Eyelid Surgery (Blepharoplasty)


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. 

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

  • Infection

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 

  • Scarring

  • 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