What is Eyelid Surgery (Blepharoplasty)?
Eyelid surgery (blepharoplasty) tightens and raises sagging upper eyelid skin. It may also involve removing or redistributing herniated fat in the lower eyelids also known as fat transposition. Typically, patients who undergo eyelid surgery want to look younger and more energetic.
An upper blepharoplasty is also known as a lid lift and can be performed to remove excess skin and raise droopy or hooded eyelids. A lower blepharoplasty is done to reduce eye bags and tighten loose skin on the lower lids. Patients can opt for these procedures to be carried out separately or together.
Eyelid surgery is frequently combined with other facial cosmetic rejuvenation surgeries, such as a facelift, brow lift, or facial fat transfer. Additionally, it can also be paired with canthoplasty, a different eye surgery procedure that is also known as a "cat-eye lift surgery."
Double eyelid surgery is often requested by patients of Asian ethnicity who wish to increase or refine the appearance of their upper eyelid crease.
What are the pros and cons of an eyelid lift?
- Eyelid surgery can give you a more youthful look, making you appear more refreshed and well-rested.
- According to a 2019 review of 28 studies, published in the Journal of Plastic & Reconstructive Aesthetic Surgery, an upper eyelid blepharoplasty, which removes extra eyelid skin and occasionally eyelid fat, has "a great variety of beneficial functional outcomes, including an increased visual field and improvement in headache-and vision-related quality of life."
- In most instances, blepharoplasty surgery can be performed on an outpatient basis, with the procedure lasting about an hour.
- Upper eyelid surgery can be done with just local anesthesia and oral sedation. However, lower lid surgery may require general anesthesia depending on the surgical method used.
- After eyelid surgery, patients are often surprised at how little pain they experience during recovery, with around just one week of considerable swelling and bruising.
- Once healed, incisions are difficult to notice as they are made in the natural crease of the eyelids.
- Medicare and private health insurance may partially cover the cost of eyelid surgery that corrects impaired vision due to excess skin on the eyelid.
- Patients usually require 4–7 days to recover, much of this is brought on by bruising and swelling, which prevent patients from engaging in social activities.
- Dry eyes, bruising, and swelling are common side effects. After the initial phase of healing, dry eye or irritation may linger. If you have a history of dry eyes, be sure to inform your blepharoplasty surgeon beforehand.
- Despite long-lasting results, the natural aging process will continue, meaning some patients may require additional eyelid lifts in the future.
- Although complications from blepharoplasty are rare, the eyes are a delicate part of the body, and there is a risk of injury to muscle fibres, nerves, and eyelashes.
- Blepharoplasty can affect your ability to fully close your eyes if too much upper eyelid skin is removed.
- It is possible for your eyelids to be mispositioned being pulled down if too much skin is removed from your lower eyelids.
During a lower blepharoplasty, too much eyelid fat can also be removed, which can cause premature hollowing and dark circles. A facial fat transfer (a long-lasting remedy) or injectable dermal fillers can help to fix this (a temporary solution). Although fat transfer under the eyes is a delicate and expensive procedure, it can restore the patient's natural volume, subtly enhancing and rejuvenating the face.
How much does Eyelid Surgery (Blepharoplasty) cost?
Average Cost: $7,075
Range: $2,950 - $13,950
Your surgeon's experience, their location, the complexity of your procedure, and a few other important factors will all affect the final cost of your eye lift surgery.
Upper-lid-only procedures are usually more affordable than lower-lid surgeries, as they are more complicated and may require general anesthesia.
In the case of severe ptosis (pronounced TOE-sis) or hooded lids affecting your field of vision (a common problem to those over 60), Medicare and private health insurance may cover a portion of the drooping eyelid surgery cost.
Is Eyelid Surgery (Blepharoplasty) safe, what are the potential risks and side effects?
While blepharoplasty surgery is generally considered safe with minimal side effects, there are some risks and possible complications, such as an allergic reaction to anesthesia or infection.
Possible upper and lower eyelid surgery risks and side effects include:
- Inflammation, including the swelling of the eyeball lining (chemosis)
- Vision being temporarily blurred as a result of applying lubricating ointment to the eyes
- Infection (visit your eyelid surgeon if you experience pain, redness, pus, warmth, or fever after your blepharoplasty).
During recovery, you may also experience watery eyes, double vision, light sensitivity and general discomfort.
The Journal of the American Medical Association Facial Plastic Surgery published a study in 2013 indicating that dry eye issues can develop or worsen following eyelid surgery. Medicated eye drops can be used to treat this condition.
Before undergoing eyelid surgery, it is important to have your eyes tested to determine whether you have any pre-existing dry eye problems. This does not mean you cannot undergo surgery, but you should begin using eye drops prior and your surgeon should take a more conservative approach.
Having too much eyelid skin removed is a rare but difficult-to-fix blepharoplasty complication that can prevent you from fully closing your eyes. Selecting an experienced eyelid specialist surgeon will minimise the chance of this occurring.
Consult with your surgeon and make them aware of any pre-existing medical conditions so that they can better evaluate the potential risks. While unlikely, surgical complications can still occur, even in the most seasoned hands.
Who is a good candidate for Eyelid Surgery?
A good candidate for eyelid plastic surgery is a healthy non-smoker with one or more of the following concerns:
Good candidates for upper eyelid surgery might have:
- Heavy, hooded eyelids
- Asymmetrical eyelids
- Drooping eyelids (ptosis), usually caused by surplus eyelid skin
Lower blepharoplasty candidates ideally have:
- Bulging fat pads under the eyes, a result of aging or genetic factors, causing eye bags and under-eye puffiness
- Eyelid wrinkles, loose skin or crepey skin texture caused by aging.
Furthermore, protruding fat pockets may also be present on the inner aspect, which can be conveniently removed at the same time.
Medicare and private health insurance may only cover upper eyelid surgery if you have documentation that the eyelid lift is medically necessary to correct vision impairment.
Check with your private health fund to see what kind of documentation they require if you decide to make a claim. Your doctor may require an eyesight test as well as photos to verify your vision impairment. Also, inform your doctor if you have difficulty driving, reading, or performing other normal activities as a result of your eyelids. Lastly, your doctor may also be able to guide you through what is and isn’t covered by Medicare.
Before engaging plastic surgeons, patients with glaucoma or a detached retina should consult an ophthalmologist.
Melon Tip: Determining the exact combination of changes to the forehead, eyebrow, and eyelids is important before charting a correction plan for eyelid drooping. In order to rectify eyelid issues, patients sometimes combine upper and lower blepharoplasty with brow lifts or nonsurgical solutions, such as injectable fillers, as it is rare that only one part of the face is causing the problem.
What is the best age to have Eyelid Surgery?
The majority of patients who seek upper or lower eyelid surgery are over 40 years old when they begin to notice aging, their eye skin becomes less elastic and starts to droop. If younger people are also experiencing eye bags or other signs of aging sooner—or if they are unhappy with their natural crease or eyelid shape—surgery is still possible.
How should you prepare for Eyelid Surgery (Blepharoplasty)?
Your surgeon should provide precise pre-op instructions following your consultation, during which you will discuss your eyelid concerns, goals and ask any questions you may have.
You may be required to:
- To ensure you are healthy enough for elective blepharoplasty surgery, you may need to see your general practitioner (GP) doctor for blood tests or a medical check-up
- Evaluate your baseline vision and eye health by getting an eye test
- Take before photos with your surgeon's team
- During the 2 weeks before your surgery, change your medication and stop using certain over the counter drugs and supplements, e.g. aspirin, ibuprofen, and vitamin E etc, which can increase bruising and bleeding.
- One month before surgery, stop smoking, vaping, and using other nicotine products
- Pick up the prescription drugs that you will need for recovery following your eyelid surgery
- Organise who will drive you to and from your procedure, stay with you the first night, and accompany you to your post-op checkup the following day.
What happens during a Blepharoplasty, Eyelid Surgery procedure?
Prior to upper blepharoplasty surgery, you will receive local anesthesia to numb the eye area. While you are seated upright, markings will be made to determine the exact amount of skin that needs to be removed.
Once you are sedated, an incision will be made along the natural crease on your eyelid and excess skin will be removed. A small amount of fat may also be removed, depending on your situation.
The operation is typically just the incision and stitching of the eyelid back together. Again in most cases, only excess eyelid skin is removed, though occasionally a muscle tuck is also performed to make the eyse look larger.
A scalpel or laser can be used to perform both upper and lower eyelid surgeries. When either tool is used correctly, they produce similar results—it just comes down to surgeon preference. Laser surgeons claim that the method creates less bleeding, while other doctors argue that laser incisions take longer to heal.
Intravenous (IV) sedation or general anesthesia is used during lower eyelid surgeries as the procedure is more uncomfortable for patients than an upper lid lift.
In addition to removing or rearranging excess eyelid fat, this procedure can also reduce puffiness and tighten lax or sagging skin.
Incisions are usually made just below or behind the lower lash line if excess skin needs to be removed.
Incisions are generally made on the inner of the lower eyelid if the aim is to remove or relocate extra fat. This transconjunctival method, often known as internal blepharoplasty, leaves no visible scar.
Additionally, doctors recommend avoiding the removal of skin and fat pads due to the risk of creating troughs under the eyes. Fat in our face tends to fade as we age. Under-eye fat removal may look good immediately, but will not be beneficial in the long run.
Through this transconjunctival technique, the fat is repositioned, a much more conservative approach with better long-term outcomes that also reduce the risk of complications post-surgery.
There is also a heightened risk of eyelid mispositioning if eyelid looseness is not addressed at the time of eyelid surgery. Lower eyelid support muscles may also need to be tightened with reinforcing stitches. “Eyelid droopy surgery” is often performed by surgeons as a midface lift and eye muscle suspension, or canthopexy.
Melon Tip: When selecting your doctor, seek out a specialist oculoplastic surgeon who is a member of the Australian Society of Plastic Surgeons (ASPS) and a Fellow of the Royal Australasian College of Surgeons (FRACS)
How long does Eyelid Surgery take?
Surgery on the upper eyelids can take 30 minutes to an hour, while the lower eyelids may take a little longer unless a transconjunctival technique is used.
Another 30 minutes can be added to the procedure length if fat transfer is performed.
Arrange to have someone you trust to drive you between your residence and the hospital clinic as blepharoplasty is normally performed on an outpatient basis.
How long does Eyelid Surgery recovery take?
Many patients are able to return to work after just seven days post-eyelid surgery, though doctors suggest a full two weeks of rest. The first 7–10 days after blepharoplasty are the worst for most people, however, most patients don’t experience significant pain during the recovery period.
Depending on the extent of your surgery, the whole healing process may take several months. Healing may just require a few days off if only a small amount of eyelid fat is removed. However, blepharoplasty recovery may take far longer if you have undergone more extensive muscle dissection, midface lifting, or fat repositioning procedures. It could take weeks or months before you look your best.
During blepharoplasty recovery, you can expect the following:
- After an eyelid lift surgery, you'll experience most of the severe bruising and swelling during week one.
- If your surgeon did not use dissolvable stitches for your operation, you will need to return a week later to get them removed. Once they are gone, you can apply makeup over the incisions in the eyelid fold to conceal the line.
- It is recommended that you apply ice packs to your eye area four times a day while you are healing.
- To decrease swelling, sleep upright, propped up with pillows, or even in a chair.
- Keeping your eyelids clean will reduce the risk of infection. Also, make sure to use any prescribed eye drops or ointments.
- Do not take pain medications such as aspirin and ibuprofen, these medications may cause an increase in bleeding. Consult your doctor regarding alternative methods for managing pain.
- Within 1 to 2 weeks, you will be able to resume strenuous activities again, such as exercise.
- Wearing contact lenses within the first 2 weeks post-surgery is not recommended. Touching or pulling on the incision area can increase the chance of infection and cause the wounds to reopen. Make sure you have a spare set of glasses on hand for this time.
- Wearing sunglasses with a dark tint until the healing process is over is advised. This can help protect your delicate skin and eyes while you heal, as well as hide any bruising. To reduce the risk of scar discolouration, incisions should be kept out of direct sunlight as much as possible.
- Most of the swelling should disappear within 2 weeks, but it may take up to 6 months for enough swelling to go down to see your final results.
- Within a year, scars from your blepharoplasty e.g. eyelid crease, the lower lid crease, just beneath the lash line, will fade until they are barely noticeable.
How long does Eyelid Surgery last?
Results last from 10 to 15 years, and possibly longer.
You may require a second surgery as your skin continues to sag and age. By restoring the appearance of your eyelids to their youthful state, we are only temporarily slowing down the ageing process.
How do you tighten the eye area without surgery?
Nonsurgical eyelid lift treatments
- Laser Resurfacing - Average Cost: $1,175
- Thermage - Average Cost: $3,300
- Anti-Wrinkle Injections - Average Cost: $400
- Dermal Fillers - Average Cost: $1,175
There are a few nonsurgical lid lift procedures are moderately effective, but a significant nonsurgical eyelid lift is not really possible. Just a reminder that nonsurgical blepharoplasty results are never comparable to results from a surgical operation.
With a laser resurfacing procedure, the eyes can be refreshed and rejuvenated without surgery. In addition to tightening the skin, erbium or carbon dioxide (CO2) lasers can smooth out fine lines and wrinkles on the eyelid. It takes 3 to 7 days for the skin to heal after the resurfacing procedure, and the results can be dramatic.
Thermage is a skin revitalisation procedure that has TGA approval and is safe to use around the eyes. It uses radio frequencies to tighten the skin. Patients most suited to this treatment only exhibit minimal to moderate sagging.
A new ultrasound device, Softwave, developed for eyebrow lifts, is able to raise eyebrows by a couple of millimetres, subsequently lifting the upper eyelids slightly. Another ultrasound device, Ultherapy, has been used extensively for similar purposes.
It is also possible to improve droopy eyelids non-surgically with injectables. There is a range of anti-wrinkle injections that can be used to raise eyebrows.
The muscles that pull the eyebrows down can be temporarily relaxed with anti-wrinkle injections, enabling the eyebrows to rise naturally. Results only last about 3 to 4 months, and outcomes are not always consistent. This treatment, despite being straightforward, has issues with precision as your provider is manually injecting every time.
Alternatively, dermal fillers can be used to pull the eyelids up by strategically injecting to elevate the brow corners.
Fillers can be selectively injected into the lower eyelid area to conceal puffy or baggy under-eyes. By doing so, a flat surface is created from the upper cheekbones to the eyes, making even minor eye bags less noticeable.
Having tight skin with just minor eye bags or hollowing around the eyes is ideal for nonsurgical under-eye treatments. Just be aware that there are risks associated with under-eye filler. It is crucial to look for practitioners who are knowledgeable and equipped to handle any complications that may arise from filler injections.
Sources & Studies
Australian Society of Plastic Surgeons n.d., About Your Specialist Plastic Surgeon, Australian Society of Plastic Surgeons, viewed 16 December 2022, <https://plasticsurgery.org.au/procedures/about-your-specialist-plastic-surgeon/>.
Hollander, MHJ, Contini, M, Pott, JW, Vissink, A, Schepers, RH & Jansma, J 2018, ‘Functional outcomes of upper eyelid blepharoplasty: A systematic review’, Journal of Plastic, Reconstructive & Aesthetic Surgery, vol. 72, no. 2, viewed 16 December 2022, <https://www.jprasurg.com/article/S1748-6815(18)30420-0/fulltext>.
Prischmann, J, Sufyan, A, Ting, JY, Ruffin, C & Perkins, SW 2013, ‘Dry Eye Symptoms and Chemosis Following Blepharoplasty’, JAMA Facial Plastic Surgery, vol. 15, no. 1, p. 39, viewed 16 December 2022, <https://www.liebertpub.com/doi/10.1001/jamafacial.2013.1>.
Therapeutic Goods Administration (TGA) 2018, Bausch & Lomb Australia Pty Ltd - Thermage FLX - Skin contouring system, radio-frequency (302120), Therapeutic Goods Administration (TGA), viewed 16 December 2022, <https://www.tga.gov.au/resources/artg/302120>.
― 2021, LC & Partners Pty Ltd - Sofwave, Sofwave System, Sofacia System, ArchMed System, ArchiMedUS System and ARC0 System - Ultrasonic skin contouring system (355305), Therapeutic Goods Administration (TGA), viewed 16 December 2022, <https://www.tga.gov.au/resources/artg/355305>.