This article has been reviewed and approved by Dr Quazi Ahmad for authenticity and medical correctness on 02 Apr 2020

All about Blepharoplasty

A blepharoplasty, also called eyelid surgery, helps to correct age-related changes in your eyelids. As you age, your upper eyelids start drooping down. Your visual fields may get blocked due to this. 

Your lower eyelids may have ‘bags’ under them. The weakness of the muscles, loss of elasticity of the skin, fat deposits on the eyelids are the main reason for this. The continuous pull of gravity is another reason.

The drooping of the upper eyelids, the bags under the lower eyelids, loose skin hanging over the eyelids, etc. can all make you ‘look old’. It can also block your vision, mainly the peripheral vision. Issues with the peripheral vision are one of the reasons why you find it difficult to reverse and park your car in a slot. An obstruction to your vision can cause a lot of other issues as well.

Blepharoplasty can help to correct the drooping of upper eyelids, remove the ‘bags’ and wrinkles from under your eyes. It not only makes you look a lot younger but also removes the obstructions in your vision.

The surgery will take around 2 hours. During the operation, the cosmetic surgeon will tighten the skin and muscles in the eyelids and removes the excess skin muscle and fat around them.

The hospital stay will be for a day or two after surgery. Complete recovery will take about a week to ten days.

Do I need a blepharoplasty? 

People opt for blepharoplasty for two reasons. The first reason is cosmetic, while the other is functional.

As said, various changes occur in your eyelids as you grow older. The drooping of upper eyelids, along with the puffiness of lower eyelids, can make you look old and tired. 

Eyelid surgery can restore a more youthful look to your eyes. The change in your eyes can have a positive impact on your overall facial appearance. It may help improve your self-image, esteem, and confidence.

Drooping of the upper eyelids can affect the way you see. Loose skin hanging from the eyelids can also obstruct your vision in no small degree. You may find it difficult to see the sides while looking straight. Blepharoplasty is for you if you want to correct these issues.

The surgery is usually for those above the age of 40 when the signs of aging start showing up. But due to family history, certain persons are born with a droopy upper eyelid or a puffy lower eyelid. In such situations, you may need the surgery before 40 years. 

Who cannot have a blepharoplasty? 

You need to be of sound physical, mental, and emotional health at the time of surgery. 

You cannot have blepharoplasty if you have:

  • High uncontrolled blood sugar or blood pressure levels
  • Bleeding disorders and if you cannot stop the use of blood thinners.

What happens during a blepharoplasty? 

The surgeon will mark some measurements in your eyelid in standing and lying down positions.

Since the surgery involves only a small area, you will be given a local anesthetic along with a mild sedative. That means you will be awake during the operation but will not feel any pain.

The surgeon will make an incision in your eyelid, along the natural crease. It is to make any post-operative scar well hidden. Through this incision, the surgeon will lift your skin to expose the underlying fat and muscle layer. 

If the muscles need tightening, the surgeon will tighten them up. The excess fat in your eyelids will either be removed or redistributed evenly. The surgeon will then lift the skin of your eyelids to tighten it and removes any excess skin. 

If your condition is fine after the surgery, you will be allowed to go home the same day. Sometimes, the surgeon will want you to stay in the hospital for a day more.

How to prepare for a blepharoplasty? 

A blepharoplasty is a minor cosmetic surgery. But still, it will put you out of regular activity for a couple of days. The main reason for this is the swelling around your eyes. It is painless but can cause some other discomfort. You may need to avoid presentations or business meetings until this settles. 

You will have a complete physical examination and a few tests, a week before the surgery. It is to assess your health status and to rule out any potential issues for operation.

You will have to tell the doctor about your past medical history. You must also inform the surgeon about any medicines you are taking right now. Some medications like blood thinners, herbal supplements, etc. will have to be stopped a few days before the surgery. It is to prevent any excessive bleeding during and after the operation.

If you smoke, you need to stop it at least two weeks before the surgery. 

You should discuss with the surgeon about all aspects of the surgery to have an idea about the possible outcome, risks, and complications.

If you are doing the surgery to remove any obstructions to vision, you will be able to feel the difference once you recover.

How will be the recovery from a blepharoplasty? 

In the morning after the surgery, you will feel some discomfort in the eyelids. Importantly you will see that the eyelids have swollen. You will also find bruises and discoloration in the eyelids. All these are normal and need not be a cause of worry.

You will have to put ice packs on top of your eyelids very often. It will help you to get relief from pain and, more importantly, will help to control the swelling of the eyelids. 

The discomfort will last only for a day or two, but the swelling will take a longer time to subside.

The surgeon will remove the sutures after 5 to 6 days.

If you use contact lenses, you should not wear them for 3 to 4 weeks and only after getting permission from the doctor.

You can go back to work in less than a week. While in your workplace, you should not do anything strenuous for a couple of weeks. You should not get exposed to dust, fumes, smoke, etc. 

While going out, you will have to wear goggles or sunglasses to protect you from the sun. These also help to protect your eyes from dust and injuries. 

The scars of blepharoplasty are usually invisible as it lies in the natural skin fold.

You can do a body bath a day after surgery, but you will have to wait for a few more days to have a head bath.

Swimming and diving will have to wait for about three weeks. 

During your recovery period, you will have to do the following things.

  • Take proper care of the surgical wound
  • Avoid excessive bending your head 
  • Take the medicines and eye drops as prescribed

You should also be aware of the signs of the risks and complications of the surgery. If you see or feel anything abnormal, talk to your doctor at the earliest. 

What are the risks and complications of a blepharoplasty? 

Though very safe surgery, a blepharoplasty also has certain risks and complications. Some of the common risks and complications are

  • Infection
  • Bleeding 
  • Dryness of the eyes
  • Bruising or swelling of the eyelids

Most of these complications can be corrected by medicines or resolve by itself within a few days.

Sometimes you may find it difficult to close the eyes properly. It can cause eye irritation, dryness of the eyes, etc. Revision surgery will be necessary for certain persons.

Though the surgical incisions are made along the natural creases to hide possible scars, very rarely a visible and prominent scar will develop.

A vast majority of persons who have a blepharoplasty have good results and do not develop any risks and complications. Due to this reason, the number of persons having a blepharoplasty has increased in numbers.

In brief

  • A blepharoplasty is a surgery to reshape your eyelids and rejuvenate your upper face once it shows signs of aging.
  • The surgery can correct drooping of upper eyelids and puffiness or eye bags in the lower eyelids.
  • A facial cosmetic plastic surgeon does a blepharoplasty
  • The duration of the surgery will be around 1 to 2 hours
  • During the operation, the surgeon will tighten the muscles in the eyelid, remove excess fat deposits, and trim excess skin. The eyelids will look tight and compact to provide a more youthful look.
  • Having realistic expectations about the outcome is essential to avoid any dissatisfaction

References / Additional Reading
This article has been reviewed by Dr Quazi Ahmad for authenticity and medical correctness on 02 Apr 2020
Dr Quazi Ahmad
Dr Quazi Ahmad
MBBS, MS (Surgery), DNB (Surgery), MRCS (EDINBURGH), MCh (Plastic Surgery), MNAMS
Dr Qazi Ahmad completed his medical graduation with a gold medal from the prestigious AMU, one of the oldest university in India.He has a busy practice in KDA(Kokilaben Dhirubhai Ambani Hospital, Mumbai) and caters to all types of complex and challenging plastic surgery cases. He is frequently invited for lectures and surgical demonstrations in plastic surgery conferences and workshops.