Eyelid Surgery: Everything You Need to Know

Upper eyelid after blepharoplasty

ivandan / Getty Images

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 bags, smooth out fine wrinkles, or both. Some seek it 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?

In eyelid surgery, the surgeon makes incisions in the upper or lower eyelid to reshape the skin around the eye.

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.

When operating on the lower eyelid, the surgeon can make an incision beneath the eyelashes. Excess skin is removed and fat is removed or redistributed. A transconjunctival 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 getting measurements, evaluating the looseness of skin, and checking the muscles that close the eyelids.

You may also be asked to get lab testing, including blood work, or a physical exam to make sure that you’re healthy enough to undergo surgery.

Most health insurance 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 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 doctor 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.

To avoid complications, let your doctor or surgeon know if you’re taking any medications, including prescriptions and over-the-counter drugs, herbs, and vitamins.

What to Bring

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.

Pre-Op Lifestyle Changes

Avoid sunburns around your eyes for at least two weeks before surgery. Your doctor 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

When you arrive at the surgeon’s office, surgery center, or hospital, a nurse will check your vitals and ask about your medical history. You’ll likely meet with the surgeon, who will go over the details of the procedure with you.

During the Surgery

The procedure should take less than two hours. The first step is to receive anesthesia. With general anesthesia, you’ll be unconscious during the surgery and unable to feel discomfort. You receive the medication either through an IV or by inhaling a gas through a mask.

Local anesthesia with IV sedation can numb the affected area and keep you from feeling pain. You’ll be under sedation, drowsy, but awake during the procedure.

Upper Eyelid

When performing surgery on the upper eyelid, the surgeon marks the area of skin to be cut with a surgical pen. This may occur before the administration of anesthesia. The skin is prepped and sterilized, and an incision is made along the markings with a blade, laser, or needletip cautery unit. The extra skin in removed and excess fat is either repositioned or removed.

Lower Eyelid

Lower eyelid surgery may be performed inside the lower eyelid (transconjunctival) or underneath the lower eyelash line (infraciliary). The area is marked with a surgical pen, and the skin is sterilized. 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 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 may usually closed with sutures or skin glue.

After the Surgery/Procedure

You’ll be taken to a recovery room where you’ll be monitored after the surgery. Once your anesthesia wears off and you’ve been cleared to go home, you’ll be given instructions for your recovery. You may be asked to make a follow-up appointment to remove stitches.

It's likely your surgeon will tell you not to drive for at least 24 hours after your procedure.

Tips for healing after eye surgery
 Verywell / Julie Bang

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.
  • Swelling or bruising in/around the eyelids, which may last one to two weeks
  • Tightness of the eyelids
  • Eye dryness
  • Itching
  • Burning

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

When to Call Your Doctor

Call your doctor if you experience anything that feels abnormal or unexpected. In particular, inform them of any the following, which may be signs of infection or another complication:

  • Increasing swelling and bruising
  • Redness around the incision
  • Severe pain
  • Temperature over 100.4 degrees F
  • Yellow or green discharge from the incision
  • Bleeding that can’t be controlled with light pressure

Healing

Your surgeon may suggest that you clean external incision sites twice a day with saline solution and apply an ophthalmic ointment on your eyelids. You may also be given cold saline compresses to use on your eyes for a day after surgery to help decrease bruising and swelling. Keep incisions clean with soap and water.

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.

If you have stitches, you’ll visit your surgeon to have them removed in about one week.

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 doctor'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, or use a sunscreen with an SPF 30 or higher, to protect the your skin and maintain the results of your surgery.

A Word From Verywell

Ask your surgeon about any questions you have before you schedule surgery or in the days after surgery. They can address your concerns and give you instructions to help guide you through recovery. Contact your physician or surgeon immediately if you have any problems or complications.

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Article Sources
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  1. American Society of Plastic Surgeons. Eyelid Surgery: Blepharoplasty.

  2. UNC Department of Otolaryngology/Head and Neck Surgery, Facial Plastic & Reconstructive Surgery. Blepharoplasty (Eyelid Surgery).

  3. Joshi N, Scawn R, Gore S. Blepharoplasty basics for the dermatologistJ Cutan Aesthet Surg. 2016;9(2):80. doi:10.4103/0974-2077.184050

  4. American Academy of Ophthalmology. Upper Eyelid Blepharoplasty.

  5. American Society of Plastic Surgeons. ASPS Recommended Insurance Coverage Criteria for Third-Party Payers: Blepharoplasty.

  6. The University of Kansas Health System. Pre and Post-Operative Instructions for Your Eyelid Surgery.

  7. American Board of Cosmetic Surgery. Eyelid Surgery Guide.

  8. American Academy of Ophthalmology. Lower Eyelid Blepharoplasty.

  9. University of Michigan Health System Plastic Surgery. Blepharoplasty (Eyelid Surgery) Post-Operative Instructions.