Blepharoplasty (Eyelid Surgery): What to Expect and How to Prepare

Medically Reviewed By Catherine Hannan, M.D.
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Eyelid surgery — also called eyelift, eyelid lift, or blepharoplasty — is the surgical removal of excess skin, muscle, and fat in the upper or lower eyelids. Many people seek eyelid surgery for cosmetic reasons. Sometimes, doctors also recommend eyelid surgery for medical reasons, such as to improve vision. Eyelid surgery is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your cosmetic or treatment choices before undergoing eyelid surgery. 

This article covers the reasons someone may undergo eyelid surgery. It also includes what the procedure involves, before and after photos, and what to expect during recovery.

Why do doctors perform eyelid surgery?

Woman's eye visible in handheld mirror
Thais Varela/Stocksy United

Your doctor may recommend eyelid surgery for medical or cosmetic reasons. You may undergo surgery on your upper eyelid, lower eyelid, or both.

Medical reasons for eyelid surgery

Certain conditions can cause changes to one or both eyelids that affect your ability to see clearly. In these cases, a doctor may recommend blepharoplasty to improve vision.

Other medical reasons for eyelid surgery include:

  • Ptosis: Ptosis refers to the drooping of one or both upper eyelids. It can be present at birth or develop later in life. Surgeons correct ptosis by shortening the eyelid muscle, which lifts the drooping lid.
  • Ectropion: This term describes drooping of the lower eyelid that causes it to turn outward. This can make the eye sensitive to wind and light and cause dry or watery eyes. Ectropion can occur for many reasons, including aging, having certain skin conditions, or sustaining an injury to the eye.
  • Entropion: This occurs when the lower eyelid turns inward toward the eye. This can cause irritation to the eye that makes the cornea vulnerable to infection. Factors such as age, infections, and scarring in the eyelid can lead to entropion.
  • Chronic dermatitis: In some cases, excess skin in the upper eyelid can cause recurrent skin irritation around the eye.
  • Difficulty wearing glasses or fitting a prosthetic eye: For some people, excess skin or drooping eyelids can cause problems with wearing corrective lenses or properly fitting a prosthesis.

Cosmetic reasons for eyelid surgery

You may choose to undergo blepharoplasty as an elective procedure to achieve the appearance you want for your eyes. This may involve surgery with the aim of:

  • removing excess fatty deposits that cause puffiness in the upper eyelids
  • altering loose or sagging skin that causes folds or affects the natural contour of the upper eyelid
  • reducing excess skin and fine wrinkles of the lower eyelid, bags under the eyes, or droopiness of the lower eyelids

Eyelid surgery cannot produce the effects of a brow lift or change the appearance of dark circles under the eyes. Your cosmetic surgeon will discuss the anticipated results of your eyelid surgery with you.

Who performs eyelid surgery?

The following specialists can perform eyelid surgery:

  • Plastic surgeons: They specialize in aesthetic and reconstructive surgery.
  • Facial plastic and reconstructive surgeons: They specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose, and throat doctors or surgeons).
  • Head and neck plastic surgeons: They specialize in plastic and reconstructive surgery of the head and neck. They also train as plastic surgeons or otolaryngologists before further specialization.
  • Ophthalmologists: They specialize in the medical and surgical care of diseases and conditions of the eye.

Before and after photos

These images show the eyelid area before and after blepharoplasty.

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Eyelid surgery before and after

Image via Healthgrades

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Eyelid surgery before and after

Image via Healthgrades

eyelid-surgery-1.jpg

Eyelid surgery before and after

Image via Healthgrades

eyelid-surgery-2.jpg

Eyelid surgery before and after

Image via Healthgrades

What happens during eyelid surgery?

Your eyelid surgery will take place in a hospital or outpatient surgery clinic. Your surgeon will perform eyelid surgery using either an anesthetic or a regional anesthetic, depending on the specific procedure.

Your surgeon will make incisions on the upper eyelids or on the lower eyelids, just below the lower eyelash line. Incisions made in the natural creases of your eyelids make scarring less noticeable.

In some cases, surgeons make incisions on the inside of the lower eyelid. These are called transconjunctival incisions. 

Your surgeon will reposition or remove fat deposits, tighten muscles and tissues, and remove excess skin in the eyelids to create the desired results. They will then close the incisions with small sutures, skin adhesives, or surgical tape.

What can you expect on the day of your eyelid surgery?

Ahead of your eyelid surgery, your doctor or medical team will discuss steps to prepare. These may include fasting for a certain time before the procedure, undergoing preoperative tests, and stopping certain medications.

On the day of your surgery, you can expect to:

  • Talk with a preoperative nurse: The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer your questions and make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown: It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist: You will likely talk with them about your medical history and the type of anesthetic you will receive.
  • Receive an anesthetic: A surgical team member will start an IV. The anesthesiologist or nurse anesthetist will start your anesthetic, and you will have a tube in your windpipe to control your breathing while you are asleep.

The surgical team will monitor your vital signs and other critical body functions during your surgery. After your procedure is complete, your care team will move you to a recovery area.

What can you expect during eyelid surgery recovery?

You will stay in the recovery room after surgery until you are alert, you are breathing effectively, and your vital signs are stable. You might have a sore throat if a tube was placed in your windpipe before the surgery. This is usually temporary, but tell your care team if you are uncomfortable.

You may still be drowsy or nauseated from the anesthetic, so you will need a friend or family member to drive you home and stay with you the first night or two.

How long will it take to recover?

You will likely have small sutures on your eyelids along with lubricating eye ointment. This may cause blurred vision. Your eyes may also be lightly wrapped with gauze.

You may have swelling and bruising around your eye for 1–3 weeks following your surgery. Most people return to work and other routine activities 10–14 days after blepharoplasty.

Will I feel pain?

Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery. However, your doctor will treat your pain so that you are comfortable and can get the rest you need.

Call your doctor if your pain gets worse or changes in any way because it may be a symptom of a complication.

What self-care steps should I take?

Your doctor will provide detailed instructions for home care during your recovery. Generally, steps you can take at home after eyelid surgery include:

  • applying eye ointment as prescribed by your doctor
  • avoiding touching or rubbing your eyes
  • applying cool compresses to your eyes to reduce inflammation and irritation
  • protecting your eyes from sunlight until your incisions are completely healed
  • not wearing eye makeup or contact lenses for 2 weeks
  • avoiding strenuous activities, particularly ones that involve bending over

When should I call my doctor?

It is important to keep your follow-up appointments after eyelid surgery. Contact your doctor for questions and concerns between appointments.

Call your doctor right away or seek immediate medical care if you have:

Ask your doctor or surgical team for guidance on what to expect following your eyelid surgery and when to notify them of any symptoms during your recovery.

What are the risks and potential complications of eyelid surgery?  

As with all surgeries, eyelid surgery involves risks and potential complications. Complications may become serious and life threatening in some cases. They can develop during surgery or recovery.

Some possible complications of eyelid surgery include:

  • asymmetry within the eyelids
  • blurred or impaired vision, dry and irritated eyes, and excessive tearing
  • difficulty closing your eyes
  • emerging sutures that your surgeon needs to manually remove (instead of sutures that dissolve on their own)
  • hematoma, which refers to bleeding under the skin that leads to an accumulation of blood under the skin 
  • lid lag, or a pulling down of the lower eyelid that is usually temporary
  • ectropion, or a rolling of the eyelid outward to expose the inner eyelid surface, which is also usually temporary
  • pain, swelling, and bruising
  • poor wound healing 
  • scarring
  • temporary eyelid numbness
  • vision loss due to bleeding behind the eye

Talk with your doctor about your individual risk factors and any steps you can take to reduce your risk of complications from eyelid surgery.

Summary

Eyelid surgery, or blepharoplasty, is a procedure that can alter the tissue of the upper eyelids, lower eyelids, or both. Surgeons may perform eyelid surgery to treat conditions that limit vision. Blepharoplasty can also be a cosmetic procedure to change the appearance of the area around the eyes.

Recovery from eyelid surgery typically involves managing swelling and bruising as the incisions heal. Most people who undergo blepharoplasty return to their typical activities within 10–14 days.

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Medical Reviewer: Catherine Hannan, M.D.
Last Review Date: 2022 Apr 28
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