Written by Annie Tye, PhD
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.
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
- 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.
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.
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 radiofrequency, 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 some cases, surgery is the best or only option such as in cases of advanced dermatochalasis (saggy, overhanging upper eyelids).
In order to receive the best results, it’s recommended that your surgeon be certified by one or more of the following:
- American Board of Plastic Surgery (ABPS)
- American Society of Plastic Surgeons (ASPS)
- American Society for Aesthetic Plastic Surgery (ASAPS)
- American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
- American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Each of these societies require that their members meet very high standards, including extensive medical training, experience, and rigorous surgical education. Although membership in any of these societies or board-certification do not guarantee a successful outcome, it can ensure that the most appropriate techniques are used for your procedure while reducing the risk of complications.
When it comes to eyelid surgery, there are some potential risks that every patient should be aware of. A few of these risks include:
- Bleeding and infections
- Malpositioned eyelids
- Skin discoloration
- Dry or irritated eyes
- Temporary blurred or impaired vision
- Possible loss of eyesight (rare)
These risks are substantially minimized when you work with an experienced surgeon.
While each person will have a somewhat unique recovery after upper or lower eyelid surgery, there is a relatively predictable recovery timeline that often includes common side effects. It is imperative that you carefully follow the aftercare instructions that were provided by your doctor.
Within the first 1-2 days:
- Your eyelids will likely feel tight, sore, and sticky
- Your eyes may feel watery or dry, and may itch
- Obvious bruising and swelling will be present and may extend to the cheeks
- You may experience sensitivity to light
- Your vision may be blurred
- You may have some difficulty closing your eyes when you sleep
- Glasses may be worn immediately, but contact lenses cannot be worn for 2 weeks
Within the first week:
- Sutures will dissolve or be removed
- Bruising and swelling will begin to subside
- Avoid activities that increase your blood pressure
- Avoid bending over or lifting heavy items
- 2 days after surgery you may begin to shower and shampoo normally
- Bruising and swelling may persist but should be consistently improving
- Many people are comfortable returning to work and engaging in social activities within 10-14 days after surgery
After 2 weeks:
- Makeup and contact lenses can generally be worn after 2 weeks, but make sure to discuss this with your doctor
- Dark eye makeup may deposit pigment into incisions, so it is recommended that dark eye makeup be avoided
After 3-4 weeks:
- Workouts may be resumed 3-4 weeks after surgery, but make sure to discuss this with your doctor
- Tiny incision lines/scars may be present for several months following surgery, but they are typically not noticeable
In all cases, there are several important considerations to keep in mind throughout your recovery:
- After your surgery you should plan on having someone drive you home
- Your vision may be blurry in the first few days after surgery. Do not drive until your vision has recovered fully
- Take care to not rub your eyes
- Avoid sun exposure in the first months following surgery. Wear sunglasses to protect eyes from irritation
- Carefully follow all instructions provided by your doctor
Following eyelid surgery, swelling can obscure the results of your procedure, as well as interfere with vision.
Those trying to reduce their recovery time should follow these tips to reduce swelling:
- Keep the head elevated while sleeping
- Use ice or cold compresses, particularly during the first 48 hours
- Avoid alcohol consumption
- Stay hydrated by drinking plenty of water
- Eat a proper diet that is low in sodium
- Get plenty of rest and avoid over-exertion
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.
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.
Several factors contribute to the cost of an eyelid surgery, including the technique chosen, the extent of the procedure, where you live, and the surgeon you choose. In most cases, you can expect to pay a total cost of $4,000 to $5,000 for a high-quality eyelid surgery.
When you undergo eyelid surgery or any surgical procedure, it is important to understand the various fees involved. There are typically three main fees involved in eyelid surgery:
- Your surgeon’s fee
- Anesthesia fee
- Facility fee
When considering eyelid surgery, be sure that your surgeon’s price quote includes all applicable charges, not just the surgeon’s own fee, so that you know how much you are expected to pay.
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 upper eyelid surgery. Insurance companies rarely cover lower eyelid surgery.
In order to determine whether your insurance may cover your eyelid 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 3 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 surgery 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, respectively. In the former case, sagging lids may leave you susceptible to dry, irritated eyes. In the latter case, your eyelashes and skin may contact your eyeball, leading to irritation and discomfort.
It is important that you confirm that your procedure will be covered by your insurance provider before scheduling the procedure.
If your insurance will not cover eyelid surgery, many surgeons offer affordable monthly payment plans that make the procedure accessible to people from all income brackets. If you are concerned about the cost of your procedure, ask your surgeon about the availability of financing during your consultation visit.
- 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