Blepharoplasty (Eyelid Surgery)

Blepharoplasty (eyelid surgery) is a surgical procedure that removes or repositions excess skin, muscle, or fat from the upper eyelids, lower eyelids, or both.

As people age, the skin around the eyes can lose its elasticity and begin to sag. Fat pockets may also shift and create puffiness or bags beneath the eyes. During blepharoplasty, a surgeon carefully trims away the excess tissue or moves it to a better position, then closes the incision (cut) with fine stitches. The result is a smoother, firmer eyelid contour. In some cases the procedure also improves the field of vision when drooping upper eyelids were blocking sight.

Blepharoplasty is performed for both functional (medical) and aesthetic (cosmetic) reasons. A doctor or ophthalmologist (eye specialist) will assess whether a patient's eyelid condition justifies surgery.

• Dermatochalasis (excess, loose skin on the upper eyelids) that impairs vision
• Drooping upper eyelids that cause difficulty keeping the eyes fully open
• Heaviness or fatigue around the eyes caused by sagging skin
• Puffy or baggy lower eyelids due to herniated fat (fat that has shifted forward under the skin)
• Fine wrinkles and redundant (extra) skin on the lower eyelids
• Asymmetry (unevenness) between the two eyelids that affects appearance or function
• Ectropion repair (when the lower eyelid turns outward) — sometimes addressed at the same time

Blepharoplasty is generally not suitable for everyone. Doctors usually advise against it or recommend waiting in certain situations.

• Uncontrolled dry eye syndrome (not enough natural moisture in the eye), as surgery can make it worse
• Uncontrolled glaucoma (high pressure inside the eye) or other active eye diseases
• Thyroid eye disease that has not yet stabilised
• Bleeding disorders or use of blood thinners that cannot be paused
• Unrealistic expectations about what the procedure can achieve
• Serious heart, lung, or kidney conditions that increase anaesthesia (the medication that prevents pain during surgery) risk

Blepharoplasty is generally considered a safe procedure, but like all surgeries it carries some risks.

• Temporary swelling, bruising, and tightness around the eyes — the most common experience in the days after surgery
• Dry, irritated, or watery eyes in the weeks following surgery
• Difficulty closing the eyes completely, usually temporary
• Asymmetry (unevenness) in the final appearance of the two eyelids
• Scarring — incisions are placed in natural skin folds to minimise visible scars, but some scarring is possible
• Infection at the incision site
• Bleeding under the skin (haematoma) requiring drainage
• Lagophthalmos (inability to close the eye fully) if too much skin is removed — rare but serious
• Changes in sensation, such as numbness or tingling around the eyelids
• Ectropion (the lower eyelid pulling away from the eye) — uncommon but may need further treatment
• Very rarely, changes in vision or, in extremely rare cases, vision loss due to pressure on the eye or its blood supply

Preparation for blepharoplasty typically begins several weeks before the surgery date. Your surgical team will give you personalised instructions, but the following steps are common.

Before the procedure, doctors usually ask patients to stop taking blood thinners, anti-inflammatory medicines such as aspirin-type drugs, and certain herbal supplements for a period before surgery, as these can increase bleeding. Smoking is usually asked to be stopped several weeks before and after surgery, because it slows healing and increases infection risk. Alcohol is generally advised to be avoided in the days leading up to surgery. If general anaesthesia (being fully asleep) is planned, fasting — eating and drinking nothing, including water — is usually required for several hours beforehand. Your team will specify the exact duration.

Tests commonly arranged before surgery include:

• A full eye examination, including tests for dry eye and a visual field test (measuring how much of your surroundings you can see without moving your eyes)
• Photographs of the eyelids taken from multiple angles for surgical planning
• Blood tests to check overall health and clotting ability
• An ECG (electrocardiogram — a recording of the heart's electrical activity) if general anaesthesia is planned or if the patient is older
• A review of all current medications and allergies

On the day of surgery, the procedure itself generally follows these steps:

• 1. The patient arrives at the surgical facility and identity and consent are confirmed.
• 2. The surgeon marks the eyelids with a surgical pen to plan exactly where incisions will be made.
• 3. Anaesthesia is given — this is often local anaesthesia (numbing injections around the eyes) with sedation (medication to help the patient relax), though general anaesthesia is used in some cases.
• 4. The surgeon makes precise incisions along the natural folds of the upper eyelid crease and/or just below the lower eyelash line.
• 5. Excess skin, muscle, and/or fat are removed or repositioned as planned.
• 6. The incisions are closed with very fine stitches, skin glue, or surgical tape.
• 7. A cool compress may be applied to reduce swelling immediately after the procedure.
• 8. The patient is moved to a recovery area to be monitored as the anaesthesia wears off.

After blepharoplasty, most patients are monitored for a short time at the surgical facility before being allowed to go home the same day. It is important to arrange for someone to drive you home and stay with you overnight, as your vision may be temporarily blurred and your eyes sensitive. Full recovery takes time, and the healing process varies from person to person.

• Cold compresses are usually applied in the first day or two to reduce swelling and bruising around the eyes.
• The head is typically kept elevated, even while sleeping, for several days to help reduce swelling.
• Eye drops or ointment are commonly prescribed to keep the eyes moist and prevent infection — the type and duration will be decided by your doctor.
• Stitches are usually removed within about a week if non-dissolving sutures were used; your surgeon will schedule this appointment.
• Strenuous activities such as heavy lifting, bending, and vigorous exercise are usually restricted for several weeks.
• Driving is not advised until vision has fully cleared and the doctor confirms it is safe — this varies between patients.
• Screen use (phone, computer, television) is often limited in the first few days as it can cause eye strain and dryness.
• Sun exposure and wind should be avoided; when going outdoors, sunglasses with UV protection are recommended for several weeks.
• Contact lenses are usually not worn for several weeks after surgery; glasses can typically be used sooner.
• Makeup, especially near the eyes, is generally avoided until the incisions are fully healed.
• A follow-up appointment is usually scheduled within the first week to check healing, and further visits may be arranged at intervals afterwards.
• Final results — including the full resolution of swelling and the fading of scars — can take several months to become apparent.