Eyelid Surgery (Blepharoplasty)

Eyelid surgery is not one operation. It is a family of small, precise procedures for lids that sit too low, too high, too loose, too turned-in, or simply carry enough extra skin to block the upper visual field. Sometimes the goal is vision. Sometimes comfort. Sometimes appearance too, and that is not a dirty word; eyelids are on your face every day.

Types of Eyelid Surgery

Ptosis Surgery

Corrects drooping upper eyelid:

• See Ptosis Surgery for detailed information
• Tightens or repositions the muscle that lifts the eyelid
• Several techniques available

Upper Blepharoplasty

Removes excess upper eyelid skin. This treats dermatochalasis, can improve the superior visual field, and is often combined with ptosis repair when the lid itself is also low.

Lower Blepharoplasty

Addresses lower eyelid skin, fat, and laxity. It may soften under-eye bags, tighten a loose lid, or improve the lid-cheek transition. Lower-lid surgery needs careful planning because overdoing it can create dryness or lid retraction.

Eyelid Malposition Surgery

Entropion repair

• Eyelid turns inward
• Lashes rub on cornea
• Causes discomfort and damage

Ectropion repair

• Eyelid turns outward
• Eye exposed and dry
• Tearing problems

Eyelid Retraction Surgery

For thyroid eye disease:

• Lowers upper eyelid if too high
• Raises lower eyelid if too low
• Improves exposure and appearance

When Surgery Is Recommended

Medical Reasons (May Be Covered by Insurance)

• Superior visual field blocked by eyelid skin or ptosis
• Chronic irritation from entropion, ectropion, or lashes rubbing the cornea
• Corneal exposure because the eyelids do not protect the eye well
• Thyroid eye disease causing lid retraction or exposure

Documentation Often Required

• Visual field testing showing obstruction, often taped and untaped
• Photos showing eyelid position
• Documentation of symptoms: brow strain, blocked vision, trouble reading, trouble driving

Cosmetic Reasons

• Appearance concerns without functional problems
• Usually not covered by insurance

Before Surgery

Evaluation

• Complete eye examination, including dry-eye and corneal-surface assessment
• Eyelid measurements and brow-position assessment
• Visual field testing if medically indicated
• Photos for documentation
• Medication review; blood thinners are adjusted only if the prescribing clinician clears it

Medical Clearance

• May need clearance from primary doctor
• Review of health conditions
• Discussion of anesthesia options

The Procedure

Anesthesia

• Usually local anesthesia with sedation
• General anesthesia sometimes used, especially for longer or more complex procedures
• Outpatient surgery in most cases

Duration

• 30 minutes to 2 hours depending on procedure
• Bilateral surgery takes longer

What Happens

• Incisions are placed in natural eyelid creases or hidden inside the lid when possible
• Excess skin, muscle, or fat is removed or repositioned
• Lid tendons or muscles may be tightened
• Sutures are placed; some dissolve, some are removed later

Recovery

First Few Days

• Swelling and bruising are expected. Purple and yellow colors, the whole little sunset.
• Ice compresses help early
• Sleep with the head elevated
• Use antibiotic ointment as directed, knowing it may blur vision
• Avoid straining, bending over, and heavy lifting

First Week

• Sutures may be removed (5-7 days)
• Swelling begins to improve
• May have blurred vision from ointment
• Avoid makeup around eyes

First Month

• Most swelling resolved
• Can usually resume normal activities by 2 weeks
• Avoid strenuous exercise for 2-3 weeks
• Final results develop over weeks to months

Risks and Complications

Common

• Bruising and swelling
• Temporary dryness or gritty feeling
• Minor asymmetry
• Scarring, usually well hidden

Less Common

• Infection
• Bleeding
• Over or under-correction
• Difficulty closing eye
• Need for revision surgery

Rare

• Vision loss (very rare)
• Significant asymmetry
• Chronic dry eye

Results

Expected Outcomes

• Improved visual field when obstruction was present
• Better eyelid position
• More rested or symmetric appearance
• Results are usually long-lasting, though age-related eyelid changes can continue

When to Expect Final Results

• Swelling resolves: 2-4 weeks
• Final settling: 2-3 months
• Scars mature: 6-12 months

Cost Considerations

Insurance Coverage

May be covered if:

• Visual field obstruction documented
• Medical necessity demonstrated
• Prior authorization obtained

Out-of-Pocket

• Varies by procedure and location
• Cosmetic surgery not covered
• Ask about all fees upfront

Frequently Asked Questions

How long do results last?

Results are typically long-lasting (10+ years), though aging continues and some patients eventually need revision.

Will I have visible scars?

Incisions are placed in natural creases and typically heal very well. Most scars are not noticeable after healing.

Can both upper and lower lids be done together?

Yes, often upper and lower blepharoplasty are performed at the same time.

When can I wear makeup again?

Usually 1-2 weeks after surgery, once incisions have healed.