Eyelid Surgery: Everything You Need to Know

Eyelid surgery, also called blepharoplasty, helps sculpt or lift the tissues around the eyes. It can be performed on the upper or lower eyelids to remove excess skin and fat and smooth out fine wrinkles.

Some seek eyelid surgery for cosmetic purposes—to help tighten sagging skin and bring a more open look to the eyes. Others are recommended for the procedure because skin around the eyes is impairing vision.

What Is Eyelid Surgery?

Eyelid surgery is done by a plastic surgeon and may be performed on the upper eyelids, lower eyelids, or both. The operation begins with the surgeon making an incision.

With the upper eyelid, the incision is usually made around the natural crease of the eyelid. This allows the surgeon to remove or reposition excess fat, readjust muscles, and remove excess skin.

With the lower eyelid, the surgeon makes an incision beneath the eyelashes. Excess skin is removed and fat is removed or redistributed. An incision can also be made on the inside of the lower eyelid. With this, excess fat is removed or redistributed but no skin is removed.

Your surgeon will recommend either general anesthesia or local anesthesia with intravenous sedation, depending on your condition and the extent of your surgery.

Eyelid surgery is usually performed as an outpatient procedure.

Contraindications

You may not be a good candidate for surgery if you have:

• An uncontrolled medical condition, such as diabetes
• Dry eyes
• Had previous eye surgeries
• An inflammatory skin condition, such as eczema and psoriasis
• Psychological issues or unrealistic expectations for the surgery

Potential Risks

Some of the possible complications for eyelid surgery include:

• Changes in sensation or numbness around eyelashes
• Dry eyes
• Sensitivity to bright light, including the sun
• Outward rolling of the lower eyelid
• Lid lag, or pulling down of lower eyelid (usually temporary)
• Difficulty closing your eyes
• Temporary or permanent change in vision

Purpose of Eyelid Surgery

Eyelid surgery can help reshape and firm the area around the eyes. It can be used to treat fatty deposits that make the eye area look puffy, bags under the eyes, drooping lower eyelids, and loose skin around the eyelids that can sometimes impair how well you see.

Before you schedule your eyelid surgery, you’ll have a consultation with your surgeon. You’ll discuss your goals for the surgery, your medical conditions and history, any previous surgeries, and medications you are taking.

Your surgeon will examine your eyes and eyelids, which may include taking measurements, evaluating the looseness of skin, and checking the muscles that close the eyelids.

You may also be asked to see your primary care provider for a pre-operative workup. This often includes routine blood tests (e.g., a complete blood count), an electrocardiogram (ECG), and a physical exam to make sure that you’re healthy enough to undergo surgery.

Most health insurance plans won’t cover eyelid surgery for cosmetic reasons. However, the procedure may be covered if there’s a medical reason for it. One such example is blepharochalasis, a condition in which inflammation of the upper eyelids thins and stretches the skin, causing it to fold downward and impede vision.

Check with your health insurance provider to see what’s covered by your policy before scheduling your surgery.

How to Prepare

Ask your surgeon any questions you have about the procedure. During your pre-op appointment, you'll discuss what type of anesthesia will be used, the steps involved in your particular surgery, and what kind of results you can expect.

Location

Eyelid surgery may be performed in an office-based facility, an outpatient surgery center, or a hospital.

What to Wear

Wear loose fitting, comfortable clothes the day of surgery. You may want to wear a shirt that buttons or zips, rather than one that you have to slip over your head. If you wear contact lenses, remember to wear glasses that day.

Food and Drink

Avoid eating or drinking after midnight the night before your surgery. This ensures that your stomach is empty before you receive anesthesia. If your healthcare provider has asked you to take medication, take it with a small sip of water.

Medications

You should avoid taking aspirin, Advil (ibuprofen), Aleve (naproxen), Coumadin (warfarin), or any anti-inflammatory or blood-thinning medicines for five days before your surgery since they can cause issues with bleeding.

What to Bring

On the day of surgery, remember to bring your ID, insurance card, and any necessary paperwork. Also, bring along someone to drive you home after your procedure.

Since you may be sensitive to light after surgery, bring along sunglasses to wear after your procedure.

Pre-Op Lifestyle Changes

Avoid sunburns around your eyes for at least two weeks before surgery. Your healthcare provider may give you a recommendation for what type of sunscreen to wear around your eyes.

Also avoid smoking, ideally for at least two weeks before surgery. Smoking can reduce the size of your blood vessels, decreasing your body’s ability to deliver blood and oxygen, slowing healing, and increasing the risk of infections.

Your eyes may be a little blurry for the first couple of days after blepharoplasty, particularly if your surgeon gives you an ointment to use on your eyes. In preparation for that, you may want to download some audiobooks ahead of time so you have them ready for your recovery period. If you have a voice assistant, setting it up to make/receive calls can also be useful.

What to Expect on the Day of Surgery

Your eyelid surgery should take less than two hours. In addition to your plastic surgeon, an operating room nurse and an anesthesiologist (if undergoing general anesthesia) will be present during the procedure.

Before the Surgery

When you arrive for your surgery, a nurse will check your vitals and place an IV in your arm or hand. This IV is used to deliver medication or fluids (as needed) during your procedure.

Next, you’ll meet with your surgeon who will go over the details of the procedure with you and mark your upper and/or lower eyelids with a surgical marking pen.

When your surgeon is ready, you will be walked into the procedure room where you will lie flat on a procedure table or chair. A nurse will then clean your face with a bacteria-killing solution and place sterile drapes around your head.

During the Surgery

If you are undergoing local anesthesia, the surgeon will inject a numbing medication into your eyelid(s). You will also be given a sedating medication through your IV to make you drowsy and sleepy during the procedure.

If you are undergoing general anesthesia, you’ll receive medication either through an IV or by inhaling a gas through a mask. This medication will render you temporarily unconscious during surgery and unable to feel discomfort. An endotracheal tube will also be placed to provide breathing and oxygen support during surgery.

Upper Eyelid

When performing surgery on the upper eyelid, the surgeon makes an incision with a blade, laser, or needle-tip cautery unit along the incision marking site.

The extra skin is removed and excess fat is either repositioned or removed using electrocautery (heat from an electric current) or ligation (clipping) and scissors.

Lower Eyelid

Lower eyelid surgery may be performed inside the lower eyelid (transconjunctival) or underneath the lower eyelash line (infraciliary). Steps may vary, but often include the following:

• Transconjunctival: An instrument is used to pull down the lower lid. An incision is made through the conjunctiva and lower eyelid retractors are placed inside the lid. Three fat pads, visible underneath the eye, are reduced or repositioned. The incisions are closed with absorbable sutures.
• Underneath lash line (infraciliary): An incision is made 1 to 2 millimeters (mm) underneath the lash line. A small amount of excess skin may be removed. The fat pockets are reduced or repositioned in the same way as the transconjunctival incision.

Eyelid incisions are usually closed with sutures or skin glue.

After the Surgery

After the surgery is completed, you’ll be taken to a recovery room where you’ll be monitored. Your surgeon will likely give you ice compresses to help reduce any immediate post-operative swelling. These are to be placed on your eyelids for around 20 minutes.

Once your anesthesia wears off and your surgeon gives you the OK, a friend or family member can take you home.

Recovery

Complete recovery is expected to take 10 to 14 days. As with any operation, blepharoplasty has side effects, most of which are minor and temporary.

They can include:

• Pain: Expect some for the first few days after surgery; it should improve as the week goes on.
• Initial swelling or bruising in/around the eyelids, which may last one to two weeks but can in some cases last a few months
• Tightness of the eyelids
• Eye dryness
• Itching
• Burning

Your eyes may also feel tired more quickly than usual for the several weeks.

Healing

Your surgeon may suggest that you clean external incision sites twice a day with a cotton swab soaked in saline solution or hydrogen peroxide. Following this, you will apply a prescription ophthalmic ointment over the stitches.

You may also be given cold saline compresses to use on your eyes for a day after surgery to help decrease bruising and swelling.

To keep the surgical area clean and reduce your risk of infection:

• Don’t wear make-up on or around your eyes while the incision is healing.
• Avoid rubbing your eyes.
• Don’t go swimming.
• Wear glasses instead of contact lenses for two weeks after surgery.

Wearing dark sunglasses whenever you’re outside can help with light sensitivity, and wearing sunscreen on your face can protect healing skin.

You can expect to see your surgeon for a follow-up appointment two to three times the first week after surgery. During these appointments, your incision sites will be checked and your stitches will be removed.

Coping With Recovery

Plan to take this time off work, if possible. If your job requires you to be physically active, you may want to take a bit more time. If it involves constantly working at a computer, you may consider working part-time and increasing your hours as you get better.

You may also want to arrange for someone to help you at home for one to two days after your procedure.

Sleeping with your head elevated 45 degrees on several pillows, or laying on a recliner, can help decrease any swelling.

Follow your healthcare provider's instructions regarding activity limitations, which are likely to include avoiding:

• Lifting anything heavy, taking part in strenuous activities, or exercising heavily for at least two weeks
• Bending over/placing your head in a downward position for up to four weeks

Long-Term Care

While sun protection is helpful in recovery, it's also important long after that. Avoid sun exposure as much as possible. And when outdoors, use sunscreen with an SPF of 30 or higher to protect your skin and maintain the results of your surgery.

While most sunscreens are safe to use around the eye, mineral-based sunscreens with ingredients like zinc or titanium dioxide are better options since they won't sting or irritate the delicate skin in this area.

Possible Future Surgeries

The results of upper eyelid surgery last anywhere from five to 15 years, and the results from lower eyelid surgery are basically permanent. Due to these long-lasting results, you will likely not need another surgery.

That said, while removed fat and excess skin will not return after surgery, even if you gain weight, your face will change naturally with age. Therefore, you may opt for another eyelid surgery in the future (or other plastic surgery like a brow lift or facelift) to address these age-related changes.

A Word From Verywell

If you are considering eyelid surgery, it's important to pick a board-certified plastic surgeon who has lots of experience performing this type of procedure.

During your initial consultation, don't hesitate to ask the surgeon about their credentials, how many of these procedures they have performed in the past, and their complication rate. You should also ask to see before and after eyelid surgery photos of previous patients so you go into surgery with realistic expectations.