Blepharoplasty — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Blepharoplasty is eyelid surgery that removes or repositions excess skin, fat, and occasionally muscle from the upper and/or lower eyelids. It is performed by plastic surgeons or oculoplastic surgeons (ophthalmologists specialising in eyelid surgery) and may be undertaken for cosmetic or functional (medical) indications. Upper blepharoplasty addresses the sagging or hooding of the upper lid that accumulates with age due to dermatochalasis (excess skin laxity) and prolapsed orbital fat. Lower blepharoplasty targets under-eye bags (herniated orbital fat) and wrinkled lower lid skin. The procedure has been performed for over a century and is among the most commonly performed facial aesthetic surgeries globally, with approximately 240,000 procedures performed in the United States annually. Functional upper blepharoplasty is differentiated from cosmetic surgery by documented visual field impairment (superior visual field loss greater than 12 degrees) on formal perimetry testing, which determines insurance coverage eligibility in many countries. Blepharoplasty is eyelid surgery that removes or repositions excess skin, fat, and occasionally muscle from the upper and/or lower eyelids. It is performed by plastic surgeons, oculoplastic surgeons (ophthalmologists specialising in periocular surgery), or maxillofacial surgeons. Upper blepharoplasty primarily addresses functional visual field obstruction caused by dermatochalasis (excess overhanging upper eyelid skin) and is one of the most commonly performed aesthetic and functional surgeries in older adults. Lower blepharoplasty addresses infraorbital fat prolapse causing lower eyelid bags. Over one million blepharoplasty procedures are performed annually worldwide. In patients over 40, it is frequently combined with brow lift or mid-face lift for comprehensive periocular rejuvenation. As a functional procedure, upper blepharoplasty that restores superior visual field may be covered by health insurance where documented visual field impairment is present.

Blepharoplasty is indicated for two distinct populations with different motivations. Functional candidates include patients with dermatochalasis (redundant upper eyelid skin) causing measurable peripheral visual field restriction (typically superior field loss greater than 12 degrees on formal perimetry), ptosis (drooping of the upper lid from levator muscle dysfunction) impairing daily activities, or chronic brow ache from the effort of compensatory brow elevation. Cosmetic candidates seek correction of cosmetically bothersome periorbital aging — upper lid hooding, lower lid puffiness from orbital fat herniation, excess lower eyelid skin (dermachalasis), and hollow upper lids from orbital fat atrophy. Good cosmetic candidates are non-smokers in stable general health with realistic expectations, stable thyroid disease (thyroid eye disease must be quiescent for at least 12 months), no dry eye disease, and no active anticoagulation therapy that cannot be paused. Photographs in natural light and formal visual field testing are standard pre-operative requirements. A complete ophthalmological assessment should precede functional surgery.

Blepharoplasty is typically performed under local anaesthesia with intravenous sedation, though general anaesthesia may be used for bilateral procedures or anxious patients. Upper blepharoplasty: with the patient sitting upright preoperatively, a skin pinch test marks the amount of redundant skin to be excised. The incision is planned within the natural upper lid crease (approximately 8–10 mm above the lid margin in women; 6–8 mm in men). Local anaesthetic (lidocaine 2% with adrenaline 1:100,000) is infiltrated. The redundant skin and a strip of orbicularis oculi muscle are excised with a 15-blade scalpel or fine scissors. Herniated medial and central fat pads are reduced or redistributed. Haemostasis is achieved with bipolar diathermy. The skin is closed with running 6-0 sutures. Lower blepharoplasty: a transconjunctival (through the inside of the lower lid, no skin incision) or subciliary (2 mm below the lash line) approach is used depending on the primary pathology. The procedure takes 1–3 hours for bilateral upper and lower blepharoplasty. Sutures are removed at 5–7 days. Blepharoplasty is typically performed under local anaesthesia with intravenous sedation. Upper blepharoplasty: with the patient supine, an elliptical excision of skin (and orbicularis muscle if required) is performed within the natural upper lid crease, typically removing 8–15 mm of tissue. Pre-aponeurotic fat is conserved or selectively excised. The wound is closed with a continuous or interrupted suture creating a defined lid crease. Lower blepharoplasty: a transconjunctival approach (incision inside the lower lid, no external scar) removes or redistributes herniated fat without skin excision — ideal when skin laxity is minimal. A subciliary (skin) approach is used when skin resection is required, with careful preservation of the orbicularis oculi to prevent ectropion. Any concurrent ptosis repair (levator advancement) or canthopexy for lower lid support is performed before wound closure. Total surgical time is 60–120 minutes for combined upper and lower blepharoplasty.

Patient satisfaction rates after blepharoplasty exceed 90% in published series, making it one of the most consistently satisfying aesthetic surgical procedures. Functional blepharoplasty improves the superior visual field by 12–15 degrees on average, with most patients reporting significant relief from brow ache and eye fatigue. Cosmetic blepharoplasty produces a more rested and youthful periorbital appearance by eliminating skin hooding (upper lid) and under-eye bags (lower lid). Results of upper lid blepharoplasty typically last 5–10 years before further skin laxity requires consideration of revision surgery; lower lid results are frequently permanent as fat redistribution does not recur in the same manner. Transconjunctival lower blepharoplasty leaves no visible scar. Coblation or radiofrequency skin resurfacing can be combined with lower blepharoplasty to address fine rhytids simultaneously. Patient-reported outcome measures (FACE-Q scale) consistently demonstrate improvements in appearance-related quality of life, psychological wellbeing, and self-confidence following blepharoplasty.

Blepharoplasty is a relatively safe procedure when performed by an experienced surgeon, but patients must be counselled on potential complications. Asymmetry is the most common patient concern, though minor pre-existing asymmetry is universal and should be pointed out before surgery. Dry eye syndrome may worsen temporarily after upper blepharoplasty due to altered lid mechanics and reduced blink efficiency; lubricating drops and ointments are used routinely post-operatively. Lagophthalmos (inability to fully close the eye) can result from excessive skin excision; it is usually temporary but can be chronic if over-resection occurs. Haematoma (collection of blood) occurs in 1–2% and may require drainage. Infection is rare (<0.5%) with prophylactic antibiotic ointment. Scarring is generally minimal given the placement of incisions within natural skin creases; hypertrophic scars are rare. Diplopia (double vision) from muscle injury is rare (<0.1%). Most seriously, retrobulbar haematoma causing acute vision loss is an extremely rare emergency (<1:10,000) requiring immediate orbital decompression.

Most patients go home the same day of surgery. Swelling and bruising (periorbital ecchymosis) peak at 3–5 days and substantially resolve over 10–14 days. Cold compresses applied for 20 minutes every hour for the first 48 hours significantly reduce swelling. The head should be elevated on two pillows during sleep for the first 2 weeks. Lubricating eye drops (preservative-free artificial tears) are used every 1–2 hours for the first 2 weeks, and lubricating ointment is applied at night. Sutures are removed at 5–7 days. Patients avoid heavy lifting, strenuous exercise, and wearing contact lenses for 2–3 weeks. Make-up over the eyelid incisions is avoided for 3 weeks until skin healing is complete. Reading, watching television, and working on a computer may resume as soon as comfort permits, usually within 3–5 days. Social readiness (minimal visible bruising and swelling) is typically achieved at 2 weeks. The final cosmetic result is visible at 2–3 months once all oedema resolves and scar maturation is complete.