What Is Blepharoplasty?
Blepharoplasty is a kind of surgery performed on the eyelids. It’s done to remove excess skin from the upper eyelids and reduce bagginess from the lower eyelids. It’s also called an eye lift.
Why Is Blepharoplasty Done?
This surgery is usually done for cosmetic reasons. It's also an effective way to improve sight in older people whose sagging upper eyelids get in the way of their vision.
The eyelid aging process
As skin ages, it gradually loses its elasticity. A lack of elasticity plus the constant pull from gravity causes excess skin to collect on the upper and lower eyelids.
Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and get in the way of seeing.
The fat that cushions the eyeball from the skull can also cause bulges in the upper and lower eyelids. The thin membrane that holds the fat in place weakens with age, letting the fat come forward into the lids like a hernia.
An eye lift won’t get rid of dark circles under the eyes, crow's feet, or other facial wrinkles. It’s often done along with other procedures such as laser resurfacing, filler injections, or forehead lifts.
How can blepharoplasty help you see better? Sagging skin around your eyes can limit how much you can see out of the corner of your eye -- called your peripheral vision. It also can reduce your upper field of vision. That means that you’ll see less when looking up unless you lift your chin or your eyebrows.
Such vision problems can be dangerous. For example, you may have trouble seeing traffic lights when you’re driving. Eyelid surgery can eliminate or at least reduce those vision problems by removing the skin that’s blocking your vision.
Who Is a Good Candidate for Blepharoplasty?
If you are in good overall health, at least 30 years old, and have no other eye problems, you are likely a good candidate for blepharoplasty. If you've been diagnosed with health conditions, it doesn't rule you out for eyelid surgery. However, you should talk to your eye doctor about your health history. Make sure to mention whether you have any of the following conditions:
- Eye diseases such as glaucoma, dry eye, and detached retina
- Thyroid diseases such as Graves’ disease, hypothyroidism, and hyperthyroidism
- Heart disease, high blood pressure, and other circulatory diseases
Keep in mind that eyelid surgery will not dramatically change your appearance or alter the structure of your face, though it can enhance your looks and boost your confidence. Before deciding to have a blepharoplasty, consider what you would like to achieve and discuss your goals and expectations with your surgeon.
Types of Blepharoplasty
There are two main types of blepharoplasty: upper eyelid blepharoplasty and lower eyelid blepharoplasty. Let’s take a look at both.
Upper eyelid blepharoplasty
This is one of the most common procedures that surgeons perform on the face. It’s done to improve your appearance, to help you see better, or both. During upper eyelid surgery, your surgeon will remove your drooping eyelid skin and excess fat, and if necessary, repair the muscles that help open your eyes.
Your surgeon may recommend a brow lift be performed at the same time for a couple of reasons:
A drooping brow may be the cause of your drooping eyelids.
A brow lift may reduce the amount of upper eyelid skin that needs to be removed.
Lower eyelid blepharoplasty
A very common surgery, lower eyelid blepharoplasty involves moving or removing what are called fat pads. These can form under your eyes, creating bags and circles. The procedure also includes the removal of excess skin and strengthening of muscles and tendons. While you’re still under anesthesia, your surgeon may perform an additional procedure that will help maintain the long-term results of your blepharoplasty. This procedure will be one of the following:
Canthoplasty. In this procedure, your surgeon tightens the muscles, tendons, and ligaments around the outer corners of your eyes, where your upper and lower eyelids meet, called the canthus.
Canthopexy. In this less complex procedure, your surgeon tightens the outer corner of your eyes with invisible stitches, leaving your muscles and tendons untouched.
If you need both upper and lower eyelid surgery, your surgeon may be able to perform them together.
You’ll need to arrange for another person to drive you home after your surgery. Also, you should have someone stay with you on the night of the procedure.
Expect and plan to stay home from work and limit your activities for several days after surgery while your eyelids heal. Some people have dry eyes after surgery, but that rarely lasts more than 2 weeks. If you have dry eyes lasting more than 2 weeks, contact your doctor.
At home, you should have the following items ready:
Ice pack (or you can use freezer bags filled with ice, frozen corn, or peas)
Small gauze pads
Eye drops or artificial tears (ask your doctor to recommend the proper type to meet your particular needs)
Clean washcloths and towels
Over-the-counter painkillers (which your doctor can recommend)
Talking to your doctors
If you have decided to undergo blepharoplasty, don’t rush into it. Make sure to have detailed conversations with your regular doctor, your eye doctor, and your eye surgeon.
It’s important for each doctor to review your medical history and to understand any current medical issues that could interfere with the success and safety of your eyelid surgery. Here are some of the topics you should discuss:
Drug allergies. Allergic reactions to anesthesia, for example, can be severe and even fatal. Let your doctor know if you are allergic to any medications.
Dry eye. As many as one in four people develop dry eye after eyelid surgery. If you already have dry eye, the surgery can make it worse.
Other eye problems such as glaucoma.
Current medications. Your doctor will review the medications that you take, both prescription and over-the-counter ones. Some drugs may present risks during surgery. For example, drugs and supplements that help prevent blood clots, such as aspirin, fish oil, and the prescription drug warfarin, up your risk of bleeding and, potentially, vision loss.
You also should undergo a full physical exam as well as a comprehensive eye exam and vision test. Your surgeon will take photos of your eyelids to help plan for the surgery.
An eye lift usually takes about 2 hours if both upper and lower eyelids are done together. Your doctor will most likely use local anesthesia (a painkiller injected around the eye) with oral sedation.
If you undergo the procedure at a hospital or surgical center, you’ll most likely receive IV sedation.
If you're having all four eyelids done, the surgeon will probably work on the upper lids first. The surgeon will usually cut along the natural lines of your eyelids. Through these cuts, your surgeon will separate the skin from the underlying tissue and remove the excess fat and skin (and muscle if indicated). Next, the surgeon will close those cuts with very small stitches. The stitches in the upper lids will stay for 3-6 days. The lower lids may or may not require stitches, depending on the technique used.
Surgery on the lower eyelids may be done using one of several techniques. In one method, your surgeon makes a cut inside your lower eyelid to remove fat. That cut won't be visible. Your surgeon can then soften fine lines in the skin using a CO2 or erbium laser.
Another method involves making a cut along the eyelash margin. Through that cut, your surgeon can remove excess skin, loose muscle, and fat. The cut line fades after a short time.
After either of these procedures, your surgeon may recommend laser resurfacing.
Your surgeon may also recommend that your eyelid surgery be done along with another procedure called ptosis surgery. Ptosis is a condition that causes one or both of your upper eyelids to droop. That drooping can block your vision, sometimes completely. It’s usually caused by a problem with the muscle that lifts your upper eyelid. Some people are born with ptosis, while others develop it later in life, due to aging, injury, or disease.
During ptosis surgery, the surgeon will use stitches to tighten the muscle used to raise your eyelid. The goal is to improve your vision and appearance.
After the surgery
Your doctor will probably put ointment in your eyes to keep them moist and cover them with cold compresses while you’re in the recovery room. Right after surgery, you may have blurry vision from the ointment and be sensitive to light. Your eyes may feel dry or watery.
It will help to put ice packs on your eyes and sleep with your head raised the first night after surgery. Your doctor will give you detailed instructions for taking care of yourself.
Upper eyelid surgery is good for at least 5-7 years, and the results may last the rest of your life. Lower eyelid surgery rarely needs to be repeated. Of course, your eyes will still age after the procedure.
If your lids sag again, a forehead lift rather than another eye lift may be the preferred procedure.
Keep in mind that you won’t immediately look your best after surgery. You’ll have bruising and swelling for up to about 2 weeks, and small scars that will take a few months to fade completely. However, once you have healed fully, you can expect to look more youthful and better rested, which should help you feel more self-confident. And, if your vision had been affected by your eyelids, you should be able to see better.
After surgery, your eyelids will likely be puffy and numb. You will have both bruising and swelling around your eyes, like having black eyes, and that can take months to fully heal, though most people feel comfortable being out in public within 2 weeks. You also will have small surgical scars. These will fade within a few months. During that time, protect the scarred skin from the sun by wearing dark sunglasses outdoors until you have fully healed. Sunglasses also will help if your eyes are temporarily more sensitive to light.
Your vision may be blurred for a few days after surgery, or you may experience double vision occasionally. This can be due to several things:
- The eye ointments your doctor prescribes
- Increased sensitivity to light
- Watering eyes
Play it safe and do not drive until your vision returns to normal.
Follow the instructions from your surgeon about how to care for yourself following surgery. Your instructions likely will include the following:
- Use ice packs on your eyes for 10 minutes every hour on the first night after surgery and 4-5 times over the next day.
- Use the prescribed eye drops or ointments.
- Elevate your head above your chest while sleeping for a few nights.
- Use cool compresses to help ease swelling.
- Take acetaminophen (Tylenol) for pain.
- Do not take aspirin, ibuprofen (Advil, Motrin, etc.), naproxen sodium (Aleve), naproxen (Naprosyn), or other drugs or supplements that increase the risk of bleeding. Your doctor can provide you with a full list of what to avoid.
- Avoid heavy lifting or other strenuous activities and exercises for a week.
- Don’t smoke.
- Don’t rub your eyes.
- Don’t wear contact lenses for about 2 weeks.
Like all surgical procedures, blepharoplasty does have some risks. Fortunately, serious risks are rare. Still, you should talk to your eye doctor and your surgeon about the potential complications that you may experience. This discussion can help guide your decision about surgery.
The risks you will face include:
- Dry eyes (or worsened dry eyes if you already have the condition)
- Discoloration of your eyelids
- Noticeable scarring
- Difficulty closing your eyes (called ‘lid lag’ or lagophthalmos, which may be temporary)
- Sagging outwards of your eyelid (called ectropion, this may require corrective surgery)
- Temporarily blurred vision
- Bleeding behind your eye (called retrobulbar hematoma, this rare complication is a medical emergency that can cause blindness)
If you smoke, you have a higher risk of complications. Quit at least one month before surgery.
Chronic health problems, such as diabetes, also raise your risk of complications and slow healing. Be sure to discuss your current health with your doctor before you commit to surgery.
It’s hard to say precisely how much blepharoplasty will cost you. The most recent estimates put the average cost of cosmetic eyelid surgery at $4,120. But the price of the procedure ranges quite dramatically depending on where it’s performed. For example, one Boston hospital charges $10,000 for blepharoplasty on the upper and lower eyelids of both eyes. Meanwhile, a Salt Lake City, Utah, hospital charges up to $6,375 for the same procedure. And an Atlanta hospital will charge you $6,000 to $8,000.
Lower eyelid surgery tends to be significantly more expensive than upper eyelid surgery. In one New Jersey practice, for example, lower eyelid surgery costs up to $6,750, while upper eyelid surgery costs as much as $5,000. A practice with several locations in New York charges up to $7,500 for lower eyelid blepharoplasty but no more than $5,200 for an upper eyelid procedure.
Be aware that other fees also will be in play. In addition to the surgeon’s fees, you’ll have to pay for anesthesia costs, hospital or facility charges, medications, and tests.
If you plan to have eyelid surgery for cosmetic reasons, do not expect your health insurance plan to cover the costs. But blepharoplasty performed to help you see better should be covered by health insurance. Check with your insurance company to see what your policy covers.
Choosing a Blepharoplasty Surgeon
Once you have decided to have eyelid surgery, it’s time to pick a surgeon. You can ask your eye doctor or primary care doctor to recommend one. Patient reviews also can be helpful in selecting candidates. Be sure to meet with the surgeon so that you can review their experience and qualifications as well as their proposed plan for your procedure. Here are some questions to ask:
- Am I a good candidate for a blepharoplasty?
- How many times have you performed this procedure?
- Can you show me before and after photos of your blepharoplasty patients?
- What results do you expect for me?
- What board certifications do you hold? (Your surgeon should be board-certified by the American Board of Plastic Surgery. You can check this here.)
- What technique will you use to perform the procedure? Why is it right for me?
- What are the risks of this surgery? What complications are most common and how do you address them if they occur?
- Where will the procedure take place and is it an accredited surgical facility?
- Where do you have hospital privileges?
- What type of anesthesia will be used?
- Who is the anesthesiologist and what are their qualifications?
- What will my post-surgery care involve?
- What degree of pain should I expect and how will that be managed?
- What happens if something goes wrong or I’m not happy with the outcome?
During your conversation, your surgeon should listen carefully to your questions and concerns and address them thoroughly. Your surgeon also should provide you with realistic expectations. If you don’t feel comfortable with the surgeon, that’s fine. Keep looking until you find a surgeon who puts you at ease.