Information about the procedure
Correction of the upper and/or lower eyelids to remove excess skin and fatty bags and reduce a tired appearance around the eyes.
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What it involves
Blepharoplasty is the surgical correction of the eyelids: excess skin is removed and, where needed, fat around the eyes is redistributed or removed. The aim is not to change your expression but to restore a fresher, more rested appearance in which your eyes remain recognisably your own.
Eyelids age differently in different people. In some, excess skin predominates; in others, herniated fat; in others still, laxity of the outer corner of the eye. Blepharoplasty is therefore not a single operation but several different procedures, combined according to your individual anatomy.
Types and approaches
Upper blepharoplasty
A strip of excess skin is removed from the upper eyelid, together with a small amount of the underlying muscle or fat if needed. The incision is placed in the natural eyelid crease, where it heals as a fine line that is practically invisible when the eye is open. This is the most commonly performed eyelid operation and usually the one with the quickest recovery.
Lower blepharoplasty
Corrects eye bags and loose skin of the lower eyelid. When the main problem is herniated fat without significant excess skin, a transconjunctival approach can be used — through the inner surface of the eyelid, with no external incision and no visible scar. Where there is also excess skin, a subciliary incision is made just below the lash line.
Combined upper and lower
When both upper and lower eyelids show marked changes, the two operations are performed in a single session. Recovery takes slightly longer than after upper blepharoplasty alone, but you go through one period of swelling instead of two.
Eyelid reconstruction after tumour removal
After excision of a basal cell carcinoma or another lesion on the eyelid, both form and function are restored — the ability of the eyelid to close fully and protect the cornea. Local flaps or grafts are used, depending on the size and location of the defect. This operation is reconstructive, not aesthetic, and is planned together with the oncological treatment.
Who it is suitable for
Suitable for
- Heaviness or hooding of the upper eyelid skin
- A restricted upper field of vision due to marked excess skin
- Fatty bags under the eyes that do not respond to lifestyle changes or skincare
- A tired appearance despite normal sleep and good general health
- Asymmetry between the two eyelids
- A wish for correction after a previous operation with an insufficient or excessive result
Not suitable, or postponed, in cases of
- Active inflammation of the eyelid or conjunctiva — surgery is postponed
- Severe dry eye that has not been assessed and treated beforehand — blepharoplasty can make it worse
- Uncorrected brow ptosis, where removing skin alone does not solve the problem
- Uncontrolled high blood pressure, bleeding disorders, poorly controlled diabetes
- Unrealistic expectations — the operation refreshes the eyes but does not stop ageing
Preparation
- A consultation assessing the eyelids, eyebrows, eye position and skin quality
- An ophthalmological examination if dry eye, ptosis or another eye condition is suspected
- Stopping aspirin, NSAIDs and blood-thinning supplements about 10 days before surgery — only after agreement with your treating doctor
- No smoking for at least two weeks before and after surgery
- Someone to accompany you on the day of surgery if you are having sedation or general anaesthesia
How it is performed
Upper blepharoplasty is most often performed under local anaesthesia, with light sedation if needed. Lower and combined procedures may require sedation or general anaesthesia. The operation takes about 45 to 120 minutes for upper blepharoplasty and two to three hours for lower or combined surgery.
Before any incision is made, the amount of skin to be removed is marked precisely — with you sitting upright and your eyes open, because this is the position in which your eyelids will be seen. Removing too much skin is a mistake that is difficult to correct, so the marking is the most important part of the operation.
The incision is closed with fine sutures. After upper blepharoplasty under local anaesthesia you go home the same day. Lower or combined surgery usually involves one overnight stay.
Recovery
- The first 48 hoursSwelling and bruising are at their most pronounced. Intermittent cold compresses and sleeping with your head raised reduce the swelling considerably. Your vision may be slightly blurred by the eye ointment.
- The first weekThe stitches are usually removed between the fifth and seventh day. The bruises begin to change colour and fade. Reading and screen use are possible, but your eyes tire more quickly than usual.
- 2–4 weeksMost patients look presentable after 10–14 days — women with the help of make-up. At this stage the scar is pink and still visible at close range.
- 1–3 monthsThe scar fades and softens. The slight swelling around the incision gradually subsides.
- 6–12 monthsThe scar reaches its final appearance. When the incision is correctly placed, it blends into the natural crease and is not noticeable.
Pain and discomfort
Blepharoplasty is one of the better-tolerated operations. Most patients describe not pain but tightness, stinging and a feeling of heaviness in the first few days. Ordinary painkillers for the first 48 hours are usually enough. Severe or increasing pain — especially on one side and accompanied by loss of vision — means you should contact your surgeon immediately.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Swelling and bruising — expected, not a complication
- Temporary dry eye, stinging or watering, usually settling within a few weeks
- Asymmetry between the two sides, sometimes requiring a minor correction
- Difficulty closing the eyelid fully if too much skin has been removed
- Downward pulling of the lower eyelid (ectropion) — rare, more common when the eyelid is already lax
- Infection or poor scar healing — rare with proper care
- Retrobulbar haematoma — very rare but an emergency, with severe pain and deteriorating vision
Results and longevity
The result of upper blepharoplasty is long-lasting. The skin that has been removed does not come back, but ageing continues, so after 8–12 years some patients consider a further refresh.
After lower blepharoplasty the result is also long-lasting, but skin quality and the position of the midface continue to change with age.
A good result is recognised by what you do not see: no pulled look, no rounded eye, no change in expression. The people around you notice that you look rested without being able to say why.