What to Know About Blepharoplasty (Eye Lift Surgery)

Droopy eyelids or noticeable bags under your eyes can make you appear tired and older than you feel, especially after 40. Eye lift surgery (blepharoplasty) rejuvenates your eyes by tightening excess skin or repositioning fat deposits around your eyelids. 

If you're curious whether blepharoplasty could help you look refreshed without an artificial or "overdone" appearance, here's what you need to know.

What is Eye Lift Surgery?

Blepharoplasty involves altering the upper eyelids and lower eyelids. It’s one of the most common aesthetic procedures in the U.S.

Doctors use many techniques when approaching an upper or lower blepharoplasty. However, no concrete data prove that one approach is superior.

Blepharoplasties focus on removing or repositioning excess fat and sagging skin around the eye area. Most doctors use a conservative approach to avoid complications.

Why People Consider Eye Lift Surgery

For the most part, it’s a cosmetic surgery people use to improve their appearance. Studies show that around 12% to 17% of adults experience noticeable excess eyelid skin (dermatochalasis) by middle age.

This makes eyelid lifts one of the most popular cosmetic surgeries worldwide. However, others may need an eye lift procedure to correct vision obstruction caused by drooping eyelids.

What are the Different Types of Eye Lift Surgery?

Before an upper blepharoplasty, a doctor evaluates certain features of the eyelid, including:

• Crease definition and visibility
• Degree of pretarsal show (distance between the lash line and skin fold in a neutral gaze)
• Height of eyelid fold
• Volume of eyelid fold
• Contour of eyelid fold

The condition of these features determines the approach the doctor uses during the procedure. Lower blepharoplasties have two main approaches: transcutaneous and transconjunctival.

A transcutaneous approach involves an incision in the skin below the lower eyelashes. It then deepens into the muscle. A transconjunctival approach is a simpler and faster technique involving an incision in the conjunctiva (inside the eyelid).

How to Prepare for Surgery

Before the procedure, your doctor will gather your complete medical history. This often includes past procedures, existing eye conditions, current medication and supplements, and cardiovascular conditions.

The doctor will also study your facial features and learn your aesthetic preferences. This allows them to identify factors that may increase the risk of postoperative complications.

They will also assess the positioning of your brow and cheek during an upper and lower blepharoplasty, respectively. These features influence the upper and lower eyelids, so it’s common to consider them during any procedure involving the eyes or the area around the eyes.

Customizing Your Surgical Plan

After the consultation, the doctor will take preoperative photos of your eyes. These photos capture the eyes from different angles and positions, including:

• Front view
• Lateral view
• Three-quarters to the side
• A close-up
• Eyes closed
• Eyes open, looking upward
• Eyes squinting

Doctors customize each surgical plan according to your present features and desired outcome. The surgeon may also show the blepharoplasty results using computer imaging technology. 

What Happens During Surgery?

Blepharoplasties are performed under local or general anesthesia. However, this largely depends on the doctor’s preference and surgical plan.

The surgeon will have different techniques, depending on whether the surgery is an upper or lower blepharoplasty, for example:

Upper Eyelid Surgery

The doctor will identify where the upper eyelid crease rests on each eye during an upper blepharoplasty. This helps them determine where to place the incision. 

It also tells them how much excess skin to remove while keeping enough tissue for normal eyelid closure. In some cases, they might remove a small amount of orbicularis oculi muscle, the muscle surrounding the upper and lower eyelid.

Removing this can help refine the contour of the eyelid. Once the procedure ends, the doctor sutures the incision. After the area heals, the scar will be less visible because of the incision’s placement in the eyelid crease.

Lower Eyelid Surgery

Doctors can perform a lower blepharoplasty with a transcutaneous or transconjunctival approach. A transconjunctival approach involves placing an incision inside the lower eyelid. 

The doctor repositions the orbital fat instead of removing it completely. Some will excise a small amount if the situation calls for it. 

Due to the incision placement, the scar won’t be visible after healing. This approach creates a smoother contour in the upper face and reduces the chances of the skin around the eyes darkening.

What Happens After the Surgery?

After surgery, you should have someone drive you home. You may also want to ask someone to help around the house during the first 2 days.

It’s also normal to experience various side effects during the first week of healing. Some common side effects include:

• Bruising
• Constipation
• Mild pain
• Swelling of the lids
• Tightness of lids
• Dryness
• Itching
• Burning
• Excessive tearing
• Light sensitivity
• Blurred or double vision
• Difficulty closing eyes during sleep

Doctors recommend applying cold compresses or ice packs during the first 48 hours to relieve bruising. Sutures are usually removed 5 to 7 days post-op. 

For dry eyes, doctors will usually prescribe artificial tear drops for relief.

Recovery and Results Timeline

Knowing what to expect post-surgery helps you manage your recovery effectively:

Time Period	What to Expect / Recommendations
Days 1 to 2	Mild discomfort. Use ice packs to reduce swelling and acetaminophen for discomfort. Keep your head elevated.
Days 3 to 7	Swelling and bruising typically peak during this time before subsiding. Non-dissolvable stitches are removed around 5 to 7 days.
Days 7 to 10	You can resume work and light activities after this time. However, avoid wearing contact lenses and eye makeup.
Weeks 2 to 6	You can gradually resume regular exercise and other physical activities after two weeks. The scars will begin fading, and the swelling will be reduced.
Months 6 to 12	The scars will look nearly invisible by this time, and the final results will fully settle in.

While results can last decades for many, ongoing aging could gradually reintroduce eyelid droopiness. However, only a small percentage (about 5-10%) seek minor touch-ups or revisions.

Eyelid Surgery Outlook and Success Rates

A 2020 study showed a 96.7% success rate among young people and 97.4% among older people. Meanwhile, recent studies show that the satisfaction rates of blepharoplasty are around 86% to 94% across various techniques and age groups. 

Most patients experience meaningful improvements in their quality of life with minimal complications. Overall adverse event rates remain under 10%, typically limited to temporary bruising or swelling.

Major complications such as orbital hemorrhage or vision loss occur in fewer than one in 2,000 cases. In a 330-patient series, 94% reported high satisfaction while only 6% required minor revisions.

Who Is A Good Candidate for Eye Lift Surgery?

Ideal candidates typically notice visible signs like excess eyelid skin (dermatochalasis), fatty deposits around the eyes, or even reduced peripheral vision. 

However, there are factors that make you unsuitable for eye lift surgery; these include:

• Dry eyes. Surgery could exacerbate symptoms; careful evaluation is needed.
• Thyroid disease. May impact healing and swelling.
• Blood thinners (anticoagulants). Could increase bleeding risks during and after surgery.

What Are the Risks of Eye Lift Surgery?

Like any surgical procedure, blepharoplasty carries certain risks, although serious complications are very rare when performed by experienced surgeons.

Common risks include inflammation, scarring, dry eye, temporary blurred or double vision, and abnormal orbital skin pigmentation. You can prevent many of these risks through preoperative planning, surgical technique, and proper management.

More severe complications of blepharoplasties include:

• Ectropion (outward turning of the eyelid)
• Vision-threatening hematoma
• Excessive bleeding or infection
• Retrobulbar hemorrhage (bleeding behind the eye)
• Post-blepharoplasty lower eyelid retraction (PBLER)
• Eyelid malposition

How Much Does Eyelid Surgery Cost?

On average, cosmetic eyelid surgery costs around $4,000 to $8,000. The cost will vary depending on various factors, such as the type of blepharoplasty and additional tools or equipment. 

The eyelid surgery cost usually includes the following:

• Surgeon's fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Medical tests

Insurance typically won’t cover eyelid surgery costs since they’re considered cosmetic. However, you may be eligible for coverage if your eyelids cause a “visually significant” obstruction of your visual field.