What to Know About Blepharoplasty (Eye Lift Surgery)

Key Takeaways

• An eyelid surgery is also called blepharoplasty. This cosmetic surgery addresses issues like excess skin, puffiness, droopy eyelids, or bagginess under the eyes.
• Ideal candidates for this procedure are people in good physical and mental condition. 
• Blepharoplasty has a high success rate.
• Manageable complications from the procedure are minimal and can be avoided through careful preoperative planning and surgical technique. More severe complications rarely occur.

What is Eyelid Surgery?

Eyelid surgery, medically known as blepharoplasty, involves altering the upper eyelids and lower eyelids.²  It’s one of the most common aesthetic procedures in the US.

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 excess fat and sagging skin around the eye area. Most doctors use a conservative approach to avoid complications.

Eyelid Surgery Approaches

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.² 

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).

Doctors will always aim to preserve as much tissue as possible to balance the volume loss that comes with aging.

Eye Lift Procedure: What to Expect

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

Preparing for Surgery

Here’s how you and your surgeon will prepare for surgery:

Medical History and Assessment

The doctor will gather your complete medical history, which includes:

• Past cosmetic procedures (especially around the eye area)
• Existing eye conditions
• Existing cardiovascular conditions
• Current medications and supplements

Facial Study and Photography

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.

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

Customizing Your Surgical Plan

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. 

The plan is only complete once you agree on the procedure type and the desired outcome.

During Surgery

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

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.

Some cases call for removing a small amount of the orbicularis oculi muscle. This is the muscle surrounding the upper and lower eyelid. The removal 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. However, a study among American oculoplastic surgeons showed that more doctors prefer the latter course.³

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. It also reduces the chances of the skin around the eyes darkening.

After Surgery

Here’s what you can expect and should do after receiving eyelid surgery:

Immediate Effects 

After surgery, it’s normal to experience bruising around the eyes. Doctors recommend applying cold saline compresses during the first 48 hours. Sutures are usually removed 5 to 7 days post-op.

Dry eye syndrome is another common experience, and it can persist longer than 2 weeks in 11% of patients.⁵ Doctors usually prescribe artificial tear drops to ease this side effect.

After surgery, the person should have someone drive them home. They should also ask someone to help them around the house during the first 2 days after surgery.

It’s normal to experience side effects during the first few weeks of healing. These include:

Aftercare Tips

Healing is a slow process, although some side effects will gradually improve within a few days.  The doctor will likely prescribe pain medication. Do not take aspirin unless your doctor approves it.

Other aftercare tips include:

• Keep the incisions clean with soap and water
• Check the area for signs of infection every day
• During the first several days, sleep with the head slightly elevated at 45 degrees to minimize swelling
• Activities should be kept at a minimum during the first 5 days
• Don’t wear contact lenses or perform strenuous activities during the first 2 to 3 weeks
• If desired, resume reading and watching TV 2 to 3 days after surgery, while work can resume in 2 weeks
• Avoid exposing the scars to the sun for at least a year and always wear sunblock with a minimum of SPF 30
• Only wear face makeup once the sutures are removed

To avoid constipation, doctors recommend walking as soon as it’s possible to do so. It can also reduce swelling and lower the risk of developing blood clots.

It’s normal for scars to look pink for at least 6 months after surgery. 

When to Call the Doctor

Call the doctor immediately if you experience any of the following symptoms:

• Increased swelling, bruising, or redness
• Increased pain
• Any side effects from the prescribed medication (rash, nausea, constipation, etc.)
• Oral temperature over 100.4°F
• Yellow or green discharge from incisions
• Foul odor from incisions
• Uncontrollable bleeding from the incisions
• Loss of feeling or motion

What Can Eyelid Surgery Fix?

Eyelid surgery can fix both medical and aesthetic issues. 

Some people get an upper lid blepharoplasty to improve their vision. Droopy upper eyelid skin can get in the way of a person’s eyesight, and an eye lift can fix that. Improved eyesight can also result in fewer vision-related headaches.

Eye lifts can also fix aesthetic issues like:

• Puffiness
• Eye bags
• Excess skin and fat
• Fine wrinkles
• Droopy upper eyelids
• Hooded upper eyelids 

While eyelid surgery can remove excess skin, it won’t remove crow’s feet or deeper wrinkles around the eye area.

Who is a Candidate for Eyelid Surgery?

You’re a good candidate for eyelid surgery if you:

• Are in good physical and mental condition
• Have poor eyesight due to droopy eyelids 
• Want to improve the appearance of eye bags or puffiness around the eyes

If you have glaucoma or dry eyes, your doctor may opt for a more conservative surgical approach. They may also treat your condition first before performing eyelid surgery. 

If a person has had LASIK surgery, they must wait 6 months before proceeding with eyelid surgery. This allows their blink reflex to return to normal.

Risks of Eyelid Surgery

Complications from an eye lift procedure are minimal, especially if the doctor’s approach was conservative. Common risks include:

• Increased inflammation
• Scarring
• Dry eye syndrome
• Infection
• Corneal trauma during surgery
• Eyelid asymmetry
• Abnormal orbital skin pigmentation

You can prevent many of these risks through preoperative planning and surgical technique.  The significance of these complications also lessens after appropriate management.

More severe complications of blepharoplasties include:

• Retrobulbar hematoma or hemorrhage. Blood pools in the space behind the eye. A rare complication with a 1 in 2,000 to 1 in 25,000 chance of occurring.⁵ It can lead to vision loss if not treated immediately.
• Post-blepharoplasty lower eyelid retraction (PBLER). A rare complication of lower blepharoplasty. The lower lids are pulled down after healing, resulting in vision problems.
• Eyelid malposition. Incorrect positioning of the upper or lower eyelid. More common in lower blepharoplasty procedures.

How Much Does Eyelid Surgery Cost?

On average, cosmetic eyelid surgery costs around $4,120.⁸ The cost will vary on various factors, such as the type of blepharoplasty and additional tools or equipment. 

The eyelid surgery cost usually includes the following:⁸

• 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. 

Eyelid Surgery Outlook and Success Rates

Regardless of a person’s age, blepharoplasties have a high success rate. A 2020 study showed a 96.7% success rate among young people and 97.4% among older people.⁷

Most people who’ve had eyelid surgery to fix the bagginess under their eyes have expressed long-term satisfaction with their results. Some have also reported an improvement in their quality of life.

In a separate study in 2018, 128 people were monitored for 6 months after their blepharoplasty procedures. Over 107 reported a very high satisfaction rate by the sixth month.¹ None of these people developed severe complications.