Blepharoplasty is a type of eyelid surgery that removes sagging skin around the eyes. The surgery can be cosmetic, or a person may need it to improve vision. Both upper and lower eyelids can have blepharoplasty, and surgeons may combine it with other facial cosmetic procedures.

As skin ages, it often loosens and begins to sag around the corners and edges of the eyes. Fat deposits may also begin to shift, creating a puffy appearance beneath the eyes.

During a blepharoplasty, a surgeon removes excess skin and fat and tightens the area to retain a more youthful appearance.

A surgeon may also perform the procedure to remove skin that obstructs a person’s vision. It does not affect the eyebrows or lighten dark under-eye circles.

This article looks at blepharoplasty, procedures, risks, results, and more.

A surgeon performing a blepharoplasty.Share on Pinterest
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Blepharoplasty is a facial surgery involving the upper or lower eyelids.

It can help to improve a person’s vision when drooping skin gets in the way of the eyes. Surgeons can also perform a blepharoplasty as a cosmetic procedure to tighten or remove skin around the eye.

A blepharoplasty can fix:

  • drooping or draping skin that prevents normal vision
  • sagging skin around the upper eyelid that creates an unnatural fold
  • fatty deposits underneath eyelid skin
  • dark circles beneath the eyes
  • drooping lower eyelids that reveal white below the colored iris
  • extra skin on the lower eyelid
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Learn more about drooping eyelids, blepharoplasty, and similar procedures.

There are two common reasons why someone may choose blepharoplasty.

Improving vision

In some cases, sagging or excess skin around the eyes can obscure a person’s vision. This skin can hang unnaturally in the contour of the eye and prevent normal vision, particularly from the side of the eye.

Getting a blepharoplasty to remove the excess skin may help to improve a person’s vision in this case.

Cosmetic preference

Another reason a person may consider a blepharoplasty is to change the appearance of their eyelids and the skin around their eyes.

As skin ages, it loses the ability to produce and support collagen in the eyelids and upper eyes. Fibers that connect muscles that control the eye can detach with aging and lead to eyelid drooping. Fat can also move into the tissue of the eyelid, causing a puffy or droopy appearance.

Blepharoplasty can remove excess skin and fat and secure loosened muscles, possibly leading to a more youthful appearance.

There are two types of blepharoplasties — a lower blepharoplasty and an upper blepharoplasty. Surgeons sometimes perform them together.

A lower blepharoplasty focuses on the area below the eye. A surgeon will make a cut below the lower eyelash line and tighten the skin below the eye.

An upper blepharoplasty involves altering the skin and muscle above the eye. The surgeon will make a cut where the new crease of the eyelid should be.

This section provides some photographs of completed upper and lower blepharoplasty procedures and combined surgeries.

Before the surgeon conducts any type of surgical procedure, a person will go through multiple consultation appointments.

For a cosmetic procedure, the surgeon and the patient will discuss the desired outcomes in detail. A person should be very open and specific about what they want from the procedure.

Both parties will work together to ensure the person thinks thoroughly about their desired outcomes and that they understand the risks of the procedure.

Once both the surgeon and the patient are comfortable with the plan, they will arrange a convenient date for the surgery.

Surgery generally takes about 1–2 hours, and an individual is able to go home the same day.

Prior to surgery, a person will need to remove any makeup and contact lenses.

Before the procedure, a healthcare professional may insert an intravenous (IV) line into the person’s arm. This will provide sedatives, fluids, and medications during the surgery.

Most individuals will receive a general anesthetic, which means they will be unconscious during the procedure. They will not feel any pain.

The surgery may involve a lower blepharoplasty, upper blepharoplasty, or both. The procedures are different for each, and the techniques may also differ between surgeons. The surgeon and patient will discuss the techniques prior to the surgery.

Lower blepharoplasty

For a lower blepharoplasty, a surgeon will choose a site to make an incision. This may be along the lower lash line or inside the lid along the mucosa.

Depending on the specific case plan, the surgeon may remove or reposition fat beneath the eye to get the desired effect.

In line with the agreed procedure, the surgeon may perform a canthopexy or canthoplasty to fix a drooping lower lid.

During a canthopexy, they fix the outer corner of the eye to the underlying facial structure to prevent further drooping.

A canthoplasty is a more involved procedure that requires more intricate surgery to remove and reattach sagging skin.

Upper blepharoplasty

During an upper eyelid blepharoplasty, the surgeon makes an incision where the new crease of the eyelid should be. They remove any excess skin and additional fat from above the eyelid before closing the incision.

Sagging or drooping skin around the eyelids may also happen due to brow ptosis. If so, the surgeon may arrange a separate procedure called a brow lift in addition to an upper blepharoplasty.

After the surgery, healthcare professionals will take the individual to a recovery room, where they will gradually wake up from the anesthetic.

During this time, it is normal to feel sleepy and sometimes nauseated. The person can also have difficulty seeing at first. A family member may be able to visit at this point.

A surgeon or other healthcare professional can prescribe medication to help with any pain. They may suggest placing ice packs on the eyes to help reduce bruising and swelling.

The person who underwent surgery will not be able to drive home themselves. A friend or family member must be present to make sure the person gets home safely.

Bruising, swelling, and blurry vision will be normal for the first week or two.

A person should follow all the surgeon’s aftercare instructions, including:

  • using ice packs on eyes
  • regularly cleaning the incisions
  • wearing sunglasses
  • avoiding makeup and contact lenses
  • avoiding swimming or getting the face wet
  • avoiding strenuous activities
  • avoiding driving while taking medications

It may take 10–14 days for bruising and swelling to subside, but it can take several months for complete healing. Following the doctor’s post-operative instructions will assist with the healing process.

While the skin will naturally lose elasticity over time, the results of blepharoplasty should be long-lasting, possibly for years.

Making sure the person has adequate sun protection, such as sun lotion, may lengthen the duration of the results.

There are risks with any surgery. A few complications that may arise with blepharoplasty include:

  • dry eyes
  • lagophthalmos, or “lid lag” — when the upper lid does not meet the lower lid
  • ectropion, where the eyelid turns outward
  • retrobulbar hemorrhage, or an increase in pressure due to bleeding behind the eye

Other potential complications and side effects include:

  • blurred or double vision
  • asymmetrical eyes
  • hematoma, or blood pooling under the skin that usually subsides in a few weeks
  • scarring
  • injury to eye muscles
  • lower eyelid drooping
  • lower eyelid retraction, which shows the whites of the eye
  • temporary problems with vision

Any surgery carries a risk of:

With any cosmetic procedure, there is also a risk that the person will not like the outcome. A person can try to avoid this by having clear and open communication with the surgeon performing the blepharoplasty.

When a person talks with the surgeon who will be performing the procedure, they should ask about their operating history and whether the surgeon has had any complications with this type of surgery before.

The surgeon should discuss the likelihood of complications with the patient so they can make an informed decision.

Not everyone is a good candidate for blepharoplasty.

The surgeon will conduct a full medical evaluation to determine if surgery is a viable option. The best candidates are:

  • those without medical conditions that prevent healing
  • nonsmokers
  • those with realistic goals
  • those without serious eye problems

Drooping of the skin and muscles of the forehead can cause drooping of the eyelid. This requires a different surgical procedure that the surgeon may discuss.

According to the American Society of Plastic Surgeons, the average cost of cosmetic eyelid surgery was $4,120 in 2020. This does not include the cost of anesthetic, operating room facilities, or other expenses such as prescriptions.

Insurance may cover or partially cover the cost of blepharoplasty if the person’s vision needs correction.

There are many plastic surgeons, but not all of them will be the right fit for every person. A person should always schedule an in-office consultation with a surgeon to discuss the procedure before making a final decision.

A person should write down any questions they have in the days leading up to the consultation. They should also have a brief medical history ready, including a list of medications they are taking and dosages.

During the consultation, a person should listen to the surgeon’s opinion and ask several questions, including:

  • how many times they have performed a blepharoplasty
  • what the average complication rate is
  • whether they have had any complications while performing a blepharoplasty, and the details
  • if they are board certified by the American Board of Plastic Surgery
  • where they have hospital admitting privileges
  • what the most common complications of this procedure are
  • what the surgical aftercare procedure will be
  • what to do if something goes wrong at home or the person is unhappy with the result
  • expected pain levels
  • what the pain management plan is
  • to see any before-and-after photos of their procedures
  • expected results

A person should feel very comfortable with their surgeon, with a relationship built on trust and open communication.

If there is any reason to feel uncomfortable with any of the surgeon’s responses, a person should not proceed with the surgery and look for an alternative surgeon.

The most important thing to consider prior to cosmetic surgery is why a person wants to change the way they look.

It is a good idea for a person to think thoroughly about this decision, examine why they feel this way, and not make any impulsive choices. A person should ideally consider this for at least a few months before making a consultation appointment.

They should also consider the costs involved. There may be some insurance coverage for blepharoplasty for those who have affected vision, but this is not common. Most procedures are out-of-pocket expenses.

It may take several consultations to find a surgeon that an individual is comfortable with. A quality doctor-patient relationship is very important so each can trust the other and ask questions freely.

A person should avoid making decisions hastily and not base them on advertising. They should take the time to research the procedure.

Blepharoplasty is a surgery that involves the lower, upper, or both eyelids. A surgeon may perform this procedure to correct vision obstructions or alter sagging or drooping eyelids.

It involves placing incisions along creases in the eyelid or inside the mucosa of the eye, then removing excess skin or fat that has moved from its proper placement. The surgeon may also secure the skin to the underlying facial structure to prevent it from sagging in the future.

Some drooping eyelids stem from drooping of the forehead and require a brow lift. The surgeon will discuss this during consultation.