Blepharoplasty

As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, drooping upper lids and bags under your eyes. Besides making you look older, severely sagging skin around your eyes also can impair your vision.

Eyelid surgery, or blepharoplasty (BLEF-uh-ro-plas-te), repairs droopy eyelids by removing excess skin, muscle and fat. To help decide if this surgery is right for you, find out what you can realistically expect and explore the benefits and risks involved.

Who is blepharoplasty for?

You might consider blepharoplasty if excess tissue keeps your eyes from opening completely. Removing this tissue can improve vision and make your eyes appear younger and more alert. Specifically, blepharoplasty may be an option if you have:

• Baggy or puffy upper eyelids
• Excess skin on lower eyelids
• Dark circles or bags under eyes

Blepharoplasty may be performed in conjunction with other procedures, such as a brow lift, face-lift or skin resurfacing. If you have the surgery only to improve your appearance, it might not be covered by insurance.

How do you prepare for blepharoplasty?

Before scheduling blepharoplasty, you need to meet with your surgeon to discuss the important factors that determine whether the procedure is likely to work well for you. This meeting generally includes:

• Your medical history. Your surgeon asks questions about conditions you have or have had, as well as any current medications. Detailed questions may focus on dry eyes, glaucoma, allergies that affect your eyes and other eye problems.
• A physical examination. Your surgeon conducts a complete physical examination, which includes testing your vision and tear production.
• Photographs. Your eyes are photographed from different angles. These photos help with planning the surgery and assessing its immediate and long-term effects.
• A discussion of your expectations. Think about your motivations for seeking blepharoplasty and be prepared to share your reasoning with your surgeon. Also be frank about your expectations so that your surgeon can tell you whether they're in line with usual results.

Before blepharoplasty, you may also need to:

• Stop taking medications containing aspirin or ibuprofen. These medications may increase bleeding, so it's best not to use them for two weeks before and after surgery. Take only medications approved or prescribed by your surgeon.
• Avoid exposing your skin to sunlight for one week before surgery and two to three months after surgery. Too much sun may cause permanent irregular coloration of the skin.

How is blepharoplasty done?

If you have surgery on your upper and lower eyelids, the surgeon works on your upper lids first. The surgeon makes an incision along the natural fold of the upper eyelid. Then excess skin and some muscle and fat beneath the skin are removed. The incision is closed with tiny stitches that leave a nearly invisible scar.

The incision on the lower lid is made just below the lashes in your eye's natural crease or inside the lower lid. The surgeon removes excess fat, sagging skin and muscle. Depending on where the initial incisions are made, stitches may follow the lower lid's natural crease or be placed inside the lower eyelid.

If your eyelid droops close to your pupil — as can occur in some situations — blepharoplasty is done in conjunction with another procedure to address that particular aspect of the problem, which is called ptosis (TOE-sis).

How blepharoplasty is done

How blepharoplasty is done

During blepharoplasty, the surgeon cuts inside the creases of your eyelids to trim sagging skin and muscle and perhaps remove excess fat. After the excess tissue is removed, your surgeon joins the skin with tiny stitches.

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What can you expect during blepharoplasty?

Blepharoplasty is usually done in an outpatient setting under local anesthesia. Your surgeon injects numbing medication into your eyelids and administers intravenous (IV) medication to make you relax. This makes you groggy but not fully asleep.

The surgery usually takes one to three hours, depending on the amount and location of tissue being removed. Afterward you spend time in a recovery room, where nurses and their assistants monitor you for complications. You can leave later that day to recuperate at home.

What are the results of blepharoplasty?

Blurred vision is common after blepharoplasty because of the ointment used to lubricate and protect the eyes. You may also experience excessive tearing, light sensitivity and double vision just after the surgery. In addition, your eyelids may be puffy and feel numb for several days. Expect swelling and discoloration — bruising similar to having "black eyes" — to last a week or more. Immediately after surgery, your incisions will be red and visible.

Take the following precautions for a week after the surgery, unless advised otherwise by your doctor:

• Don't lift anything weighing more than 20 pounds.
• Don't bend from your waist unless you also flex or bend your knees.
• Don't swim.
• Avoid strenuous activities, such as aerobics and jogging.
• Avoid extreme neck movements, such as moving your head forward or back or turning your head right and left.
• Sleep with your head raised higher than your chest.

Scars from the incisions may take three to six months to fade. Take care to protect your delicate eyelid skin from sun exposure during this time. For many people, the result of blepharoplasty is permanent, but for others, eyelid drooping eventually may recur.

Before-and-after results of blepharoplasty

Before-and-after results of blepharoplasty

A look at sagging eyelids before and after blepharoplasty

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What are the risks of blepharoplasty?

As with any surgery, blepharoplasty carries some risks, such as infection or reaction to the anesthetics. Other possible risks specific to this surgery include:

• Temporary numbness of the eyelid skin
• Dry, irritated eyes
• Impaired eyelid function
• Scarring
• A very small risk of blindness due to bleeding behind the eye

Talk to your doctor about how these risks apply to you. Understanding what's involved in blepharoplasty and weighing the benefits and risks can help you decide if this procedure is a good option.