Eyelid Surgery (Blepharoplasty)

Over time, eyelids tend to sag – which can lead to a number of aesthetic and functional concerns. Droopy eyelids above the eye and puffy or stretched lids below tend to give the face a tired, prematurely aged appearance. Additionally, if upper eyelid ptosis (sagging) is severe enough, it can even reduce the patient’s field of vision.

Thankfully, many patients facing these concerns can benefit from eyelid surgery. Also known as “blepharoplasty,” this procedure was designed to correct problems with the eyelids by removing excess tissues, tightening loose structures, removing excess fat to fill in hollowed areas, or resurfacing the loose skin to tighten and lighten it.

Our board-certified plastic surgeon, Mark E. Richards, MD, is proficient in many eyelid surgery strategies. He is committed to using the latest proven techniques and technology for all procedures performed at Ageless Impressions – Plastic Surgery Institute. To learn more about blepharoplasty, continue reading or contact our office to set up a consultation.

Also On This Page:

• What Is Eyelid Surgery?
• Eyelid Surgery Candidates
• Eyelid Lift Surgery vs. Brow Lift
• Complementary Procedures to Eyelid Surgery
• Types of Eyelid Surgery
• Preparing for Blepharoplasty
• Eyelid Surgery Procedure
• Blepharoplasty Recovery
• Eyelid Surgery Results
• Eyelid Surgery Risks
• Eyelid Surgery Scars
• Eyelid Surgery Cost
• Eyelid Surgery Alternatives
• Additional Eyelid Surgery FAQs

What Is Eyelid Surgery?

Eyelid lift surgery primarily focuses on excess skin and fat in the upper and/or lower eyelids. The procedure was designed to remove or reposition excess skin and fat in order to create a smoother, more youthful, less fatigued appearance. Eyelid lift surgery can also be helpful for eliminating visual obstructions caused by excess skin hanging over the eyes.

Dr. Richards often uses a state-of-the-art CO2 laser to perform blepharoplasty. This type of advanced device seals blood vessels as it cuts, allowing Dr. Richards to work with even greater precision while simultaneously reducing operating time and side effects. In his experience, laser techniques offer an innovative way to make lower eyelid surgery more effective and efficient, and generally produce the best possible results. Dr. Richards can talk more with you about this aspect of our blepharoplasty procedures during the initial consultation.

Who Is a Candidate for Eyelid Surgery?

Common problems that are likely to be corrected by upper, lower, or double blepharoplasty include:

• Extra skin in the upper eyelids that causes them to feel heavy
• Puffy bags in the lower lids
• Looseness of lower lids
• Disappearance of the upper or lower eyelid crease
• Tired or sad appearance
• Obstructed vision from eyelid skin
• Wrinkles around the eyes
• Bulges above the upper eyelid crease
• Hollows under the lower eyelids (when excess fat is transposed into the hollow)

It is important to note that not all patients will be suitable for blepharoplasty. Patients should be physically healthy, psychologically stable, and realistic in their expectations. Certain conditions may be problematic to blepharoplasty, such as insufficient tear production, a detached retina, thyroid problems, high blood pressure, and uncontrolled diabetes.

During your first-time meeting with Dr. Richards, he will review your medical history to help determine whether blepharoplasty will be safe and helpful for you. In addition to considering the issues listed above, Dr. Richards will evaluate your skin characteristics (e.g. texture, coloration, thickness, exposure to sun, potential for scarring, and others) before deeming eyelid surgery the best option. Furthermore, because allergies, some supplements, and smoking may also affect the procedure, it is important to discuss these with Dr. Richards.

Eyelid Lift Surgery vs. Brow Lift

An eyelid lift and a brow lift are both surgical cosmetic enhancement procedures that can produce remarkable degrees of rejuvenation in the upper areas of the face; however, these treatments are very different in terms of the specific concerns they are designed to address.

Folding or hanging skin past the outer corner of the eye is a good indication that the forehead has fallen. As the eyebrow descends with age, it can push down and fold over the upper eyelid skin. These are problems that can be uniquely solved by brow lift surgery. A brow lift may also be recommended for individuals who are experiencing severe signs of glabellar lines (furrows between the eyebrows) and prominent creases that appear along the forehead. In some cases, patients experience a visual obstruction or “heavy” upper eyelids because the brow has descended. This makes brow lift the more ideal treatment for these individuals. In other cases, a combination of brow lift surgery and eyelid lift surgery done together or in stages is the best option to achieve the patient’s goals.

Complementary Procedures to Eyelid Surgery

Patients frequently choose to incorporate additional procedures with their eyelid surgery. As explained above, a brow lift can improve aesthetics of the upper face and forehead by adjusting the position of the eyebrows and minimizing signs of age and stress in these areas. Alternatively, facelift surgery performed in conjunction with blepharoplasty can provide a more comprehensive facial enhancement by addressing jowl formation and neck sagging in the lower third of the face. Patients may also wish to use non-surgical treatments, such as BOTOX® Cosmetic or dermal fillers like Revanesse® Versa™ and RADIESSE®, in addition to blepharoplasty for further skin rejuvenation or volume enhancement to specific facial features.

During your initial consultation with Dr. Richards, he can talk more with you about your overall goals and recommend additional treatment options for which you may be interested.

What Types of Eyelid Surgery Are Available?

A few variations of eyelid surgery exist. In general, methods are separated into three categories: upper, lower, and double eyelid surgery.

Upper Eyelid Surgery

Upper blepharoplasty specifically targets the upper eyelids. It involves very fine incisions that follow the natural contours and creases of the eye in order to minimize the appearance of scars afterwards. At our practice, a specially designed laser is sometimes the tool of choice for upper eyelid surgery. The laser can be adjusted to project a wider-spread beam and serves to rejuvenate the surrounding skin with brief applications of its light, which vaporize the superficial skin layers.

Lower Eyelid Surgery

Lower eyelid surgery aims to address concerns in the lower lids and just under the eyes. A highly versatile technique, lower blepharoplasty can be performed at an outpatient facility and is usually in the form of one of three approaches:

• Laser resurfacing of the lower eyelid skin to tighten and shrink the outside of the lower eyelid
• A laser incision inside the lower eyelid to expose the fat pads and trim them (this can be combined with laser resurfacing of the outer eyelid skin as well)
• Wrinkled skin of the lower lids
• An external incision just below the eyelashes that extends out into the smile lines

Double Eyelid Surgery

Double eyelid surgery is a procedure designed to help patients of Asian descent who would like a “fold” placed in the upper eyelids if there is none currently. Also referred to as “Asian eyelid surgery,” this specialized type of blepharoplasty can essentially turn an upper eyelid with no crease into a more typically “Western” looking eyelid with a crease or fold in it. Double eyelid surgery can be an ideal procedure for those patients (typically of Asian descent) who were born without an eyelid crease typically located five to eight millimeters above the lashes. This procedure can be performed as a stand-alone treatment, or it can be combined with traditional eyelid surgery to simultaneously improve signs of age and fatigue.

How Do I Prepare for Blepharoplasty?

Prior to your blepharoplasty, Dr. Richards will issue in-depth instructions to help you prepare for surgery. These directions will cover habits in eating, drinking, smoking, and taking vitamins or medications. Of particular concern are aspirin, ibuprofen and Vitamin E, which should be avoided for two weeks prior to eyelid surgery. They make recovery more difficult because they exacerbate bleeding and bruising.

It is usually best to purchase products like frozen peas that can be used in baggies as cold compresses and eye drops that may help in recovering from blepharoplasty surgery. If you take prescription medications, we will generally advise you to purchase them ahead of time so that you can continue them with minimal interruption. If you are combining laser skin resurfacing with blepharoplasty, Dr. Richards may recommend certain topical skin products to prepare the skin beforehand and to treat it afterward.

What Does the Eyelid Surgery Procedure Entail?

Depending on the specific techniques being employed, eyelid surgery may be performed in an inpatient or outpatient setting. The type of sedation method being used (i.e. general or local anesthesia) is contingent upon the extent of surgery. Following the placement and closure of incisions, Dr. Richards can use a CO2 laser to tighten the skin around the eyes through skin resurfacing.

Our work on the upper eyelid is done through an incision placed in the crease (or its ideal location if there is no crease) between the eyebrow and the lid itself. Dr. Richards often uses a laser in a focused beam on the outside of the upper eyelids to make incisions to remove skin, as well as any excess fat that may be causing puffiness. Once the incisions have been made, the lids are separated from the underlying muscle. The excess skin and fat underlying the separated muscle fibers are removed, and the cuts are sewn back together.

Meanwhile, lower blepharoplasty can involve less invasive solutions like laser skin resurfacing. Alternatively, Dr. Richards may opt to place an incision either inside the lower eyelid for a scarless, minimally invasive approach, or just beneath the row of eyelashes below the eye, extending into the smile lines. When made with a focused laser, the internal incision can remove bulging fat, be easily hidden, and heal in approximately 48 hours without stitches. This approach can also be used to transfer bulging fat of the lower lids into the hollows of the upper cheek, benefiting both areas!

What Is Blepharoplasty Recovery Like?

Immediately following eyelid surgery, Dr. Richards usually applies lubricating and antibiotic ointments to the eyelids. As the anesthesia begins to wear off, your eyelids may begin to feel slightly sore. Mild pain medication, such as Tylenol®, is usually prescribed.

Elevating the head for a few days, in combination with the use of cold compresses, should reduce swelling and bruising – though a certain degree of each is normal. You will be instructed to cleanse your eyes and use eye drops, which can combat the dryness that may accompany blepharoplasty. Other temporary effects may include tearing, sensitivity to light, or blurry vision.

The sutures, if used, are usually removed within three to five days of eyelid surgery, after which swelling and discoloration should dramatically subside. Two or three days after eyelid surgery, you should be able to read or watch television. Most people feel perfectly comfortable going out in public within five to seven days; however, the eyes may still feel sensitive to light and may be easily irritated. The eyelids may also be particularly vulnerable to the effects of the sun for a while.

It usually takes one to two weeks before patients are allowed to wear contacts or makeup. Most blepharoplasty surgeons recommend avoiding strenuous activities and salty foods for a few weeks to prevent fluid buildup around the eyes. Within a few months, the scars usually fade almost completely and the full benefits of the eyelid surgery are realized.

How Long Do Eyelid Surgery Results Last?

Although individual experiences may vary, patients frequently enjoy the benefits of their eyelid surgery for many years. With this in mind, lower eyelid surgery results are liable to be longer-lasting than those of upper blepharoplasty*, which generally last between 10-20 years; this is because skin may lose elasticity as the patient ages. In any case, Dr. Richards utilizes advanced techniques and meticulous attention to detail, consistently aiming to ensure optimal and lasting outcomes for his patients.

What Are the Risks Particular to Eyelid Surgery?

Blepharoplasty, like any surgical procedure, comes with potential risks and complications. While the procedure is generally safe and complications are rare, it is important to be aware of the risks involved. For instance, side effects like swelling, bruising, and discoloration are common following this surgery, but should fade if you properly follow your aftercare instructions. Other concerns – such as infection, bleeding, scarring, blurred vision, and adverse reactions to anesthesia – are possible, but much rarer.

One of the biggest advances in eyelid surgery (blepharoplasty) has been the incorporation of the most recent generation of CO2 lasers into the procedure. The laser offers several advantages when working with the eyelids: it puts less stress on the delicate skin and it minimizes bleeding and bruising by sealing severed blood vessels as it cuts. As such, in a laser-assisted lower eyelid surgery, there is often little bleeding, scarring, or bruising. Lasers can be used both for upper and lower blepharoplasty for skin resurfacing or tissue cutting.

How Noticeable Are the Scars from Eyelid Surgery?

After healing is complete, the scars from eyelid surgery are usually unnoticeable. The skin of the eyelids heals particularly well. In most cases, Dr. Richards is able to utilize techniques that place the incisions necessary for this procedure in areas that are quite discreet, such as the natural creases in the skin surrounding the eyes, so that any scars can remain virtually undetectable.

Are There Non-Surgical Alternatives to Eyelid Surgery?

Since eyelid surgery is designed to address specific concerns that typically involve excess skin and/or fat that must be removed to achieve the patient’s goals, there is no non-surgical alternative to eyelid surgery that can produce equal results. However, there are a few non-surgical options that can improve certain aesthetic conditions around the eyes and rejuvenate these areas with effective results. The outcomes will not last as long in comparison to the results of eyelid surgery, but these treatments can be an option for the right candidate. Injectable procedures such as BOTOX® Cosmetic and XEOMIN® can be useful for the temporary reduction of crow’s feet and other fine lines around the eyes and between the eyebrows, and Ultherapy® can also be advantageous for those concerns. Some cosmetic dermal fillers, such as Revanesse® Versa™ and RADIESSE®, can be ideal for adding volume and minimizing signs of age and fatigue under the eyes. Dr. Richards can examine your skin and evaluate your needs to determine whether eyelid surgery or a non-surgical treatment is the most suitable option for your goals.

How Much Does Blepharoplasty Cost?

The average cost of eyelid surgery (based on the surgeon’s fee only) at our practice ranges from approximately $3,500 to $5,200, depending on:

• The method(s) utilized
• Fees associated with the operating facility and anesthesia
• Complexity of the procedure
• The addition of other cosmetic treatments (such as facelift surgery, BOTOX® Cosmetic, etc)
• Various associated expenses

Since this procedure is custom-tailored to the needs and goals of each patient, the price of eyelid surgery will not be the same for everyone. With that in mind, our practice will calculate a total estimate that includes all associated eyelid surgery costs once your treatment plan is developed during the initial consultation with Dr. Richards. We are happy to answer all of your questions about the breakdown of pricing and the many payment methods we accept. We can also talk with you about plastic surgery financing options that can help qualified applicants obtain a convenient monthly payment plan to help make the cost of treatment more budget-friendly. Our team is here to assist you with finding the best possible payment solution for your needs.

Additional Frequently Asked Questions About Eyelid Surgery

How much will blepharoplasty change the shape of my eyes?

Blepharoplasty is only designed to restore the shape of the eyelids to their natural state. There are additional eyelid procedures that are designed to alter the shape of the eyes. Initial change in eye shape from a standard blepharoplasty may occur due to swelling, but will resolve over time.

Can my vision be harmed by eyelid surgery?

When blepharoplasty is performed by a qualified plastic surgeon, the risk of damage to the patient’s vision is very minimal. A protective shield is placed over the eyes while the laser is being used. Careful attention to the eyelid surgeon’s instructions can minimize the risk even further. Ageless Impressions – Plastic Surgery Institute strives for eyelid surgery perfection and a full recovery of each of our blepharoplasty patients.

Is blepharoplasty covered by insurance?

Cosmetic eyelid surgery is typically not a covered benefit under most insurance policies; however, blepharoplasty that is performed primarily to address visual obstruction caused by sagging skin may be covered, at least partially, by some medical insurance plans. Our team can talk with you about potential insurance coverage once your treatment plan has been developed.

Will eyelid surgery improve my vision?

For patients who experience a condition that causes the skin to hang over the eyes and block one’s field of vision, eyelid surgery can provide a vision improvement by removing the obstruction.

What’s the difference between blepharoplasty and ptosis repair?

Blepharoplasty is primarily a cosmetic procedure aimed at removing/repositioning excess skin and fat. Ptosis repair mainly focuses on repairing or tightening a muscle under the skin of the eyelids that may have weakened with the passage of time, causing the eyelid to not open sufficiently. In many cases, blepharoplasty and ptosis repair can be performed simultaneously if both treatments are necessary to more effectively address the concerns.

How can I reduce swelling after eyelid surgery?

Following eyelid surgery, you will most likely experience swelling in the treatment areas for a brief period of time. There are several methods to help mitigate this common side effect of blepharoplasty. Using a cold compress on your eyelids (very lightly applied) can be a great way to reduce swelling in the 24 to 48 hour period following your treatment. Keeping your head elevated to avoid additional fluid collection can also help control swelling. Patients should also wear sunglasses to avoid direct sunlight on the eyelids.

These tips are quite general and may be more effective for some than others. With that in mind, Dr. Richards will provide you with detailed post-operative instructions that contain more unique guidelines that can help you achieve the smoothest recovery possible.

How should I clean my eyelids after blepharoplasty?

Following your eyelid surgery, you will likely be prescribed eye drops to combat dryness, swelling, and other temporary side effects. The precise directions for aftercare can vary depending on the techniques used and other particularities of surgery; however, Dr. Richards encourages most of his patients to use the saline eye drops multiple times each day. In addition, you may be directed to gently cleanse your eyelids after the first few days of your recovery. Rest assured that Dr. Richards will provide personalized instructions for you to follow as you heal.

When can I wear contacts again after eyelid surgery? 

Wearing contact lenses immediately following eyelid surgery can be problematic since the areas around the eyes will be very sensitive after the treatment. To avoid the potential for discomfort and/or infection, many patients who receive eyelid surgery should refrain from wearing their contacts for a minimum of two weeks following their procedure, and some may need to refrain from placing their contacts on their eyes for a longer period. Dr. Richards can provide more specific advice to you once you have been evaluated.

When can I wear eye makeup after blepharoplasty?

Patients should avoid using eye makeup and makeup on areas surrounding the eyes for a brief period of time following eyelid surgery. Applying eye makeup soon after treatment may lead to discomfort, or even a potential infection. Most patients are advised to wait a minimum of about two to three weeks before they begin applying eye makeup.

To set up a consultation for eyelid surgery, please contact us today. If you would like to get a closer look at the procedure, take a moment to visit our video gallery and view our before-and-after photos.

Medical References* 

Penn Medicine
Stanford Medicine 
Cleveland Clinic