Blepharoplasty removes the excess skin of the upper lids and the fat that makes the lower lids look tired and puffy. It is one of the smallest operations on the face, and one of the easiest to get wrong.
The operation treats skin and fat, not the colour or the quality of the skin. Dark circles from pigment, or hollowing under the eye, are a different problem with a different answer.
Dry eyes, thyroid eye disease, glaucoma and high blood pressure all change the plan, and some are a reason to wait. A thyroid condition must be stable before surgery: operating on an active thyroid eye disease can make it worse.
Upper and lower lids are separate decisions. Many patients need only one of them, and doing more than is needed is how eyelids end up looking hollow.
A fine incision in the natural crease, excess skin removed and a strip of muscle with it; fat is trimmed only where it is bulging. The scar sits in the crease and fades over three to six months. This is the part that widens the visual field.
The fat is removed through the inside of the lid, so there is no skin incision and no external scar. Suitable for fat bags with good skin tone; it does not remove loose skin. Often combined with fat repositioning to fill the tear trough.
An incision just under the lashes removes skin as well as fat, and the lid corner is supported so it does not drop. Used when there is real skin excess — and the technique where the risk of a pulled-down lid has to be managed carefully.
The lids are examined with the eyes open and closed, the amount of skin to be kept is measured, and dry eye is assessed. Photographs are taken. If there is any doubt about the tear film or the thyroid, an ophthalmology opinion is arranged before a date.
Blood thinners, aspirin and some supplements are paused about ten days before, and smoking stops four weeks before. You fast for six to eight hours. Arrange someone to take you home: the eyes are swollen and driving is not possible.
Local anaesthesia with light sedation, or general anaesthesia, one to two hours for both lids. You are awake with local, and can talk to the surgeon. Stitches are fine and removed after five to seven days; some are dissolvable.
Bruising and swelling are expected, and can be considerable for the first three to four days. Cold compresses, head elevation, and eye drops. Vision is blurry from the ointment rather than from the surgery. No contact lenses for about two weeks.
Most people are presentable after seven to ten days, with make-up from about day ten. Residual swelling settles over four to six weeks, and the scar softens over three to six months. Sun protection on the lids matters during that time.
Eyelid surgery has a short list of risks and one of them is an emergency. All of them are worth reading before the operation.
Tell us about dry eyes, contact lens use, thyroid disease, glaucoma, bleeding disorders and any blood thinner, including aspirin and fish oil. Also say if you have had filler or laser around the eyes — it changes how the tissue behaves.
The shape is set by the lids and the brow, and the operation is planned around them. Removing skin opens the eye; it should not make the eye look rounder or startled. If the brow is low, lifting the brow rather than taking more skin is often the right answer.
Partly, and only if the darkness is a shadow cast by a fat bag or by hollowing. Darkness from pigment in the skin does not change with surgery, and is treated with creams, peels or laser. This is the single most common misunderstanding about the operation.
Usually five to ten years, sometimes longer for the upper lids. The skin continues to age, and the brow continues to descend, so the result is an improvement rather than a permanent state. A second, smaller procedure is sometimes done years later.
That is decided by examination. Hooding and a narrowed visual field point to the upper lid; puffiness and a shadow under the eye point to the lower. Many patients are offered only one, and combining them is a decision about healing time as much as about result.
A front view with the eyes open and one with them gently closed are enough for a surgeon to judge which lid needs work, and how much skin can safely be kept. A coordinator replies with a plan and a written quote.
This page is general information, not medical advice. Suitability, technique and risks are decided in a consultation with a surgeon.
