Blepharoplasty is surgery to reshape the upper eyelid, lower eyelid, or both by removing or repositioning excess skin, muscle, and fat. It may be performed for functional reasons — when excess upper lid skin obstructs the superior visual field — or for cosmetic improvement of a tired or aged appearance. Most blepharoplasties are done under local anesthesia with sedation as outpatient procedures.
For a detailed guide to eyelid anatomy, see our dedicated Eyelid Anatomy page.
Am I a Candidate for Blepharoplasty?
Good candidates for eyelid surgery are adults in reasonable general health who are bothered by excess upper-lid skin, puffy lower-lid bags, or a heavy, tired appearance that no longer matches how they feel. Blepharoplasty corrects skin, muscle, and fat — it does not lift the eyebrow, erase fine crow’s-feet, or treat a drooping lid margin caused by a weak levator muscle. Understanding which structure is actually responsible for the tired look is the single most important step before surgery, because the wrong operation will not fix the problem.
Functional vs. Cosmetic Blepharoplasty
Upper-eyelid surgery falls into two categories that often overlap:
Functional (medically necessary): When redundant upper-lid skin hangs low enough to block the top of your vision, the procedure restores the superior visual field. This is documented with a formal visual-field test and eyelid photographs, and it is the version most likely to be covered by insurance.
Cosmetic: When the goal is a more rested, youthful appearance rather than improved vision. Lower-eyelid blepharoplasty for under-eye bags is nearly always cosmetic.
A droopy upper lid is not always a skin problem. If the eyelid margin itself sits low — when the distance from the pupil light-reflex to the upper-lid margin (MRD-1) is about 4–5 mm normally and drops to 2 mm or less — the cause is ptosis, a stretched or weak levator muscle, and it needs a different repair. Many patients have both excess skin and true ptosis and benefit from combining the two operations. See Ptosis vs. Blepharoplasty for how surgeons tell them apart.
Types of Blepharoplasty
Eyelid surgery is tailored to which lids are involved and what needs correcting. Explore each procedure in depth:
Choose a section, then drag the slider to step through it.
Step 1 of 9
Skin incision is marked within the crease of the eyelid
With the eyelid open, the planned incision is hidden within the eyelid crease
The excess skin is measured and marked
The eyelid skin is incised — with a laser, blade or radio-frequency cutter
The incision is opened, exposing the orbicularis muscle
The surgeon isolates the two pockets of herniated orbital fat
The prolapsed fat is removed and sculpted
Cautery is applied — with a Colorado needle (fine cautery), laser or radio-frequency device
The eyelid is sutured closed
IncisionClosure
Drag the slider to compare
Blepharoplasty is performed through external incisions placed along the natural skin lines of the eyelids — the crease of the upper lid, or below the lashes of the lower lid — or through the inner conjunctival surface (transconjunctival blepharoplasty). The surgeon removes excess skin, trims or repositions fat, and tightens supporting structures before closing incisions with fine sutures.
The operation typically takes one to three hours depending on the number of lids treated and the techniques used. After surgery, swelling and bruising are expected for 7–14 days; the final result is typically stable by 3 months.
Stepwise Surgical Description
Marking: Incision sites are marked before surgery with the patient seated upright. Meticulous marking dictates the outcome.
Anesthesia: Local anesthesia is injected for each eyelid; IV sedation is added for comfort.
Incision: Upper lid incisions follow the eyelid crease. Lower lid incisions are placed just below the lash line or through the conjunctiva.
Skin and fat excision: Excess skin is excised; the orbital septum is opened to access fat compartments. Fat is removed or repositioned as needed.
Hemostasis: Careful hemostasis is essential — the orbicularis oculi is highly vascular and retrobulbar bleeding can threaten vision.
Closure: Incisions are closed with interrupted fine sutures, removed at 7–8 days.
Recovery
Discoloration, bruising, and swelling for up to 7–14 days
Ice packs, head elevation, and restricted activity for the first week
Lubricating eye drops as prescribed
Final result stable at 3 months; upper-lid results are long-lasting (often 10+ years), while lower-lid results are more variable
Below is a surgical video demonstrating an actual upper eyelid blepharoplasty
Recovery Timeline
Swelling and bruising peak at 48 hours and resolve substantially over 1–3 weeks. The progression below shows a typical upper blepharoplasty recovery.
Day 2Week 1Week 3
Patients of Asian heritage may benefit from a specialized technique — see Asian Blepharoplasty for details on double-eyelid surgery and pretarsal crease creation.
Blepharoplasty vs. Related Procedures
The upper face ages as a unit, so blepharoplasty is frequently discussed alongside — and sometimes combined with — neighboring procedures. Choosing correctly depends on what is actually descending:
Heavy brow, not just lid skin? If the eyebrow has dropped below the bony rim, removing lid skin alone can worsen the crowding. A brow lift may be needed instead of, or with, blepharoplasty. Compare the two in Brow Lift vs. Blepharoplasty.
Midface and cheek descent? Blepharoplasty addresses the eyelids only; sagging of the cheek and jowl is a facelift question. See Blepharoplasty vs. Facelift.
Hollow tear troughs or dark circles? Volume loss at the lid-cheek junction is often better treated with fillers or fat repositioning than skin removal — see Tear Trough.
Not ready for surgery? Early or mild changes may respond to a non-surgical eye lift.
Cost & Insurance
Cosmetic blepharoplasty is an out-of-pocket expense, and the total varies with geography, the surgeon’s experience, whether one or both lids are treated, and facility and anesthesia fees. Functional upper-lid surgery may be covered when a visual-field test confirms that hooding skin obstructs the superior field; Dr. Fountain’s office documents this and seeks pre-authorization. One important nuance: when blepharoplasty is performed at the same session as ptosis repair, the skin (blepharoplasty) portion is considered cosmetic even if the ptosis repair is covered. Ask for an itemized estimate that separates surgeon, facility, and anesthesia fees. For typical prices, the medical-necessity criteria in detail, and payment options, see our Eyelid Surgery Cost & Insurance guide and Is Blepharoplasty Covered by Insurance?
Anesthesia & the Day of Surgery
Most blepharoplasties are outpatient procedures done under local anesthesia with light intravenous sedation — you are relaxed and comfortable but not under general anesthesia, which shortens recovery and lowers risk. You arrive having avoided blood thinners and aspirin-type medications for the interval Dr. Fountain specifies, the lids are marked while you sit upright, and you go home the same day with someone to drive you. Plan to keep your head elevated and apply cold compresses that first evening.
Choosing an Oculoplastic Surgeon
The eyelids are delicate, functionally critical structures millimeters from the eye itself, and the difference between an excellent and a disappointing result is often surgical judgment about how little to remove. Blepharoplasty is most safely performed by an oculoplastic surgeon — a physician with combined training in ophthalmology and plastic surgery of the eyelids and orbit. Surgeons who are ASOPRS fellowship-trained (American Society of Ophthalmic Plastic and Reconstructive Surgery) manage eyelid anatomy, tear function, and complications every day. Ask about board certification, how many blepharoplasties the surgeon performs annually, and review before-and-after photographs of their own patients. You can find fellowship-trained surgeons through our surgeon directory.
How Long Do Results Last?
Upper-eyelid blepharoplasty is durable: results are typically stable at three months and often last 10+ years, though the lids continue to age slowly like the rest of the face. Lower-eyelid results are more variable. Blepharoplasty does not stop aging, but for most patients a single well-planned operation delivers a long-lasting, natural refresh rather than a “done” look.
Potential Risks & Complications
Blepharoplasty is a commonly performed and generally well-tolerated facial procedure, but every operation carries risk. Being well informed before surgery — and choosing an ASOPRS-trained oculoplastic surgeon who manages these structures daily — is the best protection. The complications below range from common and self-limited to rare but serious.
1Pain, swelling & bruising
Expected after any eyelid surgery and almost always temporary. Cold compresses, head elevation, avoiding anticoagulants beforehand, and blood-pressure control minimize ecchymosis and hematoma.
2Scarring
Incisions are hidden in the lid crease and typically fade to a faint line. Keloid-prone patients may develop thickened or pigment-changed scars.
3Wound dehiscence
A wound that re-opens — usually from rubbing, restless sleep, or minor trauma. Careful suture technique and post-operative precautions prevent most cases.
4Upper-lid overcorrection / lagophthalmos
Removing too much skin can leave the eye unable to close fully, causing exposure and dryness. Conservative skin excision is the rule, especially after prior trauma or in thyroid eye disease.
5Lower-lid retraction & ectropion
The most visible lower-lid complication: the lid is pulled down or turns outward from skin shortage or scarring (photos below). Often requires lid-tightening or graft revision.
6Asymmetry
Small differences in crease height or fold are the most common reason for touch-up surgery; meticulous preoperative marking minimizes the risk.
7Dry-eye syndrome
Pre-existing dry eye can worsen after eyelid surgery; tear function should be assessed beforehand and treated aggressively afterward.
8Diplopia (double vision)
Very rare — from injury to an extraocular muscle (most often the inferior oblique) during lower-lid fat removal. Usually transient; persistent cases are treatable.
9Ocular injury
The eye itself is immediately adjacent to the surgical field; corneal abrasion or (extremely rarely) deeper injury can occur.
10Retrobulbar hemorrhage & vision loss
The most feared complication: bleeding behind the eye that can compress the optic nerve. Hemorrhage is rare (on the order of 1 in 2,000) and permanent vision loss is rarer still (roughly 1 in 20,000). It is treated as an emergency — the reason eyelid surgery belongs in experienced hands.
What Lower-Lid Complications Look Like
Ectropion — the lower lid turns outwardCicatricial ectropion from skin shortageMedial canthal web — webbing across the inner corner
Perspective: serious complications are rare, and most of those shown above are correctable with revision surgery. Discuss your individual risk profile — medications, dry eye, thyroid disease, prior surgery — with Dr. Fountain before the procedure.
Upper vs. Lower Blepharoplasty: Techniques Compared
Although both are called "eyelid surgery," upper and lower blepharoplasty solve different problems with different techniques, incisions, and recovery. Matching the operation to the anatomy is what separates a natural result from an operated look.
Upper blepharoplasty
Lower blepharoplasty
Primary concern
Hooding/redundant skin over the crease; heaviness
Under-eye bags, fat prolapse, crepey skin
Incision
Hidden in the natural lid crease
Below the lashes, or hidden inside the lid (transconjunctival)
Fat handling
Conservative removal; skin is the main target
Repositioned or selectively removed to smooth the lid-cheek junction
Insurance
May be covered when a visual-field test documents obstruction
Almost always cosmetic (out of pocket)
Durability
Long-lasting — often 10+ years
More variable; volume and skin quality keep evolving
The two are frequently combined in a single session (four-lid blepharoplasty). The decision is anatomic, not menu-driven: a heavy upper lid caused by a dropped brow needs a brow lift, not more skin removal, and a low lid margin needs ptosis repair rather than a skin operation.
What Determines a Natural Result
In eyelid surgery the most common regret is not "too little done" but "too much taken." A trained oculoplastic surgeon plans around three principles: preserve enough skin for the eye to close fully (avoiding lagophthalmos and exposure), keep or reposition fat rather than hollowing the socket, and respect the fellow eye so the two match. Because the tissues heal and settle over three months, conservative surgery with a planned minor touch-up beats aggressive surgery that cannot be undone. This surgical judgment — not a single technique — is why eyelid surgery belongs with an ASOPRS-trained specialist who operates on these structures daily.
Continue Reading — Your Complete Blepharoplasty Guide
This page is the hub of an in-depth library on eyelid surgery. Explore each part:
Blepharoplasty is a surgical procedure to remove excess skin, muscle, and fat from the upper or lower eyelids. It treats both cosmetic concerns (hooded or puffy lids) and functional problems (drooping skin that obstructs the visual field).
Who should perform blepharoplasty?
Blepharoplasty is most safely performed by an oculoplastic surgeon — a physician with dual training in ophthalmology and plastic surgery of the eye and orbit. Oculoplastic surgeons who are ASOPRS fellowship-trained have the deepest expertise in eyelid anatomy and function.
Is blepharoplasty covered by insurance?
Upper eyelid blepharoplasty may be covered by insurance when it is functionally indicated — meaning the drooping skin is obstructing the superior visual field, as documented by a visual field test. Purely cosmetic lower eyelid surgery is typically not covered. Note: when blepharoplasty is performed at the same time as ptosis repair, the blepharoplasty (skin) portion is always considered cosmetic and is not covered by insurance.
What is the recovery time after blepharoplasty?
Most patients are presentable in public within 10–14 days. Bruising and swelling typically peak at 48–72 hours and resolve significantly within 2 weeks. Final results, including subtle scar maturation, develop over 3–6 months.
What is the difference between upper and lower blepharoplasty?
Upper blepharoplasty removes excess skin (and sometimes fat) from the upper eyelid to correct hooding or drooping. Lower blepharoplasty addresses under-eye bags caused by fat prolapse, with or without skin removal. They address different anatomical compartments and are sometimes performed together (four-lid blepharoplasty).
What should I expect during my blepharoplasty consultation?
During your consultation, Dr. Fountain will evaluate your eyelids, discuss your aesthetic goals, and determine whether you're a good candidate for surgery. They will review your medical history, current medications, and any previous eye conditions to ensure your safety. Dr. Fountain will also explain the surgical approach, show you before-and-after photos, and answer any questions about realistic outcomes. This is an important time to communicate your concerns and establish clear expectations for your results.
What are the potential risks and complications of blepharoplasty?
While blepharoplasty is generally safe, potential complications include temporary swelling and bruising, dry eyes, and minor asymmetry between eyelids. Rare but serious complications may include infection, excessive bleeding, or changes in eyelid position. Choosing a fellowship-trained oculoplastic surgeon significantly reduces these risks, as they have specialized training in eyelid anatomy and reconstruction. Most patients experience minimal complications when they follow post-operative care instructions carefully.
How much does blepharoplasty cost?
Cosmetic blepharoplasty cost varies with your location, the surgeon's experience, whether one or both lids are treated, and facility and anesthesia fees. Functional upper-lid surgery may be covered by insurance when a visual-field test documents that excess skin obstructs your vision. Ask for an itemized estimate that separates surgeon, facility, and anesthesia fees.
How long do blepharoplasty results last?
Upper-eyelid blepharoplasty results are typically stable by three months and often last 10 or more years, though the eyelids keep aging slowly with the rest of the face. Lower-eyelid results are more variable.
Are you awake during blepharoplasty?
Most blepharoplasties are outpatient procedures performed under local anesthesia with light IV sedation. You are relaxed and comfortable but do not usually need general anesthesia, which speeds recovery and lowers risk.
What is the difference between blepharoplasty and a brow lift?
Blepharoplasty removes excess eyelid skin and fat, while a brow lift raises a sagging eyebrow. If the eyebrow has dropped below the bony rim, removing lid skin alone can make crowding worse, so the two procedures are sometimes combined. See our Brow Lift vs. Blepharoplasty comparison for details.
