Eyelid Surgery (Blepharoplasty)By
Hedy Marks, MPH
What is eyelid surgery?
Eyelid surgery, also called eyelift, eyelid lift, or blepharoplasty, is the surgical removal of excess skin, muscle and fat in the upper or lower eyelids. Many people seek eyelid surgery for cosmetic reasons. It can reduce sagging and puffiness in the eyelids and create a more rested and rejuvenated appearance. Sometimes, doctors recommend eyelid surgery for medical reasons to improve vision.
Eyelid surgery is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your cosmetic or treatment choices before having eyelid surgery.
Looking for a Doctor?
Other procedures that may be performed
Your doctor may recommend other procedures in addition to eyelid surgery to enhance your appearance. These include:
Brow lift, also called a forehead lift, to tighten sagging skin in the forehead area
Facelift (rhytidectomy) to reduce the signs of aging in the face and neck
Resurfacing to improve the texture and tone of your skin
Why is eyelid surgery performed?
Your doctor may recommend eyelid surgery to improve vision or the appearance of the eyes. Your doctor may only consider eyelid surgery for you if other treatment options that involve less risk of complications have not been effective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on eyelid surgery.
Good candidates for eyelid surgery are adults who have healthy facial tissues and muscles and no serious eye conditions. Your doctor may recommend eyelid surgery if:
You have excess fatty deposits that cause puffiness in the upper eyelids.
You have loose or sagging skin that causes folds or affects the natural contour of the upper eyelid, sometimes impairing vision.
You have excess skin and fine wrinkles of the lower eyelid, bags under the eyes, or droopiness of the lower eyelids.
Who performs eyelid surgery?
The following specialists perform eyelid surgery:
Plastic surgeons specialize in aesthetic and reconstructive surgery.
Facial plastic and reconstructive surgeons specialize in plastic and reconstructive surgery of the face. They initially train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons).
Head and neck plastic surgeons specialize in plastic and reconstructive surgery of the head and neck. They also train as plastic surgeons or otolaryngologists (ear, nose and throat doctors/surgeons) before further specialization.
Ophthalmologists specialize in the medical and surgical care of diseases and conditions of the eye.
How is eyelid surgery performed?
Your eyelid surgery will be performed in a hospital or outpatient surgery clinic. Your surgeon will make incisions on the upper eyelids or on the lower eyelids just below the lower eyelash line. Incisions made in the natural creases of your eyelids makes scarring less noticeable. In some cases, surgeons make an incision on the inside of the lower eyelid, called a transconjunctival incision.
Your surgeon will reposition or remove fat deposits, tighten muscles and tissues, and remove excess skin in the eyelids to create the desired results. Your surgeon will close the incisions with small sutures, skin adhesives, or surgical tape.
Eyelid surgery is usually an outpatient procedure. Your surgeon will decide how to perform the surgery and if you need to stay in the hospital based on certain factors. These include your diagnosis, age, medical history, general health, and possibly your personal preference.
Learn about your treatment options and understand how your doctor will perform your eyelid surgery.
Types of anesthesia that may be used
Your surgeon will perform eyelid surgery using either anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your eyelid surgery
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and recovery until you are alert, breathing effectively, and vital signs are stable.
What are the risks and potential complications of eyelid surgery?
As with all surgeries, eyelid surgery involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, which can be life threatening
Potential complications of eyelid surgery
Complications of eyelid surgery include:
Asymmetry within the eyelids
Blurred or impaired vision, dry and irritated eyes, and excessive tearing
Difficulty closing your eyes
Emerging sutures that your doctor needs to manually remove (instead of dissolving on their own)
Hematoma, bleeding under the skin that leads to an accumulation of blood under the skin
Lid lag, a pulling down of the lower eyelid, or ectropion, rolling of the eyelid outwards to expose the inner eyelid surface. Both lid lag and ectropion are usually temporary.
Pain, swelling and bruising
Poor wound healing
Temporary eyelid numbness
Vision loss due to bleeding behind the eye
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Following your doctor’s instructions after surgery. This often includes elevating your head, applying cold compresses to reduce swelling, cleaning the eye area, and using lubricating eye ointment
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Stopping smoking. Smoking increases your risk of poor wound healing and may affect the aesthetic outcome.
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or visual disturbances
Protecting your eyes from the sun by wearing darkly tinted sunglasses
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my eyelid surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for eyelid surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), blood thinners, and vitamin and herbal treatments. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before eyelid surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Am I a good candidate for eyelid surgery? Are there any other options for treating my condition?
How will you perform my eyelid surgery?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
When can I shower after eyelid surgery? How should I care for my incisions?
How will I look after the surgery?
What kind of assistance will I need at home?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular office hours.
What can I expect after my eyelid surgery?
Knowing what to expect can help make your road to recovery after eyelid surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may still be drowsy or nauseous from sedation or anesthesia, so you will need a friend or family member to drive you home and stay with you the first night or two.
You will likely have small sutures on your eyelids along with lubricating eye ointment. This may cause blurred vision. Your eyes may also be lightly wrapped with gauze.
Recovery after surgery is a gradual process. Recovery time varies depending on the number of incisions, your general health, age, and other factors. You will most likely have swelling and bruising around your eyes and face after eyelid surgery. Bruising should lessen within 10 days. Swelling gradually decreases over the following months. Scars may take six months or longer to fade.
Will I feel pain?
Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after eyelid surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incisions
How might eyelid surgery affect my everyday life?
If you had eyelid surgery for a vision problem, it may cure your condition or significantly improve your vision.
If you had eyelid surgery for cosmetic reasons, the new appearance of your eyes may give you increased satisfaction with your overall appearance and increase your self-confidence. Many surgeons caution that it is important to be realistic about how much eyelid surgery can improve your self-image. Ask your surgeon what eyelid surgery can and cannot do for your overall appearance.
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