Blepharoplasty (Eyelid Surgery)

Overview

Blepharoplasty, or eyelid surgery, is a procedure designed to correct droopy eyelids by removing excess skin, muscle, and fat. As you age, your eyelids can stretch and the muscles supporting them weaken, causing the accumulation of excess fat above and below the eyelids. This can lead to sagging eyebrows, drooping upper eyelids, and under-eye bags.

In addition to cosmetic improvements, severe sagging eyelid skin can impair peripheral vision. Blepharoplasty aims to address these issues, improving both vision and the aesthetic appearance of the eyes.

Reasons for undergoing blepharoplasty

You might consider blepharoplasty if droopy or sagging eyelids obstruct your ability to fully open your eyes or pull down your lower eyelids. Removing excess tissue from the upper eyelids can also improve your vision. Both upper and lower lid blepharoplasty procedures can help make your eyes appear more youthful and alert.

Blepharoplasty may be recommended if you have:

Droopy or baggy upper eyelids
Excess skin on the upper eyelids that affects peripheral vision
Sagging skin on the lower eyelids
Under-eye bags

Sometimes, blepharoplasty is performed in conjunction with other procedures such as a brow lift, facelift, or skin resurfacing. Insurance coverage for blepharoplasty may depend on whether the surgery corrects a condition that impairs vision. If the procedure is solely for cosmetic purposes, it is unlikely to be covered.

Risks

Potential risks associated with eyelid surgery include:

Infection and bleeding
Dry, irritated eyes
Difficulty closing the eyes or other eyelid-related issues
Noticeable scarring
Damage to eye muscles
Skin discoloration
Need for follow-up surgery
Temporary blurred vision or, in rare cases, loss of eyesight
General surgical risks such as reactions to anesthesia and blood clots

Discuss these risks with your doctor to understand how they apply to your situation. Knowing the details of blepharoplasty and weighing its benefits against risks can help you decide if this procedure is suitable for you.

Preparation

Before scheduling blepharoplasty, you will meet with a plastic surgeon and possibly an eye specialist or an oculoplastic surgeon to:

Review your medical history, including previous surgeries and current or past medical conditions such as dry eyes, glaucoma, allergies, circulatory issues, thyroid problems, and diabetes. Your doctor will also inquire about your use of medications, vitamins, herbal supplements, alcohol, tobacco, and drugs.
Discuss your expectations and motivations for surgery to ensure realistic goals and a satisfactory outcome.

Before the procedure, you will undergo:

A physical examination, including tests of tear production and measurements of your eyelid structures.
A vision examination, which includes peripheral vision testing to support any insurance claims.
Eyelid photography from various angles to aid in surgical planning and document the surgery’s effects.

You will also be advised to:

Stop taking medications such as warfarin, aspirin, ibuprofen, naproxen, and any supplements that may increase bleeding. Your surgeon will provide specific instructions on when to discontinue these medications.
Quit smoking several weeks before surgery to optimize healing.
Arrange for transportation to and from the outpatient surgery center, and plan for someone to stay with you for the first night post-surgery.

What to expect

Before the procedure

Blepharoplasty is typically performed on an outpatient basis. Your surgeon will administer local anesthesia to numb your eyelids and intravenous medication to help you relax.

During the procedure

If both upper and lower eyelids require treatment, the surgeon usually starts with the upper lids. They make an incision along the natural fold of the eyelid, remove excess skin, muscle, and possibly fat, and then close the incision.

For the lower lid, the surgeon makes a cut just below the eyelashes or inside the lower lid’s natural crease. They may remove or reposition excess fat, muscle, and sagging skin before closing the incision.

If your upper eyelid droops close to your pupil, your surgeon may combine blepharoplasty with a procedure called ptosis to reinforce the eyebrow muscle.

After the procedure

Following surgery, you will spend time in a recovery room where your condition will be monitored for any complications. You can usually return home later the same day to continue recovering.

Immediately after surgery, you may experience:

Blurred vision due to lubricating ointment applied to your eyes
Watery eyes
Light sensitivity
Double vision
Swollen, numb eyelids
Swelling and bruising resembling black eyes
Pain or discomfort

Your doctor will recommend the following post-surgery steps:

Apply ice packs to your eyes for 10 minutes every hour on the night of surgery, and four to five times the following day.
Gently clean your eyelids and use prescribed eye drops or ointments.
Avoid strenuous activities, heavy lifting, swimming, and smoking for at least a week.
Refrain from rubbing your eyes and avoid putting in contact lenses for about two weeks.
Wear dark, tinted sunglasses to shield your eyelids from sun exposure and wind.
Sleep with your head elevated higher than your chest for a few days to reduce swelling.
Use cool compresses to alleviate swelling.
Return to your doctor’s office after a few days to have stitches removed, if necessary.
Avoid aspirin, ibuprofen, naproxen, and other medications or supplements that may increase bleeding for about a week, opting for acetaminophen for pain relief if needed.

Seek immediate medical attention if you experience shortness of breath, chest pain, irregular heartbeat, severe eye pain, bleeding, or vision problems.

Results

Many people are satisfied with the outcomes of blepharoplasty, noting a more refreshed and youthful appearance and increased self-confidence. Results can be long-lasting for some individuals, although droopy eyelids may reoccur in others.

Bruising and swelling typically diminish within 10 to 14 days, allowing you to resume public activities comfortably. Scars from surgical incisions may take months to fade, so it’s important to protect your delicate eyelid skin from excessive sun exposure.

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