Blepharoplasty

What is Blepharoplasty

Blepharoplasty is surgery to reshape the upper eyelid, lower eyelid, or both by removing or repositioning excess skin, muscle, and fat. It may be performed for functional reasons — when excess upper lid skin obstructs the superior visual field — or for cosmetic improvement of a tired or aged appearance. Most blepharoplasties are done under local anesthesia with sedation as outpatient procedures.

Upper Eyelid Blepharoplasty

Upper eyelid blepharoplasty removes the strip of excess skin that accumulates over the lid crease with age. When this skin overhangs the lashes and obstructs the superior visual field, the procedure becomes functional and may be covered by insurance — documented with visual field testing and photography. Incisions are placed within the natural eyelid crease and heal to a nearly invisible line.

Lower Eyelid Blepharoplasty

Lower eyelid blepharoplasty is performed almost exclusively for cosmetic reasons — to reduce herniated fat bags and lower lid skin wrinkling. Two approaches are used depending on anatomy:

• Transconjunctival (internal): Incision through the inner conjunctival surface; no external scar. Preferred when skin excess is minimal and fat removal or repositioning is the primary goal.
• Transcutaneous (external): Incision just below the lash line allows concurrent skin removal. Requires precise tension-free closure to avoid ectropion (lid turning outward).

Fat repositioning — moving orbital fat over the orbital rim rather than simply removing it — fills the tear-trough hollow and produces a more natural result than pure excision.

Four-Lid Blepharoplasty

When both upper and lower eyelids require surgery, all four lids are treated in a single session. Combined upper and lower blepharoplasty provides the most complete periorbital rejuvenation and is appropriate when both skin excess and lower lid fat herniation are significant.

Surgery Description

Blepharoplasty is performed through external incisions placed along the natural skin lines of the eyelids — the crease of the upper lid, or below the lashes of the lower lid — or through the inner conjunctival surface (transconjunctival blepharoplasty). The surgeon removes excess skin, trims or repositions fat, and tightens supporting structures before closing incisions with fine sutures.

The operation typically takes one to three hours depending on the number of lids treated and the techniques used. After surgery, swelling and bruising are expected for 7–14 days; the final result is typically stable by 3 months.

Stepwise Surgical Description

1. Marking: Incision sites are marked before surgery with the patient seated upright. Meticulous marking dictates the outcome.
2. Anesthesia: Local anesthesia is injected for each eyelid; IV sedation is added for comfort.
3. Incision: Upper lid incisions follow the eyelid crease. Lower lid incisions are placed just below the lash line or through the conjunctiva.
4. Skin and fat excision: Excess skin is excised; the orbital septum is opened to access fat compartments. Fat is removed or repositioned as needed.
5. Hemostasis: Careful hemostasis is essential — the orbicularis oculi is highly vascular and retrobulbar bleeding can threaten vision.
6. Closure: Incisions are closed with interrupted fine sutures, removed at 7–8 days.

Recovery

• Discoloration, bruising, and swelling for up to 7–14 days
• Ice packs, head elevation, and restricted activity for the first week
• Lubricating eye drops as prescribed
• Final result stable at 3 months; effects typically last 5–10 years

Below is a surgical video demonstrating an actual upper eyelid blepharoplasty

Recovery Timeline

Swelling and bruising peak at 48 hours and resolve substantially over 1–3 weeks. The progression below shows a typical upper blepharoplasty recovery.

Potential Risks

Blepharoplasty is a well-tolerated outpatient procedure, but like all surgery it carries risks. Your oculoplastic surgeon reviews all risks with you before surgery.

Most Common

• Bruising and swelling — expected for 1–2 weeks; managed with ice, head elevation, and limited activity.
• Dry eyes / incomplete closure (lagophthalmos) — temporary in most patients; lubricating drops are prescribed. Patients with pre-existing dry eye are counseled before surgery.
• Lid position asymmetry — minor asymmetry is possible; significant overcorrection (ectropion, lid retraction) is rare and typically correctable.
• Ptosis — drooping of the upper lid due to levator swelling is common early; if due to levator injury it requires prompt repair.

Most Serious (rare)

• Retrobulbar hemorrhage — bleeding behind the eye can cause vision loss. Occurs in fewer than 1 in 2,000 cases. Signs are a firm, proptotic eye and vision change; requires immediate decompression.
• Corneal injury — from dryness, incomplete closure, or inadvertent contact; prevented with careful technique and postoperative lubrication.

A full list of risks and what to watch for is provided at your consultation and included in your pre-operative packet.