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Blepharoplasty (Eyelid Surgery)

As we age, gravity works against us and skin loses its elasticity causing eyelids to droop and fatty tissue to accumulate below the eyes.

When we look in the mirror we may see someone who looks older and more tired than we feel because of droopy eyelids and crepe-paper skin under our eyes. Our friends may ask if we are tired or angry in spite of adequate rest and good health.

Even with the best skin care and sun protection, aging eyes are inevitable.

The Facial and Cosmetic Surgery Center at the Massachusetts Eye and Ear Infirmary offers blepharoplasty, eyelid surgery that can restore a healthy and youthful appearance, with a firmer and more attractive eye area.

Initial Visit 

During a patient's first complimentary visit, a medical history will be taken.

There will also be a physical examination focusing on factors such as age, genetic factors, ethnic background, skin type and elasticity.

It is also important to discuss pre-existing conditions such as hypothyroidism, diabetes, and circulatory or ophthalmic disorders. The surgeon will ask what you like and dislike about your eyes. Once your surgeon understands your expectations then mutual, realistic goals can be set.


Types of Blepharoplasty

There are three basic forms of blepharoplasty: upper eyelid surgery, lower eyelid surgery and transconjunctival blepharoplasty.

In upper and lower eyelid surgery, the excess, sagging skin is removed. When the membrane under the lower eyelid weakens with age, it lets the fatty tissue bulge forward causing puffiness or "bags" to form under the eyes. Transconjunctival blepharoplasty treats this by removing this fatty tissue under the lower eyelid.

In most cases, these are cosmetic procedures that are not covered by insurance. However, when drooping upper eyelids cause vision obstruction, a medical condition called ptosis, surgery is usually covered by insurance.

Combining Blepharoplasty with Other Procedures

Many patients elect to have upper and lower lid surgery together. If a patient has ptosis (drooping eyelids that interfere with vision), their upper eyelid surgery will probably be covered by insurance, while the patient remains responsible for the cosmetic lower eyelid procedure.

Blepharoplasty is often combined with another cosmetic procedure such as a brow or face lift to produce an optimum effect.

Surgical Procecdures

Blepharoplasy is usually performed under local anesthesia. In upper eyelid surgery, the incision is hidden in the natural crease of the eyelid. Excess skin and fatty tissue are removed and incisions are closed with fine sutures, to minimize scarring.

With lower eyelid surgery, an incision is made just below the lower lash line. Fatty deposits are removed and the loose skin is excised. Sometimes a lid tightening procedure is also used. Incisions are closed with fine, self-dissolving sutures.

When surgeons perform transconjunctival blepharoplasty, the incision is made inside the lower rim of the eye. The surgeon then divides the fatty tissue and muscle to remove the excess fat, and incisions are closed.

Pre-Operative Instructions

For two weeks prior to surgery, patients are required to avoid smoking, alcohol and any product containing aspirin. Smoking interferes with circulation and healing, and products containing aspirin or ibuprofen increase the risk of bleeding.

Post-Operative Instructions

Please arrange for someone to pick you up after surgery. After the procedure, your eyelids will be lubricated which may cause temporary, blurry vision.

Oral medications may be prescribed for pain or discomfort. There may be bruising, swelling, tearing and itching for about a week. At first, incisions may be red and bumpy but will flatten out and fade with time.

If non-dissolvable stitches were used, they will be removed one week after surgery.

Following surgery, patients are advised to sleep with their head elevated and to apply cold compresses.

Normal activities can be resumed after ten days, but strenuous activities such as aerobics or lifting should be avoided for three weeks.

Sunglasses and sun screen (SPF 15 or higher) should be worn outdoors.

Surgical Risks

All surgical procedures carry inherent risks, such as the possibility of infection. Sometimes, blepharoplasty patients have difficulty closing their eyes when asleep. Although this condition is quite rare it can be permanent. Lower lids may droop or look pulled down. This condition, ectropion, may require additional surgery.

Other potential complications include hematoma (an accumulation of blood under the skin) and changes in sensation around the eye area.


Most patients find blepharoplasty, which ranks as one of the five most common cosmetic procedures, surprisingly easy and are pleased with its dramatic and long lasting effect of making you look rested, refreshed and more alert. To learn if you are a good candidate for blepharoplasty, please call for a consultation at our Facial and Cosmetic Surgery Center.