Blepharoplasty (eyelid surgery): pictures, costs, recovery time

Medically reviewed: 15, February 2024

Blepharoplasty: Eyelid surgery

Plastic surgery of the upper and lower eyelids is also called – blepharoplasty, is a plastic surgery, during which the lifting and removal of excess skin and fatty tissues of the eyelids, which contributes to improving the appearance of the eyelids, eliminating or reducing age-related changes around the eyes.

The result of blepharoplasty is the disappearance of “bags” and wrinkles under the eyes, puffiness, freshness and youthful look. Conduction of blepharoplasty is possible both in isolation and in conjunction with other aesthetic procedures and operations.

Anatomy and structure of the eyelid

Eyelids are the most important anatomical structure of the human eye, protecting it from drying out, injuries, damage by small mechanical particles, exposure to physical and chemical factors. The eyelids are formed by complex folds in the structure of which special formations are located.

The outer side of the eyelid is covered with skin. The skin of the eyelids is the thinnest in the entire human body, the thickness of the dermis of the eyelids is less than 1 mm. Under the skin of the eyelids is the circular eye muscle, which controls their mobility. A thin membrane separates the circular muscle from the fat layer of the eyelids.

The inner surface of the eyelid is lined with a connective tissue membrane – a conjunctiva that passes to the anterior surface of the eyeball and forms a conjunctival sac.

The basis of the eyelid is formed by cartilaginous plates. The innervation of the eyelids is carried out by the branches of the facial nerve, woven into the circular muscle of the eye at its outer and lower margins.

The skin of the eyelid ages very early: after 30 years, it loses its elasticity, stretches and saggers, because of what the fat deposits around the eyes become noticeable. The omission of the tissues of the forehead and eyebrows adversely affects the appearance of the upper eyelids, giving the look a weary and heavy expression.

After carrying out blepharoplasty and removing excess skin and adipose tissue of the upper and lower eyelids, not only face rejuvenation occurs, but also stabilization of intraocular pressure and improvement of peripheral vision.

For carrying out blepharoplasty, plastic surgery has developed and uses a variety of techniques that are tailored to the individual complaints and characteristics of each patient after careful study and analysis.

Reasons to Consider Blepharoplasty

Patients may seek blepharoplasty due to several reasons, both aesthetic and functional concerns. Some individuals might feel self-conscious about signs of aging, like fine lines, creases, or loose skin near their eyes, impacting self-esteem and confidence levels negatively.

Others encounter reduced peripheral vision because excessive skin hoods over their eyes, necessitating surgery for practical purposes. Regardless of motivation, consulting a certified plastic surgeon remains vital when considering any elective surgical procedures like blepharoplasty.

Types of corrective blepharoplasty – eyelid surgery

The operations of eyelid surgery are performed both on the lower and upper eyelids and are respectively called the lower or upper blepharoplasty.

• During the upper blepharoplasty, excess skin and fat on the upper eyelids are eliminated, causing them to overhang.
• Lower blepharoplasty can be performed traditionally, with the removal of intraorbital fat or with its preservation (lower fat-preserving blepharoplasty). Conduction of both upper and lower blepharoplasty is possible by percutaneous or transconjunctival access.

Blepharoplasty is often supplemented with laser eyelid peeling to eliminate excess skin and fine wrinkles. In the presence of pronounced age-related changes, in addition to blepharoplasty, periosteal or subperiosteal facelift can be performed (temporal or blepharoplastic access).

Upper Blepharoplasty

As we age, our upper eyelids may start drooping, causing us to appear tired or older than we actually are. This condition might even obstruct vision in severe cases. Upper blepharoplasty, commonly known as an eyelid lift, aims to correct these issues by removing excess fat, tissue, and skin from the upper eyelids. Patients usually undergo this procedure due to cosmetic reasons, improved vision, or both. It is vital to maintain realistic goals and expectations regarding the outcome, focusing on a refreshed, rested, and youthful appearance rather than perfection.

The ideal candidates for upper blepharoplasty generally experience some common traits associated with aging or genetics. These can consist of:

• Sagging or loose upper eyelid skin creating folds or hindering vision
• Puffiness caused by fat herniation around the eyes
• Deep creases above the eyelids impacting overall facial expression
• Desire for enhanced self-confidence in personal appearance

It is crucial to note that patients must have no serious eye conditions, sufficient physical health, and positive motivations behind seeking this treatment. Consult a board-certified plastic surgeon specializing in oculoplastic surgery to determine candidacy properly.

Upper Blepharoplasty Procedure Details

In upper blepharoplasty, incisions typically occur within the natural eyelid crease—the area where eyebrows meet the upper lids. Utilizing this strategic location minimizes noticeability once healed completely. For individuals with excessive eyebrow descent accompanied by redundant forehead skin, alternative approaches may involve supratarsal fold fixation or direct brow lifts. Discuss preferences and potential scar locations with your surgeon before proceeding.

• Fat Removal vs Repositioning

Depending on individual needs, surgeons might choose between two methods for addressing protruding orbital fat: removal or repositioning. During the initial evaluation, assess whether there is adequate support for repositioned pads nearby without risking future prominence relapse. Otherwise, remove the unwanted deposits carefully to avoid altering surrounding structures’ aesthetic balance improperly.

• Muscle Tightening

When levator aponeurosis separation leads to ptosis (droopy eyelids), concurrent muscle tightening becomes imperative. By meticulously advancing weakened muscular attachments back onto tarsus, functionality and aesthetics improve considerably. However, overzealous manipulation may result in lid lag or restricted upward gaze mobility. Balanced suture placements ensure optimal contours free of unnatural tension lines.

• Skin Excision

After successfully treating underlying structural causes, residual excess skin requires precise trimming to reveal refined results harmoniously aligned along predetermined incisional paths. Careless execution often results in unsatisfactory scars varying significantly from anticipated trajectories. Masterful closure technique reduction generates subtle wound edges indistinguishably concealed within adjacent rhytides or wrinkles enhancing visual appeal significantly.

Recovery Process after Upper Blepharoplasty

Following upper blepharoplasty, expect cold compress applications several times daily for approximately three days. Lubricate lashes gently to prevent dryness or crust formation during early stages. Refrain from strenuous activities exceeding mild walks for ten days.

Avoid pulling down on lower lids while cleansing face and refrain from rubbing or touching operated areas directly. Sleep upright at 45 degrees for few nights utilizing extra pillows ensuring smoother swelling resolution. Regular application of prescribed ointments assists expedited recovery process promoting wellbeing.

Lower Blepharoplasty – Dark Circles, Bags, and Beyond

While upper blepharoplasty focuses primarily on loose skin and excess fat pockets located in the upper eyelids, lower blepharoplasty targets distinct concerns related to the region beneath the eyes, mainly involving the presence of dark circles, tear trough deformities, and prominent bags resulting from herniated fat pads. Both procedures aim to restore a youthful and well-rested appearance; however, their specific objectives vary, given the differing anatomical features involved.

Common aging indicators suitable for lower blepharoplasty comprise under-eye bags, nasojugal grooves, and marionette lines. Additionally, fine lines and wrinkles frequently develop alongside reduced skin elasticity due to collagen depletion. Genetic predispositions might accelerate these manifestations earlier in life, emphasizing the need for expert assessment by qualified professionals conversant in ophthalmic plastic surgery.

Lower Blepharoplasty Procedure Details

• Transconjunctival approach vs transcutaneous incision

Two main incision methods exist for lower blepharoplasty: transconjunctival and transcutaneous. The former involves an internal approach via the conjunctiva, leaving no external scar. This technique is particularly fitting for younger patients presenting isolated fat bulges without significant skin laxity.

Meanwhile, the latter consists of a subciliary incision placed immediately below the eyelash line, allowing simultaneous management of both fat and skin excess. Noteworthy, careful skill execution prevents eyelid malposition or rounding irregularities common among less experienced practitioners.

• Fat pad management

Fat pad manipulation represents a crucial aspect of lower blepharoplasty since its proper handling determines satisfactory outcomes. When performing transconjunctival procedures, conservative fat removal remains paramount to circumvent depressions or indentations induced by overzealous excision. Alternatively, transcutaneous approaches permit fat repositioning or redistribution for optimal restoration of facial fullness lost due to gravitational migration.

Furthermore, fat grafting has emerged as another valuable adjuvant strategy to replenish volume and achieve balanced rejuvenation.

• Tear trough correction

Addressing tear trough deformities necessitates meticulous identification and precise injection of fillers to rectify concavity responsible for casting exaggerated shadows and consequent apparent darkness. Most prevalently, hyaluronic acid derivatives serve as popular choices due to their favorable safety profiles and reversibility attributes. Moreover, advanced techniques incorporating microcanula application minimize ecchymoses and hasten recovery periods compared to conventional needle-based infiltration techniques.

• Skin resurfacing techniques

Complementarily, skin resurfacing treatments, either chemical peels, laser therapies, or intense pulse light (IPL) sessions, aid in attenuating wrinkle severity and uneven pigmentation attributed to photoaging. Beneficial modalities range from moderate non-ablative fractional lasers to deeper ablative variants, contingent upon individual necessity and provider preference. By combining these soft tissue augmentation techniques with functional improvement, the net benefit extends beyond mere aesthetic enhancements.

Recovery Process

Postoperative recovery after lower blepharoplasty shares similarities with upper counterparts yet possesses distinguishing facets worth noting. Bruising and swelling remain commonplace regardless of the chosen method; nonetheless, transconjunctival incisions tend to present diminished discomfort levels attributable to the absence of cutaneous wounds.

Customary symptom resolution follows comparable patterns, extending four weeks subsequent to the operation, although variations stemming from combined ancillary procedures mandate highly individualized anticipations. Attentive compliance with postoperative directions guarantees optimal wound healing progression and maintains acquired benefits, thereby safeguarding invested resources.

Double Blepharoplasty

Unlike separate upper or lower blepharoplasty, double blepharoplasty refers to simultaneously performed procedures targeting the upper and lower eyelids during a single operation. This holistic approach enables comprehensive rejuvenation addressing numerous signs of aging, thus maximizing efficacy and efficiency. Essentially, it encapsulates the integrated optimization of eyelid aesthetics for an invigorated, harmonious, and natural appearance.

Focus on Asian patient concerns

While applicable to all ethnicities, double blepharoplasty plays a pivotal role in addressing specific concerns predominant amongst patients of East Asian origin, namely the desire to acquire or enhance the presence of supratarsal creases (also referred to as “dual eyelids”).

Historically, certain Far Eastern cultures regard dual eyelids as a beauty norm, driving demand for this particular procedure variant. Despite growing societal acceptance of diverse definitions of beauty, countless individuals still seek double blepharoplasty to preserve traditional ideals or simply adopt a new look altogether.

Meticulous surgical planning constitutes a cornerstone element when executing double blepharoplasty within the context of East Asian patients. Crucial distinctions pertaining to eyelid anatomy, regional preferences, and procedural nomenclature require thorough understanding and appreciation. Therefore, engaging in comprehensive discussions centered on individual aspirations allows informed decision-making concerning desired outcomes, conserving native attributes integral to maintaining a naturally appealing result.

Epicanthoplasty inclusion when appropriate

Occasionally, select individuals might also benefit from concurrent epicanthoplasty alongside double blepharoplasty, especially those presenting pronounced inner-corner folds (“epicanthal folds”) obstructing complete exposure of the eye. By strategically dividing and partially excising these restrictive tissues, increased visual accessibility ensues, resulting in a wider, more alert visage.

Likewise, eliminating obstruction facilitates improved symmetry during double blepharoplasty, yielding superior overall cosmesis. Nevertheless, careful candidate screening ensures alignment of expectations, eliminates unnecessary modifications, and cultivates satisfied recipients wholly appreciative of their transformed countenances.

Augmenting Eyelids: Additional Procedures

Facial rejuvenation goes beyond merely lifting sagging skin and removing excess fat. Often, a combination of complementary treatments produces optimal outcomes. Let’s explore lateral canthal resuspension, brow lifts, fat grafting, and dermal fillers, followed by laser treatments and chemical peels.

Lateral Canthal Resuspension (Lateral Tarsal Strip)

Hooded eyes and saggy outer corners can detract from an otherwise youthful appearance. Lateral canthal resuspension addresses these concerns, tightening loose ligaments supporting the outside corners of the eyelids. Also called the lateral tarsal strip procedure, this technique creates a more defined and lifted shape without compromising normal blink function. This minor adjustment completed concurrently with blepharoplasty adds a subtle yet effective finishing touch.

Brow Lift

Combining a brow lift with upper blepharoplasty yields remarkable results, dramatically reducing forehead furrows and raising brows to an appropriately youthful position. Several brow lift methods exist, each boasting unique advantages. For instance, endoscopic brow lifts utilize tiny incisions, limiting trauma while offering excellent visualization and precision. Direct brow lifts provide instant lift and smoothing but carry slightly higher scar risk. Choosing the ideal approach depends on factors such as age, degree of sagging, and patient preference.

Fat Grafting & Dermal Fillers

Volumetric enhancement holds considerable importance in facial rejuvenation. With age, natural fat volume reduces, leading to hollowed cheeks and temples, thin lips, and an aged appearance. Fortunately, fat grafting and dermal fillers offer practical solutions.

Fat grafting harvests excess fat from donor sites, purifies it, and injects it into targeted areas for long-lasting volume. Since it uses the patient’s own cells, allergy tests aren’t required.

Dermal fillers contain synthetic materials designed to mimic natural components found in healthy skin. They come in various forms and densities, perfect for filling wrinkles, sculpting cheekbones, and plumping lips temporarily.

Each option presents merits and disadvantages, discussed thoroughly with patients before deciding.

Laser Treatments & Chemical Peels

Finally, to further enhance outcomes, incorporate laser treatments or chemical peels to address irregular skin texture, sun damage, fine lines, and dyschromias. Such procedures encourage collagen production and promote a fresher, smoother complexion. Many modalities and intensities allow tailored plans matching individual needs and expectations.

Laser treatments cater to various concerns, such as tattoo removal, vascular lesions, hair reduction, or epidermal pigmentation disorders. Each operates differently, targeting specific chromophores or tissue depths. Examples include CO2, Erbium, Alexandrite, Ruby, and Fraxel lasers.

Chemical peels apply varying concentrations of exfoliative agents, dissolving damaged surface layers. Low-grade peels address superficial issues while stronger versions tackle profound scars and wrinkles safely. Popular chemicals used include glycolic, salicylic, lactic, and trichloroacetic acids.

Preparing for blepharoplasty surgery

Blepharoplasty, also known as eyelid surgery, is a delicate procedure aimed at improving the appearance of the eyes by removing excess skin and fat from the upper and/or lower eyelids. This surgical intervention can rejuvenate the eye area, making you look younger and more refreshed.

However, proper preparation before undergoing blepharoplasty is crucial to ensure optimal results and minimize potential risks. In this chapter, we will discuss everything you need to know about preparing for blepharoplasty, presented in a clear and engaging manner that is easily understood by everyone.

Before delving into the preparations, let us first briefly explain what blepharoplasty entails. It is essentially a cosmetic or functional surgical process targeting the region surrounding the eyes. Surgeons remove extra skin, muscle tissue, and sometimes underlying fat pads to correct drooping lids, bags beneath the eyes, and wrinkles around the corners of the eyes (also called crow’s feet). By doing so, patients benefit from a revitalized facial expression and enhanced visual field if saggy eyebrows obstructed vision previously.

Preliminary Consultation with a Plastic Surgeon

Initiate your journey towards blepharoplasty with a thorough consultation with a board-certified plastic surgeon specializing in oculoplastic procedures. During this meeting, anticipate discussing:

• Medical history, current medications, allergies, prior surgeries, and tobacco/alcohol consumption patterns
• Family history of eye conditions, genetic predisposition to poor wound healing, and personal expectations from the surgery
• Physical examination of the periorbital structures, evaluating laxity, ptosis, prolapsed fat pockets, tear trough deformities, eyebrow position, and overall facial symmetry
• Clarification regarding goals, probable outcomes, potential complications, recovery duration, costs, and postoperative instructions

After assessing eligibility based on health status, candidates typically undergo photographic documentation capturing baseline appearances and facilitating precise surgical planning. These images serve as valuable references throughout each phase of treatment, enabling practitioners to compare improvements accurately.

Laboratory Testing & Additional Evaluations

Depending on individual cases, specific laboratory tests might be required preoperatively to rule out unnoticed systemic diseases contraindicated for elective operations. Typical investigations encompass complete blood counts (CBC), coagulation profiles, fasting glucose levels, kidney function tests, liver function tests, urinalysis, electrocardiogram (ECG), and chest X-rays. If any irregularities arise during these analyses, appropriate management measures must be taken to guarantee safety before proceeding with blepharoplasty.

Specific recommendations vary depending on age, comorbidities, and associated risk factors. Patients above forty years old often require mandatory ophthalmological evaluation addressing refractive errors, cataracts, dry eye syndrome, glaucoma, and retinal disorders.

An ophtalmologist performs tonometry, slit lamp biomicroscopy, and funduscopy examinations determining candidacy for upcoming surgical interventions. Furthermore, those with notable cardiovascular disease burden warrant cardiac clearance certifying fitness for general anesthesia administration during the operation.

Medication Adjustments & Lifestyle Modifications

As part of the preparatory stage, patients should discontinue certain drugs or supplements capable of increasing bleeding tendencies, thus elevating operative hazards.

Such substances include:

• nonsteroidal anti-inflammatory drugs (NSAIDs),
• aspirin,
• warfarin,
• clopidogrel,
• dabigatran,
• rivaroxaban,
• apixaban,
• garlic tablets,
• ginger,
• gingko biloba,
• omega-3 fatty acids,
• vitamin E,
• St. John’s wort.

Always consult healthcare providers before altering prescribed regimes since alternative options may exist ensuring continued wellbeing without compromising procedural success.

In addition to medication adjustments, lifestyle modifications constitute another integral facet of successful blepharoplasty preparations. Ideally, refrain from smoking cigarettes or consuming nicotine products six weeks preceding and subsequent to the scheduled date given their propensity to hinder microvessel perfusion impairing collagen synthesis.

Similarly, restrict alcohol intake four days ahead, adversely affecting platelet functioning leading to unfavorable hemorrhage incidence rates.

Concurrently, maintain hydration levels adequately and abide by recommended nutritional guidelines fostering favorable healing dynamics after surgery concludes.

Realistic Expectations & Psychological Readiness

Lastly yet significantly, cultivate realistic expectations concerning potential benefits achievable via blepharoplasty. Although surgeons strive diligently delivering satisfactory outcomes, they cannot guarantee perfection nor eradicate every aspect of aging entirely.

Blepharoplasty prices: how much will it cost?

The total cost of any plastic surgery consists of a number of components. Blepharoplasty is not an exception.

Among such defining, here it is possible to note:

• consultation of a plastic surgeon;
• preoperative laboratory tests and the delivery of necessary tests;
• complexity of the forthcoming operation;
• the price of the anesthetic used;
• postoperative hospital stay;
• follow-up observations, consultation of dressing and removal of superimposed sutures.

The presented list is a kind of common basis for all plastic clinics, each of which only introduces some adjustments and additions, setting and determining its value for each type of service.

As a result, the so-called price list is compiled and approved, where all the prices of a particular medical institution are specified in detail. It is always possible to get acquainted with him beforehand when choosing a clinic.

Average price for eyelid surgery in USA is between 2000$ and 7000$. It depends on clinic, experience of a surgeon and the location.

Where can I check the price?

It should be noted that the price list is a public document of any organization.

Almost all medical centers have their own official sites, in addition to contacts and a list of services, the price is also presented with the prices indicated on them.

In the absence of price on the site, or in the absence of the site of the clinic, you can always find contacts of the institution of interest.

On them you will be able to get detailed advice on the cost of the necessary service, as well as the possibility of receiving a price list for the e-mail specified by you.

When you visit the medical center, you also have an opportunity to get acquainted with the price on the spot, ask and discuss all the questions directly.

Blepharoplasty: how to prepare to eyelid surgery

On preliminary consultation with a plastic surgeon, the expected results of blepharoplasty are discussed. Successfully performed blepharoplasty makes it possible to achieve smoother contours in the eye area, reduce the number of irregularities – folds, furrows, eliminate overhanging of the skin and eventually get a younger and fresh look.

It is necessary to understand that with the help of blepharoplasty periodically arising edema around the eyes or small mimic wrinkles and “crow’s feet” are not eliminated, although after the plasty of the eyelids the situation can noticeably improve.

It is also necessary to assess the position of the eyebrows, and in case of their omission, decide to perform a combined operation – blepharoplasty and endoscopic face lifting.

In the presence of so-called “paint” bags together with blepharoplasty, the middle zone of the face is lifted, and the elimination of pigmentation or a network of wrinkles around the eyes is supplemented with laser or chemical peeling.

Before the operation of blepharoplasty, an assessment is made of the degree of elasticity of the skin, especially the lower eyelid. In elderly patients with reduced elasticity of the skin of the eyelids during the blepharoplasty, cantopexy is performed, which allows to avoid the lower eyelid lowering.

Preoperative preparation for blepharoplasty includes the passage of physician-appointed medical examinations and tests (standard blood test, ECG, therapist consultation, if necessary, consultation of narrow specialists), a conversation with an anesthesiologist for choosing the right method of anesthesia.

How is the eyelid surgery performed?

Usually, blepharoplasty is performed in conditions of short-term hospital stay under local or general anesthesia in combination with local infiltration anesthesia and takes from 30 minutes to 1-2 hours.

The optimal procedure for blepharoplasty is determined by the operating surgeon individually for each case. Today it is possible to conduct blepharoplasty using methods that exclude external incisions and sutures, which allows achieving maximum aesthetic results.

Produced in the course of blepharoplasty incisions are located along the natural folds of the eyelids, which makes them subsequently virtually invisible. At the end of the operation, blepharoplasty is applied to the eyelids aseptic bandage, which is removed after 4-6 hours. Postoperative pain syndrome is not significant.

Blepharoplasty postoperative period

Removal of cutaneous sutures is performed 4-5 days after blepharoplasty. An extract from the hospital is carried out in the evening on the day of the operation or on the following day.

Postoperative edema of the tissues can persist up to 1-2 weeks, bruises – for 5-8 days. At this time, it is recommended to perform special hygienic treatment of the eyes to prevent the formation of crusts, to sleep with an elevated head to reduce edema of the eye tissues, to limit head movement. After blepharoplasty, it is natural to short-term decrease in skin sensitivity in the eyelash growth zone.

If the postoperative period is favorable, the patient can return to work after 7-10 days. From this time, use of decorative hypoallergenic cosmetics is permitted. After blepharoplasty for 1-2 weeks, it is recommended to wear sunglasses, protecting the eyes from ultraviolet radiation.

In the early postoperative period (up to 2-3 weeks), restrictions on exercise and physical activity are imposed. Within two weeks after blepharoplasty, it is desirable to exclude the use of decorative cosmetics in the operation area and the wearing of contact lenses.

Evaluate the final results of blepharoplasty probably not earlier than in 6 months. If minor correction is required, it is usually carried out at the same time.

In most patients, postoperative scars are invisible, and the results of blepharoplasty persist for an average of 7-10 years.

Eyelid surgery: Contraindications

In addition to general somatic diseases that prevent any plastic surgery, specific contraindications to the performance of blepharoplasty are the presence of:

• acute and chronic inflammatory diseases of the conjunctiva,
• lacrimal ducts and glands,
• dry eye syndrome,
• blepharohalasia (excessive puffiness around the eyes),
• blepharospasm, hyperthyroidism and other eye diseases.

Risk and Complications

The greatest concern in after blepharoplasty is associated with patient dissatisfaction with the results of the operation.

To ambiguously perceived by patients side effects of blepharoplasty should be attributed a slight change in the shape of the eyes, their rounding, and therefore increases the visible part of the protein. With a strong tension of the lower eyelid, due to the removal of excess skin during blepharoplasty, there may be a drop in the corners of the eyes, which gives the look a dull, sad look.

In the case of the initially low tone of the lower eyelid or the removal of excess skin, it is possible to pull the lower eyelid downward – the ectropion, which can disappear on its own within six months. With the preservation of ectropion after 6 months after blepharoplasty, a reoperative operation may be required to surgically correct this complication.

Septic complications, bleeding, visual impairment and corneal trauma after blepharoplasty are extremely rare. In the first weeks after blepharoplasty, all patients develop swelling and bruising of the eye area.

It should be noted that the aesthetic results of blepharoplasty and their duration largely depend on the behavior of the patient himself. With due care of the skin of the eyelids and maintenance of general health, the result of blepharoplasty will be persistent and long-term.