Got tired eyes or bags under the eyes? Then consider eyelid surgery. This procedure, called blepharoplasty, is a surgical procedure that reduces bagginess from lower eyelids and removes excess skin from the upper eyelids.

The procedure involves the removal of excess skin, muscle and underlying fatty tissue. While it is primarily a cosmetic procedure, blepharoplasty is also an effective method for improving sight in older patients whose sagging upper eyelids obstruct their vision.

Blepharoplasty will not eliminate dark circles under the eyes, remove crow's feet or other facial wrinkles. It is often performed in conjunction with other facial surgery procedures such as laser resurfacing or forehead lifts.

The Eyelid Aging Process

As skin ages, it gradually loses its elasticity. A lack of elasticity, combined with the constant pull from gravity causes excessive skin to collect in the upper and lower eyelids. Excess skin on the lower eyelid causes wrinkles and bulges and on the upper eyelids an extra fold of skin forms which can hang over the eyelashes and obstruct vision.

Bulges in the upper and lower eyelids can also be caused by the fat that cushions the eyeball from the skull. The thin membrane that holds the fat in place weakens with age, allowing the fat to protrude into the lids.

Who Is a Good Candidate for Eyelid Surgery?

The best candidates for blepharoplasty are individuals with good physical and mental health who have realistic expectations. Most are 35 years or older, but if baggy eyelids or droopy eyelids are hereditary, you may decide to have the surgery at a younger age.

Eyelid surgery can enhance your appearance and help build your confidence. However, it may not result in your ideal look or cause people to treat you any differently. Blepharoplasty will not alter your facial structure. It is important to know your face well before you decide to have surgery. Think carefully about your expectations and discuss them with your surgeon.

Are the Changes Made by Eyelid Surgery Permanent?

Blepharoplasty will not stop your eyes from aging. However, the procedure is usually very long lasting. Upper eyelid surgery can last anywhere from five to seven years to an entire lifetime, while lower eyelid surgery rarely needs to be done more than once.

If your lids are once again sagging, the proper procedure is oftentimes a forehead lift, not another blepharoplasty.

How Should I Prepare for Eyelid Surgery?

You will need to have another person drive you home after your surgery. You should also have someone stay with you the night of the procedure.

Expect and plan to stay home from work and limit your activities for several days after surgery to give your eyelids a chance heal. Some patients experience dry eyes after surgery, but the condition rarely lasts more than two weeks. If you have dry eyes lasting more than two weeks, contact your doctor.

At home, you should have the following items readily accessible:

• Ice cubes
• Ice pack or you can use freezer bags filled with ice, frozen corn or peas.
• Small gauze pads
• Bowl (for water)
• Eye drops or artificial tears (ask your doctor to recommend the proper type to meet your particular needs)
• Clean washcloths and towels
• Over-the-counter painkillers (which your doctor can recommend)

How Is the Procedure Performed?

Blepharoplasty usually takes about two hours if both upper and lower eyelids are done together. Your doctor will most likely use local anesthesia (a painkiller injected around the eye) with oral sedation.

If you are having the procedure completed at a hospital or surgical center, you will most likely receive intravenous sedation.

If you're having all four eyelids done, the surgeon will probably work on the upper lids first. The surgeon will usually make incisions following the natural lines of your eyelids. Through these incisions, he or she will separate the skin from the underlying tissue and remove the excess fat, skin and muscle. The incisions are then closed with very small sutures. There will be sutures in both upper lids that will remain for three to six days. The lower lids may or may not require sutures depending upon the technique used.

Surgery on the lower eyelids may be done using one of several techniques. The transconjunctival technique is performed by making an incision inside the eyelid. No incision is visible following surgery. Through the incision, fat may be removed to correct baggy lower eyelids. Then, fine lines in the skin can be softened using a C0₂ or erbium laser.

Another method, called the transcutaneous technique requires an incision along the eyelash margin. Through the incision, excess skin, loose muscle and fat can be removed. The incision line fades after a short amount of time.

After either of these procedures, laser resurfacing may be recommended.

What Should I Expect During Recovery?

There will be stitches in both lids that will remain for up to about a week. It is common for swelling, and occasionally, bruising to occur, but within one to two weeks the eyelids will look normal.

What Are the Possible Complications From a Blepharoplasty?

As with any surgical procedure, there is some degree of risk. However rare they may be, it is important to be aware of potential complications before you decide to have the surgery.

Complications and unwanted results from blepharoplasty are rare, but sometimes they do occur. Most patients are very satisfied with the blepharoplasty procedure.

Problems can include:

• Bleeding
• Infection
• Dry eyes
• Abnormal discoloration of the skin of the eyelids
• Eyelid skin that folds in or out abnormally
• An inability to fully close the eyes
• A pulled down lower lid lash line or a possible loss of vision

If you experience any of these complications, contact your doctor as soon as possible.

Does Insurance Cover Blepharoplasty?

An insurance carrier may only agree to cover this surgery if the patient's eyelids are drooping to a level that impairs his or her vision. Otherwise, the procedure is considered cosmetic and not medically necessary.

Reviewed by the doctors at The Cleveland Clinic, Department of Plastic Surgery

Edited by Cynthia Dennison Haines, MD, on April 1, 2005.

Portions of this page © The Cleveland Clinic 2005-2006

sourceLast Editorial Review: 4/17/2008

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