One of the most common reasons to consider eyelid surgery (blepharoplasty) is for droopy eyelids. The procedure removes and tightens excess eyelid skin and fat, offering a more youthful appearance. There are also medical reasons for undergoing eyelid surgery as droopy eyelids can, in some cases, obstruct your vision.
While the procedure is often referred to as an eyelid lift, this is not factually correct, as the eyelids are not lifted during surgery. There are a number of different surgical techniques that a surgeon may use depending on the patient’s anatomy and their unique goals.
The two primary types of eyelid surgery are upper and lower blepharoplasty:
An upper blepharoplasty uses incisions that allow for the removal of skin and fat. A thin stitch is then used to close the skin and crease and eyelid crease.
A lower blepharoplasty usually involves incisions into the skin directly below the lashline or, alternatively, on the inside of the eyelid (called a transconjunctival approach). This approach gives access to the eyelid without any visible incisions and is used for patients who require the removal or addition of fat. It is often combined with laser resurfacing of the eyelid skin which visibly reduces lines and wrinkles.
Upper Eyelid Surgery
If you feel like your eyes always look tired, or are drooping, giving your face a sad expression, then upper eyelid surgery can help to restore their naturally youthful shape. The procedure removes sagging, wrinkled and excess skin, giving your eyes a more open, refreshed appearance.
Lower Eyelid Surgery
If you’ve noticed puffy, sagging bags beneath your eyes that are making you look like you haven’t slept well, then lower eyelid surgery might be the right solution. As we age, herniated fat often collects beneath the eyes resulting in bags that become more noticeable over time as our skin loses elasticity. Puffiness and bags can occur in patients as young as their mid-twenties resulting in a prematurely aged appearance.
The Advantages and Disadvantages of Eyelid Surgery
Blepharoplasty surgery is considered low risk and offers long-lasting results, making it one of the most popular cosmetic surgical procedures.
Here are some answers to the most frequently asked eye lift questions in your area:
How is blepharoplasty surgery done?
Blepharoplasty can be done on the upper or lower eyelids or both at the same time. During the procedure, the surgeon will make incisions into the crease of the upper eyelid and beneath or behind the lower eyelid so that the incisions are unnoticeable after they have healed.
While you are lying down, the surgeon will mark the areas where excess skin and fat needs to be removed. If necessary, underlying muscle will also be removed. The tissue is removed using surgical instruments (including scalpels, cutting lasers, surgical scissors, and other specialized cutting devices). The surgeon will then use sutures or tissue adhesives to reconfigure the area around the eyelid and eyebrow.
The surgeon will carefully monitor the amount of skin, muscle, and fat that needs to be removed, taking into account your facial muscle structure, eyebrow symmetry and your bone structure. If you have dry eyes, the surgeon may opt to remove less tissue and, in so doing, avoid exposing more of the eye to the air so that symptoms don’t worsen.
Additional optional steps in the procedure include:
How do you prepare for eyelid surgery?
Before undergoing eyelid surgery, you will need to have a detailed examination and discussion with your surgeon that covers the benefits, as well as the potential risks of the procedure. Your doctor will provide preoperative instructions that you will need to follow closely so that you are prepared for the surgery itself as well as recovery afterward. This will include any medication for pain relief or to minimize discomfort (such as gauze, gel packs and artificial tears).
You will also need to clarify whether the procedure will be done under local or general anesthetic (this usually depends on the complexity of the blepharoplasty and whether you are undergoing additional cosmetic procedures at the same time).
Before the day of the procedure (especially if it will be done under general anesthetic), you may need to:
How long is the recovery time?
Compared to other facial cosmetic procedures, the recovery time after blepharoplasty is relatively short. You may notice that bruising and swelling are worse on the day after the surgery, but both the
swelling and the bruising quickly begin to go down.
In the first 48 hours after the surgery, you can use cool compresses to reduce the bruising and swelling, and light exercise (such as a gentle walk) can also accelerate healing. The thin bandages that your surgeon placed over the incision sites will usually be removed after 5 or so days, and the sutures used in the procedure will dissolve between four and seven days after the procedure. If your surgeon used non-dissolving stitches, they can be removed a week later.
You may experience red and bloodshot sclera (the whites of your eyes) and, while your eyes heal, you should not wear eye makeup. If you wear contact lenses, you can use them again once the swelling has subsided enough for you to be able to wear the lenses comfortably.
You should be able to return to normal activities seven to ten days after the surgery, and the majority of bruising and swelling should have disappeared after two weeks.
Your doctor will offer advice on pain medication that you can take. In most cases, you will only need non-prescription pain relief. You can expect discomfort, but if you have severe pain or impacted vision, you should call your surgeon immediately.
What are the risks and possible complications of eyelid surgery?
One of the possible complications of eyelid surgery as that you may temporarily be unable to close your eyelids comfortably or completely, resulting in dry eyes. This condition will usually resolve itself after a week or two and can be managed with eye drops. In some cases, the condition persists past two or three months and may require additional corrective surgery.
Other possible complications include:
How much does eyelid surgery cost? Does insurance cover the cost of blepharoplasty?
The costs for the procedure vary, but in your area you can expect to pay between $2,000 and $5,000. Surgeons charge different rates based on their experience, their sub-specialty, and the facility in which the surgery is performed.
$2,000 is the starting price for a simple procedure for both upper eyelids, without removing fat. $5,000 would be for a more complicated procedure addressing all four eyelids, including the removal
of excess fat. These estimates are for surgeon’s fees only, and additional costs for the facility in your area might be between $800 and $2,000.
In general, eyelid surgery is not covered by insurance, as it is considered a cosmetic procedure. The exception to this if you are undergoing a functional blepharoplasty. Then you well require prior authorization before the surgery and, if approved, your health insurance will cover the majority of the costs. This will only be done for upper eyelid surgery if your visual field is obstructed.
Who Are the Best Candidates for Eyelid Surgery?
If you have drooping or sagging skin around your eyes due to aging, a blepharoplasty procedure will usually be a good option, especially if you are in good health. For most people, eyelid surgery is done for cosmetic reasons after the age of 40 which is when patients typically begin to notice the signs of aging around the eyes as the skin loses elasticity. While it should make a big difference to your appearance, it is important to have realistic expectations.
An ideal candidate for a lower eyelid procedure would have puffiness under the eye. Puffiness can be hereditary, as a result of fluid accumulation or related to aging, where fat pads under the skin become more visible as the skin thins and muscles weaken.
If you have concerns about whether it is the right choice for you, schedule an appointment with a cosmetic surgeon or an eye specialist who will check the area and evaluate if you have medical problems related to your eyelids that need to be addressed.
You will need to be evaluated for surgical risk factors that include dry eye problems, diabetes, and thyroid eye disease. Health problems may mean that you cannot safely undergo the procedure.
Smokers have an increased risk of complications following surgery as they heal more slowly so, if you are a smoker, you may need to stay away from cigarettes for several weeks before the surgery.
Performing eyelid surgery on people of Asian descent is more difficult due to their unique eyelid structure, making this population group more at risk of sub-optimal outcomes.
How long does a blepharoplasty last for?
After successful eyelid surgery, you can expect the effects to last for 10 to 15 years. The aging process will continue and, as with any cosmetic procedure, your improved appearance will not last indefinitely. And, at some point in the future, you might need another eyelid lift.
Which procedures are often combined with eyelid surgery?
Many patients will choose to address signs of aging by having several facial procedures at the same time. Eyelid surgery can be performed as a stand-alone surgery. However, it is often combined with a facelift (to address jowls and sagging) and/or a brow lift (for sagging and forehead wrinkles) for full facial rejuvenation.
Are there non-surgical alternatives?
If you have concerns about eyelid surgery and would prefer a non-invasive alternative, injectables offer temporary results.
Alternatives to Upper Eyelid Surgery:
Droopy eyelids can be improved with Botox or Dysport to raise the eyebrows. This correction is done by injecting into the muscles that pull the eyebrows down. This costs around $500 to $600 in your area, and the effects last for four to six months. Fillers such as Restylane or Juvéderm are also an option and can be used to raise the corners of the eyebrows, pulling the eyelids up with them. You can expect to pay around $700 for this treatment, and the results will last between 6 and 18 months.
Alternatives to Lower Eyelid Surgery
Lower lid puffiness can be addressed with fillers. Fillers detract from the puffiness, without resolving the issue, by creating a smooth surface from the eye to the upper cheeks. This is most effective if the patient has tight skin under the eyes with minor puffiness.