Board‑Certified Rhinoplasty Surgeon

Eyelid surgery (blepharoplasty)

Eyelid surgery, or blepharoplasty, is a procedure that alters the appearance of the upper eyelids, lower eyelids, or both. The goal is to improve the look of the area around the eyes and enhance vision that may be obstructed by drooping eyelids.

Blepharoplasty can address the following:

Excess skin that hides or blocks your vision
Loose or sagging skin that creates folds or disrupts the natural contour of the upper eyelid (which can sometimes impair vision)
Excess fat deposits that appear as puffiness in the eyelids
Under‑eye bags
Drooping lower eyelids (to prevent showing the white below the iris)
Excess skin and fine wrinkles of the lower eyelid

Important points before undergoing blepharoplasty

Before undergoing blepharoplasty, there are several important points to keep in mind:

Upper eyelid surgery is often performed separately from lower eyelid surgery. Be prepared for two distinct procedures.
Blepharoplasty cannot remove dark circles under the eyes, lift drooping eyebrows, or eliminate wrinkles around the eyes (wrinkles can sometimes be treated with Botox).
The cost of cosmetic surgery is usually not covered by insurance, so you should discuss it with your doctor in advance. Some blepharoplasty costs may be covered if the surgery is done for medical reasons — for example, if the eyelids droop over the eyelashes and block your vision. Ask your surgeon about any expenses you should expect.
Smokers are at a higher risk of complications. If you are serious about having surgery, you should try to quit smoking.

Medical considerations for blepharoplasty

Before surgery, you should discuss a wide range of medical issues with your doctor or surgeon. For example:

Physical health – An examination helps your doctor or surgeon decide whether the treatment is suitable for you.
Medical history – Certain pre‑existing medical conditions and past surgeries may affect the decision about this procedure, including the type of anesthesia or sedation used. In particular, let your doctor know if you have any eye diseases such as glaucoma, dry eye, excessive tearing, or retinal detachment; any thyroid disorders such as Graves’ disease, hypothyroidism, or hyperthyroidism; any cardiovascular disease, high blood pressure, or other circulatory problems; or if you have diabetes.
Eye examination – You may need to be evaluated by an ophthalmologist (eye specialist) before surgery.
Possible risks and complications – It is important to understand these so you can determine whether blepharoplasty is right for you.
Medications – Tell your doctor and surgeon about any medications you regularly take or have recently taken, including over‑the‑counter products such as fish oil and vitamin supplements.
Past reactions to medication – If you have ever had a bad reaction or side effect to any medication, including anesthesia, inform your doctor and surgeon.
Preparing for surgery – Your surgeon will provide detailed instructions on what to do at home to prepare for the procedure. For example, you may be advised to take a specific medication or adjust the dosage of an existing one.
Dr. Narges Mikaniki recommends carefully following all pre‑surgery instructions.

Tissue adhesive in blepharoplasty surgery

Tissue adhesive, or fibrin sealant, can be used during surgery to hold layers of tissue together and reduce bruising after the procedure. It is made from human blood components derived from donated plasma. Before use, the plasma is screened for hepatitis, syphilis, and human immunodeficiency virus (HIV). The blood components are also heat‑treated to prevent possible virus transmission.

Tissue adhesive has been used for many years as a sealant in cardiovascular and general surgeries.

Immediately after blepharoplasty

After the procedure, you can expect:

Mild pain or discomfort
Numbness
Use of a cool compress, gauze, and dressing over the eyes
Swelling and bruising around the eyes
Possible bruising on the white of the eye
A watery sensation or dryness in irritated eyes
Increased sensitivity to light

In what cases is eyelid surgery performed?

You may have a local anesthetic with sedation or general anesthesia. Your surgeon will advise you on which option is best for you. The procedure can vary depending on the surgical details, but in general, the surgeon will:

For treating upper eyelid drooping, make an incision along the natural skin crease of the eyelid.
For treating the lower eyelid, make an incision just below the lash line or inside the lower eyelid (a transconjunctival incision).
Remove excess skin and reposition or remove excess fat.
If necessary, tighten underlying tissue (such as muscle) with sutures.
Ensure all incisions are hidden within natural age lines and skin folds.
Close the incisions with sutures, surgical tape, or tissue adhesive.

At‑home self‑care after blepharoplasty

Follow your surgeon’s guidance; general at-home self-care recommendations include:

Follow all wound care instructions. Apply the eye ointment as directed.
Expect some pain and swelling around the eyes for a few weeks.
Avoid any trauma to the eyes; for example, do not rub them.
Use cool compresses to help manage short-term irritation, discomfort, and dryness.
Protect your eyes from sunlight until the healing process is complete — this is very important.
Report any bleeding, severe pain, or unusual symptoms to your surgeon.

Complications of eyelid surgery

All surgeries carry some degree of risk. Some possible complications of blepharoplasty include:

Anesthesia risks, including allergic reactions
Surgical risks such as bleeding or infection
Blood clots, which may cause cardiovascular or pulmonary complications
Temporary or permanent numbness in certain areas
Temporary blurred or impaired vision
Dry eyes or excessive tearing
Difficulty closing the eyes; for example, the upper eyelid may remain open during sleep, which can dry the eye surface and cause ulcers (This is why it is essential to choose a skilled, experienced, and certified surgeon)
Eyelid retraction; downward pulling of the lower eyelid (often temporary)
Ectropion; a loose lower eyelid that turns outward
Eyelid disorders, including abnormal positioning of the upper eyelids (ptosis) or loose eyelid skin. These disorders may also be accompanied by sagging of the forehead and eyebrows.
Formation of lumps inside the lower eyelid that may irritate the surface of the eye
Hollow or unnatural-looking eyes if too much fat is removed
Itchy, inflamed scars
Bleeding behind the eye
Additional surgery to treat complications

This list is not exhaustive. For example, your medical history or lifestyle may put you at risk for other complications. You should speak with your surgeon for more information.

Eyelid surgery recovery period

Swelling after surgery gradually decreases over time. Many people find that blepharoplasty makes a real difference in their appearance, especially if the upper eyelid skin was very loose or they had large bags under the eyes. Your final results will become apparent within a few weeks, but it may take up to a year for the incision lines to fully heal.
While blepharoplasty can be expected to permanently correct certain issues, you will still experience the effects of aging.

What alternatives are there to blepharoplasty?

There is no other medical alternative to blepharoplasty that can change the position or reshape the eyelids. Speaking with a counselor or psychologist may help you overcome concerns about your appearance. However, if your eyelid surgery is medically necessary and not solely for cosmetic enhancement of the eye area, it should be noted that in such cases, blepharoplasty is the only option. For more information, please contact us.