Blepharoplasty
Eyelid surgery performed by an eye surgeon, not only on the eye’s behalf.
Overview
Blepharoplasty removes the excess skin, and where necessary the herniated fat, that gathers in the eyelids with age. It is one of the most frequently requested procedures in ophthalmology, and one of the most frequently requested for the wrong reason — because a heavy upper lid is sometimes a drooping lid, which needs a different operation altogether.
The distinction matters. Excess skin is treated by removing skin; a lid whose lifting muscle has weakened is not. Assessment therefore begins with measurement rather than with a mirror: lid height, muscle strength, the position of the brow, the stability of the tear film and, where the lid obstructs vision, a visual field test that documents it.
Being an ophthalmologist changes the emphasis. The eyelids exist to protect the cornea and spread the tear film with every blink. Removing too much skin from an eye that is already dry, or that does not close completely at night, leaves a patient uncomfortable however elegant the result looks. Planning within those limits is also what keeps the outcome natural rather than operated.
When to seek assessment
- Heaviness of the upper lids, or lifting the eyebrows in order to see
- Excess skin resting on the lashes, or folding over the lid margin
- Loss of the upper part of your field of vision
- A tired appearance that does not reflect how you feel
- Under-eye fullness or loose lower lid skin
- Difficulty applying make-up along the lid crease
Diagnosis
How the assessment is made
Lid measurement
Lid height, crease position and the strength of the muscle that lifts the eyelid are measured. This distinguishes excess skin from a genuinely drooping lid — two problems that look similar and are corrected differently.
Visual field testing
Where the lids obstruct the upper field of vision, a formal test documents how much. This establishes the procedure as functional rather than cosmetic, which also matters for insurance.
Tear film and surface assessment
Dryness is measured and treated before surgery is planned. It is the single most common reason for discomfort afterwards, and it is entirely preventable.
Brow and facial balance
A heavy brow can create the appearance of a heavy lid. Assessing the two together prevents an operation that corrects the wrong level.
Treatment
Options and what each one is for
Upper eyelid blepharoplasty
Removal of the excess skin — and, where it contributes, a small amount of fat — through an incision placed within the natural crease of the lid, where the scar becomes almost invisible as it settles.
Lower eyelid blepharoplasty
Correction of under-eye fullness and loose skin, planned with attention to lid support so that the lid position is not weakened. Where appropriate the approach is from inside the lid, leaving no visible scar.
Conservative planning in dry eyes
Where the ocular surface is fragile, less skin is removed and the surface is treated first. A slightly more modest correction is preferable to months of discomfort.
Recovery
What to expect afterwards
First 48 hours — cold compresses
Cold is what limits bruising, and the first two days are when it counts. Apply a cold pack wrapped in a clean cloth for ten to fifteen minutes every hour while you are awake. Rest it gently on the lids — no pressure. Swelling peaks at around forty-eight hours; this is expected, not a complication.
Sleeping and position
Sleep on your back with your head raised on two pillows for the first three to four nights. Lying flat or on your side allows fluid to collect in the lids overnight, which is why swelling often looks worse in the morning.
Ointment, drops and cleaning
A thin film of the antibiotic ointment you are given is applied along the incision two to three times daily for about a week. If the lids do not close fully at first, lubricating drops during the day and ointment at night protect the surface. Clean the lashes gently with cooled boiled water; do not scrub or soak the wound.
Days five to seven — stitches
Stitches are removed at five to seven days, which takes a couple of minutes and is not painful. Bruising begins to fade from this point and usually looks much better by day ten.
Weeks two to four — returning to normal
No strenuous exercise, heavy lifting, bending forwards, swimming or saunas for two weeks — all raise pressure around the eyes. Avoid rubbing, and leave contact lenses out for about two weeks. Make-up on the lids can usually be resumed at two weeks. Most people are comfortable in company within ten to fourteen days.
Scar care and sun
Once healed, sunglasses and sun protection matter: ultraviolet light darkens a fresh scar. Gentle massage along the crease may be advised from around three weeks. The scar fades to near-invisibility over three to six months, and the final contour is assessed then rather than earlier.
When to make contact urgently
Severe or increasing pain, rapidly worsening swelling with tightness, sudden loss of vision or double vision, or heavy bleeding require assessment immediately rather than at the next appointment. These are uncommon, but they are the reason instructions are given in writing.
Questions
Frequently asked
If your question is not answered here, it is welcome in consultation — or by message before you book.
Frequently both. When excess skin obstructs the upper field of vision, the operation is functional and is documented with a visual field test — which is also what insurers require. The improvement in appearance follows as a consequence.