hours before the surgery
• Preparing sunglasses to use after the surgery to protect the fragile skin of your eyelids against the sunlight

The night before the surgery you need to take a shower and have a good restful sleep. You also need to have someone to accompany you to the surgery facility to drive you back home.

Blepharoplasty surgery can be performed in a clinic or a hospital as an outpatient procedure, which means the patient can go home immediately after the surgery.

There are a few techniques that can be used to perform this surgery. One of them involves making an incision inside the lower eyelid and the other involves making the cut in the eyelash margin.

During eyelid surgery, depending on the problems of the eyelids, the surgeon will:

• Make a small incision in the natural eye lines
• Separate the skin from the tissues beneath it
• Remove the excess skin and fat cells (may remove muscles in some cases)
• Remove the fat from the bags under the eyes
• Tighten the muscles and tendons of the eyelids
• Close the incision using stitches

Blepharoplasty usually takes about 1 hour if performed on upper eyelids and 2 hours for lower eyelids. It can be performed with local anesthesia or general anesthesia. 

Following the surgery, it will take a couple of months to fully recover but after that, you will be able to enjoy a more youthful appearance. Eyelid surgery results are considered long-lasting, but the aging process may affect the results in the long term. Generally, you should expect to enjoy the improved look for about five to seven years after a typical upper eyelid surgery. However, the results of double eyelid surgery and lower eyelid surgery are permanent.

Just keep in mind that you need to follow your doctors' instructions after the surgery to ensure full recovery and have maximum results.

Blepharoplasty recovery time is short. It usually takes 2 or 3 weeks to recover from eyelid surgery. Swelling and bruising are common after eyelid surgery but they will go away after a week or two.

Blepharoplasty healing time is a bit longer. It takes about 2 months for the wounds to fully heal. To improve the results and fasten the recovery process you should follow some eyelid surgery recovery tips:

• Keep your head elevated while sleeping or resting
• Apply a cold compress to your eyes to reduce the swelling
• Make sure to clean your eyes as your doctor instructed using the right ointment and eyedrops
• Wear sunglasses if you need to go outside to protect your eyes from both sun rays and wind
• Avoid any vigorous workout for a couple of weeks
• Avoid wearing contact lenses on your eyes
• Do not rub your eyes for a few weeks following the surgery
• Do not smoke or use other tobacco products for a few weeks
• Be sure to have enough sleep and rest
• Avoid putting makeup on the incision before they fully heal

Most people can go back to work about 7 to10 days following a blepharoplasty depending on the nature of their job. Some people may have to wait longer, so make sure to ask your doctor when is the right time to return to work and resume your normal activities.

Blepharoplasty scars

As the surgeon usually makes the incisions in the natural creases of the eyelids, scars after eyelid surgery will be barely noticeable. However, if you want to reduce the scarring as much as possible and prevent any visible scars you need to let the wounds heal properly and avoid anything that may delay healing including:

• Smoking
• Consuming alcoholic beverages
• Exposure to sun rays without sunscreen

It is important to take care of the wounds after a blepharoplasty. Proper eyelid surgery aftercare will minimize scarring and provide better results.

Blepharoplasty is considered safe but it is possible for some patients to suffer from side effects due to the surgery. Blepharoplasty complications are usually mild. They include:

• Puffiness and numbness near the eyelids
• Eye dryness
• Bruising
• Having difficulties closing eyes at night
• Vision changes (usually temporary but can be permanent)
• Hematoma

Most of these side effects will go away by themselves after a short time. More serious complications of eyelid surgery, which happen rarely, include:

• Bleeding excessively
• Blot clotting
• Infection
• Muscle damage
• Eyelid retraction
• Vision loss

The cost of blepharoplasty can change drastically from one country to another. Due to these differences, a lot of patients may prefer to travel abroad to undergo blepharoplasty for cheaper prices.

Blepharoplasty has an average cost of $3,200 for upper eyelids and $6,800 for lower eyelids in the US. Eyelid surgery prices may change depending on some factors, thus it is important to ask your doctor to have a cost estimation before arranging the surgery.

Some patients may prefer non-surgical treatments over blepharoplasty. For these patients, there are several possible alternatives for eyelid surgery that may provide similar results in some cases, including:

• Botox
• Fillers
• Ultherapy
• Skin resurfacing

Just keep in mind that blepharoplasty alternatives are short-lived, meaning you will need to repeat the treatment if you wish to have youthful looks for a longer period of time.

Even when you are a perfect candidate for blepharoplasty mistakes can happen, leaving you with results that are different from what you expected. A blepharoplasty that has gone wrong can make you feel frustrated, but you can fix a botched eyelid surgery with revision blepharoplasty.

The technique surgeon will use for fixing a botched blepharoplasty depends on the problem and how complex it is.

How to sleep after blepharoplasty?

For two weeks following blepharoplasty you need to sleep with your head raised using several pillows to make the swelling subside faster.

Can blepharoplasty be done twice?

Blepharoplasty can be done twice if your eyelids sag again, usually because of aging. Revision eyelid surgery can also be done to improve the result of a previous surgery or to fix a botched blepharoplasty.

Can blepharoplasty change the shape of the eyes?

Blepharoplasty is not supposed to change the shape of your eyes, but it can make your eyes look a little bigger by lifting your upper eyelids and removing your eyebags.

Can blepharoplasty fix uneven eyelids?

Yes, during the procedure the surgeon can adjust the muscles and fix uneven eyes, giving you symmetrical facial expressions.

Can blepharoplasty cause blindness?

Permanent vision loss is among the possible complications of blepharoplasty, but it is an extremely rare event.

Can blepharoplasty fix ptosis?

Generally, blepharoplasty is not a complete treatment for ptosis and you need to have ptosis repair surgery.

Is blepharoplasty covered by insurance?

Blepharoplasty can be covered by insurance if performed for a functional reason and proved to be medically necessary (ask your insurance company to make sure if it covers your eyelid surgery costs).

Can blepharoplasty cause nerve damage?

It is possible to have nerve damage after blepharoplasty, causing weakness in the facial muscles. Usually, this is a temporary problem that goes away with time.

How long does it take to see the results of blepharoplasty?

You have to wait for your eyelids to heal completely before you see the difference. Final blepharoplasty results usually appear after 4 to 6 weeks.

Does blepharoplasty hurt?

You will feel some pain after the surgery but it is usually mild to moderate. You can handle the pain with OTC pain killers.

How long do blepharoplasty results last?

While blepharoplasty results are long-lasting, the effect of aging on the results is unavoidable. The results of an upper blepharoplasty that is done to correct droopy eyelids usually last for about 5 to 7 years, but the results of double eyelid surgery or lower eyelid surgery are usually permanent.

Is blepharoplasty safe?

Yes, eyelid surgery is one of the safest cosmetic procedures with a low complication rate. However, you should choose a qualified surgeon with extensive experience to minimize the risks of the surgery.

Will blepharoplasty remove dark circles?

Lower eyelid surgery is an effective way to get rid of eye bags but it can also improve dark circles under the eyes.

Will blepharoplasty get rid of wrinkles?

Blepharoplasty can reduce the wrinkles around the eyes to some extent by removing the excess skin around the eyes.

Will blepharoplasty remove crow's feet?

No, blepharoplasty does not remove crow’s feet.

Will blepharoplasty affect vision?

You may have double or blurred vision after eyelid surgery but this is a short-term side effect. In extremely rare cases, blepharoplasty may cause temporary or permanent vision loss.

Can I have blepharoplasty and brow lift at the same time?

Both blepharoplasty and brow lift are used to give you more youthful looks. Sometimes surgeons combine blepharoplasty and brow lift to improve the results. however, not every patient needs to undergo both procedures.

A brow lift should not be performed for patients who already have natural high brows as it can make them look shocked all the time.