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What is Blepharoplasty?

Blepharoplasty, also known as eyelid surgery, is a surgical procedure to improve the appearance of the eyelids. It can be used to effectively treat conditions such as loose or sagging skin, fatty deposits that appear as puffy eyelids, bags under the eyes, drooping lower eyelids, excess skin and wrinkles of the lower eyelid.

Upper eyelid surgery can also help with functional vision problems, for example, when excess skin is obstructing vision or when the upper lid is resting lower than it should (which can happen for a variety of reasons). You should have a full eye exam prior to thinking about eyelid surgery to improve your vision and also look for any issues that might make eyelid surgery more challenging, such as dry eyes. Your eye care provider can also do visual field testing, which measures how much your vision is obstructed by excess skin.

Who is a Candidate for Blepharoplasty?

Aging in the upper eyelid consists of drooping or heavy lids, which can happen when skin and/or muscle is loose, and fatty deposits can make the eyes look puffy. Upper blepharoplasty can address all of these concerns and restore the youthful contour of the upper lid.

In the lower eyelid, aging can result in bags under the eyes, drooping lower lids that reveal the white part of the eye below the iris, and excess skin with fine wrinkles in the lower eyelid.

Most candidates for blepharoplasty are at least 35 years old, but if heavy lids run in your family, you might consider eyelid surgery earlier. The delicate skin around the eyes is one of the first areas in the face to show aging.

Several medical conditions can make this surgery more difficult or risky, including thyroid problems (low thyroid hormone levels or Graves’ disease), dry eye, high blood pressure or other cardiovascular disease, and diabetes. Dr. Yee—our board-certified plastic surgeon—generally asks that your primary physician clear you for cosmetic surgery, but for eyelid surgery a visit to your eye doctor is recommended as well.

How is a Blepharoplasty Performed?

For the upper eyelid surgery, Dr. Yee makes incisions following the natural upper lid crease, so the scar will be hidden within that fold. Excess skin and muscle are removed, and conservative fat removal is performed if necessary.

For lower lid surgery, the incision is typically just under the lash line. Again, excess skin and muscle are removed, and fat is repositioned and removed to create a smooth contour with the cheek. If the lower lid is loose, sometimes a “lateral canthopexy” is performed to tighten the lower lid and reduce the appearance of the white part of the eye below the iris. If the skin is in good condition, only the fat needs to be removed or repositioned, and then the incision may be hidden inside the lower eyelid, leaving no external scar.

Eyelid surgery may be performed under local anesthetic with sedation, or a general anesthetic, depending on the extent of surgery. It is an outpatient surgery.

Recovery from Blepharoplasty

Because of the very thin delicate skin around the eyes, swelling is much more noticeable than in other areas, and cool masks can help control the puffiness; keeping a fresh cold mask on for the first 72 hours, as much as possible, is recommended, along with keeping your head elevated (sleep in a chair or with a 45º wedge under your head). It usually takes about two weeks for the majority of the swelling to go down; bruising is also normal. Strenuous exercise should be avoided for the first few weeks after surgery; you can gradually start to increase activities after 3 weeks so that you are back to normal by the end of the 4th week.

Have more questions about eyelid surgery? Please call to schedule a consultation with Dr. Yee.