Eyelid Surgery (Blepharoplasty)

What is Eyelid Surgery (Blepharoplasty)?

Eyelid surgery, also known as blepharoplasty or "eye lift", is a cosmetic procedure. It modifies the skin on your eyelid and around your eyes. Eyelid surgery can improve your eye function and give you a more youthful appearance.

As you age, your eyelid skin stretches. This can cause sagging eyebrows, droopy lids, and bags under your eyes.

In addition to making you look older, this can reduce your peripheral vision. The procedure may involve removing excess skin, muscles, and fat from around your eyes.

Doctors can perform surgery on the upper and lower eyelids together or separately.

While eyelid surgery may not sound like a standard procedure, it is prevalent. The American Society for Aesthetic Plastic Surgery (ASAPS) found it was among the top 5 cosmetic procedures for both men and women in 2018, with more than 115,000 surgeries performed.³

What Can Eyelid Surgery Treat?

Eyelid surgery enhances the appearance of your eyes and the surrounding areas.

But it can also treat various eyelid problems, including:

• Bags under your eyes
• Drooping eyelids
• Excess skin on the lower eyelids
• Excess skin on eyelids causing problems with peripheral vision

Whether you want to improve the look or functioning of them, eyelid surgery can:

• Tighten loose and/or sagging skin that creates natural creases in the eyelids, disturbs the natural contour of the eyelid, and may or may not impair vision
• Remove excess fat deposits that make the eyelids appear as puffy
• Remove bags under the eyes and tighten drooping lower eyelids that reveal the white of the eyes below the irises
• Remove excess skin, wrinkles, eye bags, and other unwanted skin issues in the upper and lower lids
• Improve skin elasticity in the eye area so that you don’t have droopy eyelids

Who is a Candidate for Eyelid Surgery?

Eyelid surgery is an option for anyone with eyelid-related issues, functional or cosmetic.

Good candidates for blepharoplasty include those 35 years or older who:

• Suffer from droopy lower eyelids that cause an increased amount of eye white to show
• Have sagging upper lids caused by a buildup of fatty tissue beneath the skin
• Are experiencing vision problems
• Have puffy eyelids

Persons undergoing surgery should be optimistic but also realistic about results — sometimes, revision surgery is necessary.

Nonsmokers and those without medical conditions or serious eye conditions that could interfere with healing are ideal candidates.

Medical conditions that make eyelid surgery more risky include:

• Hypothyroidism 
• Grave's Disease
• High blood pressure
• Detached retina
• Glaucoma
• Dry Eye
• Cardiovascular issues
• Diabetes

What to Expect: How is Eyelid Surgery Performed?

Pre-Surgery

Prior to surgery you'll consult with your doctor. They'll evaluate your health and any pre-existing medical conditions and potential risk factors.

They'll also likely perform a physical examination, vision test, and take pictures of your eyelids.

After, you'll go over surgery options together. Possible or likely outcomes, potential complications, and treatment plans will be covered.

Once you have the surgery scheduled your doctor will give you instructions for how to prepare. You may be advised to stop taking certain prescription, OTC, or herbal medications that increase bleeding.

If you smoke, you'll be asked to quit several weeks before the procedure. Smoking interferes with your healing ability.

You'll also have to prearrange transport from your surgeon's office after the surgery is complete.

During the Procedure

Cosmetic eyelid surgery is typically performed as an outpatient procedure. On average, it takes about 45 minutes to two hours.

Here's what typically happens:

1. Anesthesia

First, your surgeon will administer anesthesia. This could be local or general.

Local anesthesia is a numbing agent that the doctor injects into your eyelids to numb and relax the area.

General anesthesia is a medication that makes you unconscious throughout the procedure. You and your doctor will discuss which option is best for you before the procedure.

2. Incision Lines

The next step is the incision lines. If you're having both eyelids operated on, the surgeon will likely start with the upper lid, followed by the lower. The incisions are made so that the scars are well-hidden within your natural eyelid structure.

The surgeon will then remove or reposition fat deposits, tighten muscles, or remove excess skin.

3. Closing the Incisions

Once the surgery is complete, the surgeon closes the incisions. This is typically done with sutures or skin glue. Following the surgery, you may experience puffiness and pain, and swelling in the eye area. 

Eyelid Surgery Recovery Timeline & Tips

Eyelid surgery, though quick, is serious. After a few hours, the anesthesia will wear off. You may feel pain and experience swelling, dark circles, blurred vision, and other side effects after surgery.

The doctor may use a lubricating ointment, cold compresses, or a loose covering of gauze to protect your eyes after surgery. They'll then give you specific instructions on how to make your wounds heal quickly and cleanly.

Some tips might include:

• Using cold compresses (like an ice pack).
• Keeping your head elevated while you sleep.
• Eye drops to keep your eyes lubricated.
• Tylenol to manage pain.
• Not taking any non-steroidal anti-inflammatory (NSAID) medications.
• Refraining from physical activity for the 3 weeks following surgery, and sun exposure for the 6 weeks following.
• Not apply any ointments or makeup to your face for at least a week.

Eyelid Surgery Risks & Complications

Eyelid surgery is usually quick and can typically be done in a day. However, there are risks involved with all surgeries.

Risks include, but are not limited to, the following:

• Reactions to any anesthesia and/or injuries due to sedation
• Swelling and bruising around the eyes
• Difficulty closing the eyes
• Bleeding from the incision lines
• Dry eyes
• Eye infections
• Sensitivity to lights, including sunlight
• Ectropion (when the lower eyelid rolls outward) or entropion (when the lower eyelid rolls inward)
• Pain in and around the eyes
• Changes to the skin around the eyes and lash line, including numbness or tingling sensations
• Temporary or permanent changes to field of vision such as double vision or, in rare cases, blindness
• Scarring
• Lid lag (when the upper eyelid is higher than normal while you are looking down)
• The need for eyelid revision surgery

Cost of Eyelid Surgery

The cost of eyelid surgery varies but, on average, cosmetic eyelid surgery costs about $3,000. It ranges from about $2,000 to $5,000 for all four lids. Surgery on the lower eyelids tends to be more expensive than the upper lids.

The cost does not include:

• Anesthesia
• Operating room facilities
• Prescriptions
• Medical tests,
• Other plastic surgeon-specific fees

A surgeon’s fee will depend on their experience, the type of procedure, the extremity of the case, and other factors. Many surgeons offer patient financing plans.

Note that most health insurance providers don't cover cosmetic surgery or any complications associated with cosmetic surgeries, including eyelid surgery.

When eyelid surgery is performed to fix skin that covers the eyelashes, it may be covered by insurance. Check your insurance plan and speak with your provider about whether or not eyelid surgery is covered.