What is an eyelid surgery?

Eyelid surgery, or blepharoplasty, is a procedure that lifts and reshapes sagging skin on the upper or lower or both eyelids. It can also involve the removal or redistribution of excess fat in the lower and in rarer cases the upper eyelids. In this instance, a technique is used which is referred to as fat transposition.

Commonly called a lid lift, blepharoplasty is typically an outpatient surgery that can be performed on the upper eyelids to eliminate excess skin and raise drooping or hooded lids as well as on the lower eyelids to reduce puffiness and tighten loose skin. Patients may choose to have these procedures done separately or at the same time. It can also be combined with a procedure called a canthoplasty. This is a form of cosmetic eye surgery used to further refine the eye by cutting open and repositioning the outer corner of the eye to create a more exotic, almond shape. This procedure is often referred to as cat-eye lift surgery.

While an eye lift does not address crow’s feet by itself, treatments such as Botox, a temporal lift/ ponytail lift or laser therapy can help soften these fine lines. These procedures can sometimes be performed in combination with a blepharoplasty at the same time. For those looking to enhance or create an eyelid crease, there is another form of eye surgery called double eyelid surgery. This is a very popular procedure among Asian patients. Care should be taken to select a surgeon who specializes in this area as the procedure is quite different regarding the techniques used in comparison to a blepharoplasty.

Another type of eyelid surgery is ptosis repair, this is a surgery performed to tighten lax skin and or muscle of the lower or upper eyelid causing drooping. This can be an issue even in younger patients and may not necessarily be caused by aging.

What is the cost of a blepharoplasty?

In Australia, a blepharoplasty typically ranges from $3,000AUD to $8,000AUD.

In the U.S.A, the cost of a blepharoplasty (eyelid surgery) varies, but typically ranges from $4,000USD to $10,000USD. These ranges depend on the type of procedure (upper eyelid, lower eyelid or both) and the surgeon's fees and other costs. In Mexico, the average cost is significantly lower, around $2,000USD to $3,000USD. In Turkey, the cost of a blepharoplasty generally ranges from $1,200USD to $2,600USD for upper eyelid surgery alone, and $2,400USD to $5,200USD for both upper and lower eyelids.

Usually, an upper eyelid surgery (removing excess skin and/or fat) is generally less expensive than lower eyelid surgery. This is because lower eyelid surgery is usually a more complex procedure. Both upper and lower blepharoplasty can be performed together and the cost of course increases in this instance as well as when they're combined with other procedures.

How is eyelid surgery performed?

Upper blepharoplasty, unless being combined with other more involved surgeries at the same time, is usually done under local anesthetic along with a light sedative for comfort. Before the surgery, the surgeon will mark the skin around the eye while the patient is sitting upright to determine the precise amount of skin and or fat to be removed. An incision is made, taking care for it to be positioned along the eyelid’s natural crease to conceal any scarring, allowing the surgeon access to the tissues under the skin. Once the incision is made, the surgeon will remove any excess tissue, remove or reposition fat and potentially tighten the orbital muscles and the eyelid is then sutured back together. Some procedures also include a muscle tuck to make the eyes appear more open. A surgeon can perform upper and lower blepharoplasty using either a scalpel or a laser, with both techniques producing similar results depending on their preference and experience with both. Those favoring a laser claim it reduces bleeding, while others believe it leads to longer healing times.

It's important to note that lower blepharoplasty, which addresses puffiness and loose skin beneath the eyes, is performed under IV sedation or general anesthesia, as patients often experience more discomfort with this procedure. In cases where skin removal is required with a lower blepharoplasty, the incision is typically placed just below or behind the lower lash line. If the goal is to remove or reposition fat, the incision is usually made on the inside of the eyelid using a technique known as transconjunctival blepharoplasty, which eliminates visible scarring. Some surgeons prefer repositioning existing fat rather than removing it entirely to prevent under-eye hollowness, which can become more pronounced over time. A popular rejuvenating procedure to have at the same time as a lower blepharoplasty is a skin pinch where skin is removed from under the eye to further tighten that area and provide a slight lift to the orbital rim cheek juncture.

For patients with weak eyelid support muscles, tightening these muscle structures may be necessary to prevent complications such as eyelid malposition after surgery. In some cases, additional procedures like midface lifts or canthopexy may be performed to provide better structural support for the orbital rim and better results post surgery.

Different types of eyelid surgeries

As mentioned above, there are several surgeries which come under the grouping of eyelid surgeries, the most common ones are:

Upper blepharoplasty: Tightening of the upper eyelids, reduction of excess skin and/or fat and in some cases tightening the eyelid muscle as well. The most common complaint and cause for this procedure is upper eyelid hooding.

Lower blepharoplasty: Tightening of the lower eye lids and removal of excess fat in this area. The procedure is mainly used to address under eye bags or loose, sad looking under eyes.

Asian blepharoplasty: This procedure involves creating an eyelid crease in the upper eyelid and or removal of some excess fat in the orbital rim. The name as it suggests, is usually performed on Asian patients who want to open their eyes more and enhance their eye shape while still having the possibility to respect the ethnicity of their features.

Canthoplasty: This is a surgical procedure that reshapes the outer corner of the eye or a person's canthal tilt. A canthal tilt refers to the angle formed by the outer (lateral) and inner (medial) corners of the eye. It's a key feature in facial aesthetics and can significantly impact how an individual's eyes are perceived. Its primarily objective is to correct drooping or sagging outer eyelids and improve their overall appearance. It's often called "cat eye surgery" because it can lengthen the eye opening and lift the outer corner, creating a more almond-shaped or cat-like eye.

Ptosis repair: Ptosis repair is the name of a surgical procedure to address drooping eyelids, also known as ptosis. It involves tightening or shortening the muscles that lift the upper eyelid, helping to open up the eye and improve a patient's vision as well as their appearance.

How to prepare for eyelid surgery?

During your initial consultation, you’ll have the opportunity to discuss your eyelid concerns and goals with your surgeon and ask any questions about the procedure. Your doctor’s team will provide detailed pre-operative instructions to ensure you’re well-prepared for your blepharoplasty. Depending on your medical history and needs, you may be required to undergo blood tests or a medical evaluation with your primary care physician to confirm you’re in good health for elective surgery. A comprehensive eye exam, including a visual field test, may also be necessary to assess your baseline vision and overall eye health.

To help plan the procedure and potentially support insurance claims, photos of your eyelids from different angles will be taken. Adjustments to your medications will likely be recommended at least two weeks prior to surgery, with certain drugs and supplements—such as aspirin, ibuprofen, warfarin, and naproxen sodium—being temporarily discontinued to reduce the risk of bleeding and bruising. If you smoke, vape, or use nicotine products, your surgeon will advise you to quit at least a month before surgery to promote better healing.

It’s important to pick up any prescribed medications beforehand so they’re readily available during recovery. Since you won’t be able to drive immediately after the procedure, making arrangements for a friend or family member to take you home, stay with you overnight, and accompany you to your post-operative appointment the next day will help ensure a smooth recovery process.

What are the risks and possible side effects of eyelid surgery?

Although classified as being quite a safe procedure, like all surgeries, blepharoplasty carries some risks and possible side effects, though most are mild and temporary. Potential complications include bleeding, infection, dry eyes, and temporary vision changes. Some patients may experience numbness, scarring, or changes in eyelid position or sensation. More serious, though rare, complications can include vision loss, damage to eye muscles, or the need for further surgery.

Potential Risks and Side Effects:

Bleeding and Infection: As with any surgery, there's a risk of bleeding and possible infection at the incision sites. Bleeding should be monitored closely by a professional in the case of sutures having come undone and you may be prescribed antibiotics in advance to prevent the chance of infection.

Dry Eyes: Eyelid surgery can sometimes disrupt tear production, leading to dry eyes. Your surgeon may be able to advise you on certain medications that can help with this.

Temporary Vision Changes: Blurry or impaired vision can occur after surgery and usually resolves on its own throughout the healing process.

Numbness: Some patients experience numbness or altered sensation around the eyelids, this should resolve on its own as you heal and the swelling subsides.

Scarring: Visible scarring is possible but typically fades over time. Your surgeon will try and avoid scarring as much as possible by placing the incisions in your natural eye crease.

Eyelid Position Issues: In some cases, the eyelids may not close properly after surgery, causing dryness or other problems. Always speak about this with your physician to ensure the problem will resolve on its own or to see if you need secondary surgery.

Changes in Eyelid Position: Ectropion (outward rolling of the lower eyelid) or lid lag (a pulling down of the lower eyelid) may occur and may need secondary surgery to rectify.

Injury to Eye Muscles: Damage to eye muscles during surgery is a rare but possible complication. This risk is reduced by selecting a reputable board certified and skilled surgeon.

Vision Loss: Although extremely rare, permanent vision loss is a potential risk of this surgery if the surgeon damages your eye, tendons or nerves excessively.

How long does a blepharoplasty last?

A blepharoplasty can usually provide long-lasting results. Upper eyelid surgery typically lasts for 5 to 7 years, while lower eyelid surgery can be essentially permanent. The longevity of results can be influenced by factors like genetics, lifestyle, and individual aging patterns. Ageing is a natural process of life, after your eyes are rejuvenated through blepharoplasty they will be continuously ageing at the same rate the rest of your face and body will be.

How long is recovery from blepharoplasty?

Blepharoplasty recovery typically involves initial swelling and bruising for 1-3 weeks, with most people feeling comfortable in public within 10-14 days. The full appearance of the eye may continue to improve for 1-3 months.

Here's a breakdown of the most common timeline people experience after blepharoplasty

Initial Swelling and Bruising: This is the most noticeable part of recovery and the most challenging. Swelling usually peaks around day 3-4 after surgery. Applying ice packs can help minimize swelling as do some over the counter medications your surgeon may be able to advise you about.

Return to Public: Most people feel ready to go out in public and resume work within 10-14 days, though some may prefer to wait longer depending on how they are progressing through their healing journey.

Full Healing: The appearance of the eye may continue to improve for 1-3 months and final results may take 3-6 months to be completely noticeable.

Scars: While some scarring is inevitable, the eyelids generally heal well, and incisions are strategically placed within the eyelid crease to minimize scar visibility. Your surgeon may advise you on precautionary measures to take to avoid scarring as well as some over the counter medications that may help you heal as well. It's important to always follow their guidelines in regards to healing to avoid any unwanted outcomes.