What is a Blepharoplasty?

A Blepharoplasty (Eyelid Lift) is a facial rejuvenation procedure that restores a refreshed and rested appearance to the eyes by addressing extra skin and lower eyelid bags that can occur with aging. Blepharoplasty can be a rewarding experience that can improve self-confidence by improving the appearance of the Upper Eyelids, the Lower Eyelids, or both Upper and Lower Lids, making you look more rested, bright-eyed, and alert.

In extreme cases, puffy bags of skin called “festoons” can develop in the lower lids; this condition is usually genetic and requires skin excision. Extreme droop or curving out of the lower eyelids, called ectropion (creating a “show” of the sclera, the white portion of the eye) can also be corrected by blepharoplasty.

Eyelid surgery will treat the above features of aging to produce a brighter and refreshed look to the eyes. It should not change your appearance. The best facial rejuvenation procedures are not immediately obvious to others, but the brightening of the eyes will be evident to all. Beautiful, subtle, and natural results are the goal for blepharoplasty patients, without looking “done,” “surprised,” or different.

Types of Eyelid Lifts

During your blepharoplasty consultation, Dr. Horton will evaluate your eyelids and forehead, both at rest and while in motion, to assess the interplay of facial muscles. The recommended surgical approach will be tailored to your unique anatomy, taking into account factors such as skin texture and elasticity, eyebrow positioning, the degree of excess skin in the upper and lower eyelids, the presence of under-eye bags or festoons, and the overall condition of the forehead and brow area.

An upper lid blepharoplasty, lower lid blepharoplasty, four-lid (also known as a “quad”) blepharoplasty, or nonsurgical rejuvenation of the eyelids may be recommended to you as stand-alone procedures or in combination.

The Blepharoplasty Procedure

Visit our Preparing for Surgery section for detailed information about what to expect in the operating room on the day of your procedure.

A blepharoplasty is performed in the operating room under local anesthesia to constrict the blood vessels in the eyelids and limit bruising with an oral anti-anxiety medication and inhaled laughing gas, or under general anesthesia plus local anesthesia for your comfort and safety – especially if an eyelid lift is being combined with other surgeries. As with all aesthetic Plastic Surgery procedures of the face, eyelid surgery is performed under surgical “loupe” magnification to ensure exceptional precision and careful attention to detail.

The specific approach to your blepharoplasty will be tailored to your unique anatomy, the extent of skin laxity, and the presence of bulging fat or muscle in the upper and lower eyelids. Incisions are strategically placed to blend seamlessly within the natural crease of the eyelid area for minimal visibility.

After administering local anesthesia with epinephrine (to reduce bruising), the delicate eyelid skin is gently separated from the underlying tissue. Excess fat or muscle is either removed or repositioned as needed, and any small blood vessels are carefully sealed to prevent bleeding. Redundant skin is precisely trimmed, and the remaining skin is smoothly redraped without tension. Fine sutures are used to close the incisions, woven underneath the eyelid skin – these are typically removed within a week to avoid visible suture marks.

When you wake from surgery performed under general anesthesia, your vision may be temporarily blurred due to the application of protective ophthalmic ointment. Most patients find the procedure comfortable, with minimal pain. Prescription pain medication will be provided for any post-surgical discomfort, though many patients do not require it. Cool compresses will be placed over your eyes, which you can continue to use at home during the initial recovery period, although ice should not be directly applied to the eyelids. Eyelid surgery is generally performed on an outpatient basis and takes approximately 1-2 hours, depending on the complexity of the procedure.

Recovery After Eyelid Surgery

Initial healing after a blepharoplasty may include eyelid swelling, bruising, tearing, eye irritation, light sensitivity, or dry eyes that are controlled with medication, cold compresses, and lubricating ointment or drops. Initial eyelid asymmetry from swelling or an uneven appearance can occur and will normalize as healing progresses.

After approximately two weeks, obvious signs of surgery such as puffiness or discoloration should begin to dissipate. Bruising tends to follow gravity and descent downwards under the eyes to the lower eyelids and cheeks, even if only the upper eyelids are addressed. Large sunglasses can help to conceal bruising and/or concealing makeup, which can be applied within one to two weeks after surgery. Some patient wear glasses to conceal their incisions, while others get eyelash extensions or an updated hairstyle to take attention away from their healing upper eyelids.

Blepharoplasty incisions typically heal well with virtually undetectable scars due to the delicate nature of eyelid skin and robust blood supply of the face. As the initial bruising and swelling diminish, noticeable enhancements in the appearance of the eyes will become evident over the course of a few weeks.

Blepharoplasty results reveal smoother, more contoured eyelids and a rejuvenated eye area, contributing to a brighter and more youthful look. While early improvements are visible relatively soon, the full results develop gradually over several months to a year as the healing process completes and incision lines continue to fade.

Sleeping with the head elevated can help speed up the resolution of postop swelling. To prevent hyperpigmentation (darkening of the skin or incision sites) and sunburn, it is essential to strictly avoid sun exposure and consistently apply a broad-spectrum sunscreen with at least SPF 30. One week after surgery, you may apply makeup over your sunscreen, incorporating both into your daily skincare routine for optimal protection and healing. Products recommended for postoperative skin protection are available at our office as part of our Medical-Grade Skin Care regime.

Sutures will be removed in the office in the first week after surgery. Please see our Postoperative Instructions section and Special Instructions for Facial Surgery for additional information pertaining to recovery from a blepharoplasty.

Dr. Horton’s comprehensive Scar Therapy Protocol emphasizes the importance of protecting the delicate skin around the eyes from sun exposure, both during the healing process and as an ongoing habit. Limiting direct sunlight to the eyelids and face is key to minimizing future sun damage and maintaining a refreshed appearance over time.

As part of this approach, Dr. Horton advises wearing dark sunglasses to shield the healing skin and enhance comfort after surgery. Incorporating sun protection into your daily routine is a vital step in preserving your surgical results and promoting long-term skin health.

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