What is eyelid surgery?
Eyelid surgery, or blepharoplasty, is a surgical procedure that aims to restore and rejuvenate the skin surrounding the eyes. It can be performed on both the upper and lower lids with the goal of improving the appearance of wrinkles and reducing puffiness or under-eye bags, giving patients a more rested and refreshed appearance. Eyelid surgery can also restore proper eyelid function and, by removing drooping skin, increase visibility.
Cost of eyelid surgery
The average cost of eyelid surgery is $4,120 according to the American Society of Plastic Surgeons (ASPS), however this only includes the surgeon’s fee. There are several other factors that can affect the cost of your procedure. Here are some of the top factors that influence cost.
- Surgeon’s Fee: The experience and reputation of the eyelid surgeon performing your procedure can affect the cost. Highly skilled surgeons often charge a premium for their services. When researching surgeons, look for ones certified by the American Board of Plastic Surgery (ABPS) or American Board of Facial Plastic Surgery and Reconstructive Surgery (ABFPRS) with extensive training in eyelid procedures. Although board-certification and memberships in any organization does not guarantee a successful outcome, surgeons must meet stringent criteria in order to achieve membership and board-certification. You can be confident that you are working with a highly trained, and experienced surgeon who will help minimize risks associated with eyelid surgery.
- Anesthesia Fees: The administration of anesthesia involves the expertise of an anesthesiologist. The type of anesthesia used, the duration of the procedure, and the qualifications of the anesthesia provider influence the anesthesia fees. General anesthesia is typically more expensive than local anesthesia with sedation.
- Surgical Facility: The surgical facility where your eyelid surgery is being performed may impact the cost. These fees cover the usage of the operating room and other associated services. To ensure a safe experience, check to see if your surgical facility is certified by the Accreditation Associations for Ambulatory Health Care (AAAHC).
- Location Matters: The cost of living and the average pricing for medical services in a particular area can affect the cost of your procedure. In general, urban areas tend to have higher procedure fees. If you want a general idea of the prices for medical procedures in your local area, you can use the Healthcare Blue Book, which functions similarly to Kelley Blue Book for estimating car prices.
- Complexity of the Procedure: The intricacy of your procedure can affect the cost. If it involves significant reconstruction or additional procedures expect the eyelid surgery cost to be on the higher side
- Pre and Postoperative Care: The care provided before and after affects the overall cost. This includes preoperative consultations, medical tests, surgical garments, prescription medications, and follow-up appointments.
- Additional Procedures: You may incur extra costs if you’re considering having other procedures alongside your eyelid surgery such as a brow lift or neck lift.
- Insurance Coverage: In certain cases, your eyelid surgery may be covered by insurance if it is deemed medically necessary. In these instances, insurance providers may cover a portion of the procedure. However, insurance coverage can vary, and specific criteria must be met to qualify for coverage.
The total cost of eyelid surgery is between $4,500 and $12,000. If you are considering eyelid surgery, schedule a consultation with a board-certified plastic surgeon near you who can provide you with a detailed breakdown of the costs involved based on your individual needs.
Will insurance cover your procedure?
Eyelid surgeries are typically not covered by insurance. However, in cases where excess upper eyelid skin interferes with vision (a condition called dermatochalasis), insurance may cover the procedure. Insurance companies rarely cover lower eyelid surgery.
In order to determine whether your insurance may cover your surgery, you will need to be evaluated by an ophthalmologist who will assess your normal visual field compared to your visual field after taping the excess skin back. Most insurance companies will cover upper eyelid surgery if three requirements are met:
- Photographic proof of excess eyelid skin (dermatochalasis)
- A documented clinical exam by a physician
- Significant improvement in the visual field test with tape as compared to without tape
Insurance companies often require a statement from a physician indicating the medical benefit of upper eyelid surgery and the specific type of eyelid procedure that is recommended. There are a few other cases where insurance may cover upper eyelid surgery:
- Ptosis: This is a condition caused by a drooping upper eyelid that impairs vision. Ptosis differs from dermatochalasis in that ptosis is not related to excess skin around the upper eyelid but is caused by an impairment in the ability of the upper eyelid muscles to fully elevate the eyelid.
- Ectropion or entropion: These are caused by outward or inward facing eyelids. In ectropion, sagging lids may leave you susceptible to dry, irritated eyes. With entropion, your eyelashes and skin may contact your eyeball, leading to irritation and discomfort.
Before moving forward with surgery, confirm that your procedure will be covered by insurance. If your procedure is not covered, there are various financing options available to help cover the cost of your procedure.
Is eyelid surgery right for you?
Signs that you might be a good candidate for eyelid surgery include:
- Healthy with no medical issues
- Have under eye bags
- Excess fatty deposits which cause puffiness
- Excessive drooping or sagging skin around the eyes
You may not be a good candidate if you:
- Have serious eye or medical conditions (e.g. glaucoma, diabetes, thyroid disease), as these can increase the risks of complications
- Have severe dry eyes
- Have drooping eyebrows
- Are a smoker
What to know beforehand
The following are few important things patients should know about before having eyelid surgery.
- Choosing an experienced surgeon is vital to getting the results you desire and reducing the risks of complications.
- Eyelid surgery is a structural enhancement, not a transformation. The goal of eyelid surgery is to restore and rejuvenate rather than making large changes to your appearance.
- Dark under eye circles or sagging eyebrows may be better addressed with other cosmetic treatments.
- Some patients may see increased darkness under their eyes after lower eyelid surgery.
- In rare cases, patients may experience swelling and bruising for up to 3-4 weeks after the surgery.
- Makeup and contact lenses are not recommended in the 2 weeks following surgery.
- The results of eyelid surgery are not immediate. Final results are often not apparent for several months post-operation.
- It is relatively common for patients to undergo subsequent eyelid surgeries in the years following their first surgery.
- Insurance (including Medicare) may cover eyelid surgery, especially if you have upper eyelid hooding that impairs your vision.
Types of eyelid procedures
The two main types of eyelid surgery procedures are upper and lower eyelid surgery, which may be performed simultaneously.
- Upper eyelid surgery: As the name suggests, this procedure addresses the drooping or sagging of the upper eyelids. During the procedure, incisions are created in natural skin folds and excess skin and tissue is removed. If “crow’s feet” or wrinkles are a concern, the incisions may extend past the eye’s outer corner to allow the surgeon to smooth these wrinkles.
- Lower eyelid surgery: This procedure addresses puffiness or bagginess under the eyes. During the procedure, the incision may either be placed in the natural skin folds, or behind the eyelid. If the incision is behind the eyelid, rather than in the skin of the lower eyelid, it is known as transconjunctival eyelid surgery.
A variation of upper eyelid surgery is double eyelid surgery, commonly known as “Asian blepharoplasty” due to its popularity in East Asia, which reshapes the upper eyelid to include a crease.
- Double eyelid surgery (Asian blepharoplasty): This procedure is used to create a wider, larger-looking eye by adding a crease to the upper eyelid.
Regardless of the method used or whether the surgeon is working on the upper or lower eyelids, the incisions may be closed with tape, very small sutures or, in the case of transconjunctival surgery, left to heal on their own.
Upper and lower eyelid surgeries are frequently performed simultaneously but, if excess tissue is restricted to only the upper or lower eyelid area, surgery can be performed on just one set of eyelids.
In some cases, eyelid surgeries are performed at the same time as a forehead lift (also known as a brow lift) to correct drooping brows or deep lines in the eyebrow or forehead area.
Following surgery, your eyes will be swollen and bruised for 1 to 3 weeks. The appearance will continue to get better over the next few months. Most patients feel ready to go out in public after 10 to 12 days.
When will you see results?
The final results of your eyelid surgery will take several months to become apparent. While most people achieve final results within 3-4 months, in some cases they may not be apparent for more than 6 months.
How long will your results last?
You can expect the results of your eyelid surgery to be long lasting but, as with other types of cosmetic surgeries, they are not permanent. Some patients may choose to undergo subsequent eyelid surgeries in the years following an initial procedure.
Alternatives to eyelid surgery
Nonsurgical approaches to treating under eye bags, wrinkles and fine lines, or dark circles may be appropriate for some patients. The following are some non-surgical alternatives:
- A combination of dermal fillers and neuromodulators such as Botox can be used to add volume and support to help minimize the appearance of under eye bags, wrinkles, sagging skin and darkness.
- For the upper lids, Botox injections in the “crow’s feet” area have proven to be an effective way to gently lift the lateral brow and lift a bit of the hooding on the side of your eye and reduce the appearance of crow’s feet. Botox injections last for 3-4 months.
- For lower lids, ceramide creams are effective, if temporary, option. After application, ceramide creams dry clear and tighten the lower lid skin, effectively minimizing bags and wrinkles. Ceramide creams last for 4-8 hours and can be reapplied as needed.
- Other nonsurgical options for lower eyelids include ultrasound (e.g. Ultherapy), radiofrequency, CO2 lasers, and peels that tighten the skin with minimal downtime.
- Fat transfer procedures where fat is transferred from other areas of the body to the lower eyelids are sometimes an option in order to fill in the cheek-lid depression, which can create obvious shadows that contribute to the appearance of dark under eye areas.
In cases of advanced dermatochalasis (saggy, overhanging upper eyelids) surgery may be the best or only option.
- Patel BC, Malhotra R. Upper Eyelid Blepharoplasty. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537078/
- Scripps.org. What Are the Best Ways to Remove Dark Circles Under the Eyes? February 7, 2019. Available from: https://www.scripps.org/news_items/4583-what-are-the-best-ways-to-remove-dark-circles-under-the-eyes
- Raggio BS, Winters R. Lower Lid Transconjunctival Blepharoplasty. Treasure Island (FL): StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545179/
- Chen WPD. Techniques, Principles and Benchmarks in Asian Blepharoplasty. Plast Reconstr Surg Glob Open. 2019;7(5):e2271. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571304/
- Aetna.com. Eyelid Surgery: Policy Bulletin Number 0084. 2019. Available from: http://www.aetna.com/cpb/medical/data/1_99/0084.html