What is Blepharoplasty?
Eyelid surgery removes excess fat, muscle, and skin from the upper and lower eyelids. It can improve drooping lids and puffy eyes. It does not correct wrinkles, dark circles, or sagging eyebrows. These problems may be corrected through other procedures, such as a brow lift or skin resurfacing techniques.
Depending on the correction needed, some patients only require upper lid surgery and others only lower lid surgery. Upper and lower procedures may also be performed at the same time.
What can I expect at my first visit with a plastic surgeon?
At the initial visit, your doctor will likely ask you to describe in detail what your cosmetic goals are and what you would like improved. Be specific. If your surgeon understands your expectations, she'll be able to determine whether your goals are realistic and can give you an idea of the results you can expect.
Your surgeon will assess your brow position as well as the extent of excess skin, skin laxity and fat deposits to determine the technique that will give you the best results.
How much does eyelid surgery cost?
Eyelid surgery can cost between $1500 and $7,000 depending on whether you are having upper lids, lower lids, or both eyelids done.
EYELID SURGERY*
Cost Range: $1,500-$7,000
Average Total Cost
Upper and Lower Lids: $4,000
Surgeons fee: $2,500
Anesthesiologist: $700
Facility fee: $800
Lower Lids: $2,400
Surgeons fee: $1,600
Anesthesiologist: $400
Facility fee: $500
Upper Lids: $2,100
Surgeons fee: $1,200
Anesthesiologist: $400
Facility fee: $500
RELATED FEES**
Eyelid surgery $2,813
Face Lift $6,298
Forehead lift $3,148
Laser skin resurfacing $2,484
Cheek implant $2,720
Lip augmentation (surgical) $1,819
Botox® injection (per injection) $382
Microdermabrasion $149
*Fees generally vary according to region of country and patient needs.
**These fees are averages only. Fees do not include anesthesia, operating room facilities, or other related expenses.
Source: The American Society for Aesthetic Plastic Surgery Statistics.
What are the basic techniques used in blepharoplasty?
Anesthesia: General, local or sedation
Location: Hospital, surgical center or office
Surgery time: 1-3 hours
During eyelid surgery, the surgeon makes incisions above and below the eye tissue. These incisions follow the natural folds of the eye and allow the surgeon to separate the underlying fatty tissue and muscle. The surgeon then removes the fat and excises the sagging skin and muscle.
Upper Eyelid Blepharoplasty: Incisions are made in the natural skin crease of the upper eyelid. Excess skin and fatty tissue are removed and the muscles and orbital septum may be tightened to correct droopy eyelids.
Lower Eyelid Blepharoplasty: Lower eyelid surgery removes fat deposits and tightens loose skin. Tiny incisions are made along the lower lash line. Excess fat, muscle and skin are excised. If the lower eyelids are loose, a lid tightening procedure may also be required.
Transconjunctival blepharoplasty: If you have fat pockets below your eyes and do not have loose skin, your surgeon may recommend a transconjunctival blepharoplasty.
Transconjunctival blepharoplasty does not tighten the skin, it simply removes excess fat. The incision is made inside the lower eyelid, leaving no visible scar. Excess fat and muscle are removed.
What are the risks of eyelid surgery?
Complications of eyelid surgery, while rare, can cause prolonged healing, change in vision, and the possibility of requiring eye drops or ointment, temporarily or permanently.
Blindness: The risk of permanent blindness is less than 1 out of 10,000.
Blurred vision: This is a temporary condition that occurs in less than 1% of surgeries.
Corneal abrasion: This condition is temporary and is easily treated by patching the eye for 1-3 days.
Double vision: This condition is temporary and occurs in less than 1% of surgeries.
Difficulty closing eyes: This condition is usually temporary. In rare cases, corrective surgery is required.
Dry eye syndrome: Dry eye syndrome is potentially dangerous. In rare cases it leads to damage to the cornea.
Milia: Tiny skin cysts can form on the scar line. This is usually temporary, but in some cases requires surgical removal.
Retrobulbar hematoma: A rare complication in which a pocket of blood forms behind the eyeball.
What will the recovery be like?
Pain Level: Mild discomfort; 0-3 days of pain medication; may not require medication
Swelling and bruising: skin removal only: 3-5 days; skin & fat removal: 1-2 weeks
Stitches: if used, removed in 2 -5 days; no bandages
Work: Return to work after 5 days with makeup; 2-3 weeks without makeup
Exercise: Wait 2-3 weeks
Sun protection: Six months with SPF 15 or higher
Final result: Seen after 1-2 months
For faster recovery:
- Sleep with your head elevated for the first few days after surgery to minimize swelling
- Place ice compresses on your eyes for 1-3 days
- Avoid activities that dry the eyes (reading, watching television, wearing contacts, and using a computer)
- Avoid excessive blinking, which leads to increased swelling
- Wear sunglasses to protect your eyes from wind and sun irritation
- Avoid any activity that increases blood flow to the eyes (bending, lifting, crying and exercise)
- Don't drink alcohol (can cause fluid retention and delay recovery)
These are general recommendations. You should always follow your doctor's advice, as they know your individual case best.
Initial recovery takes anywhere from two weeks to one month, and the complete healing process takes up to six months as scars fade to thin white lines. After surgery your eyes may feel tight, with minor discomfort that lasts for a day or two. Your eyes will likely be swollen and bruised. Your head should be kept elevated and cold compresses applied to reduce swelling and bruising. The incisions may be red and bumpy initially and gradually flatten and fade. The swelling and bruising should disappear within 1-2 weeks depending on the extent of your surgery. During recovery, your eyes may be sensitive to light and your vision may be blurry the first few days. Your eyes may also experience burning, itching, tearing or dryness. Your doctor will likely dispense eyedrops to alleviate any discomfort.
Be sure to follow your doctor's advice carefully and go to all post-op visits.
Dr. Mark Gorney, a board-certified plastic surgeon in Napa, CA, wrote an article in the Aesthetic Surgery Journal that contained important information about preventing vision loss in the early post-operative period:
"In a survey of 5 consecutive cases of blindness after blepharoplasty, it was discovered that the only factor all patients had in common was that they were discharged very shortly after the termination of outpatient surgery. On arrival at home, all 5 patients did something to generate a sudden rise in blood pressure at the time of maximal reactive hyperemia as the epinephrine in the local anesthetic wore off, such as a constipated bowel movement, sudden coughing fit, or bending over and reaching down to tie a shoelace. It is imperative that all patients undergoing outpatient surgery involving undermining of heavily vascularized tissues be warned in writing not to perform any maneuvers that will generate a sudden rise in blood pressure. It is strongly recommended that no patient be discharged from an outpatient surgical facility until at least 3 hours after the last epinephrine-containing local injection and until there is evidence that all local anesthetic effects have worn off."
Source: Gorney M. Ten years' experience in aesthetic surgery malpractice claims Aesth Surg J March/April 2001;21:569-571
Before and After Photos