Blepharoplasty

Overview

Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that removes excess skin from the eyelids. With age, eyelids stretch, and the muscles supporting them weaken. As a result, excess skin and fat can gather above and below your eyelids. This can cause sagging eyebrows, droopy upper lids and bags under the eyes.

Besides aging, severely sagging skin around the eyes can reduce side vision (peripheral vision), especially the upper and outer parts of the visual field. Blepharoplasty can reduce or get rid of these vision problems. The surgery can also make eyes look younger and more alert.

Learn how blepharoplasty is done and about the benefits and risk of the procedure.

Why it's done

Blepharoplasty might be an option for:

• Baggy or droopy upper eyelids
• Excess skin of the upper eyelids that partially blocks peripheral vision
• Excess skin on the lower eyelids
• Bags under the eyes

Blepharoplasty can be done at the same time as another procedure, such as a brow lift, face-lift or skin resurfacing.

Insurance coverage might depend on whether the surgery repairs a condition that harms vision. Surgery only to improve appearance probably won't be covered by insurance.

Risks

All surgery has risks, including reaction to anesthesia and blood clots. Besides those, rare risks of eyelid surgery include:

• Infection and bleeding
• Dry, irritated eyes
• Difficulty closing the eyes or other eyelid problems
• Noticeable scarring
• Injury to eye muscles
• Skin discoloration
• Temporarily blurred vision or, rarely, loss of eyesight
• The need for follow-up surgery

How you prepare

Before scheduling blepharoplasty, you'll meet with a health care provider. Providers you meet with may include a plastic surgeon, an eye specialist (ophthalmologist), or an ophthalmologist who specializes in plastic surgery around the eyes (oculoplastic surgeon). The discussion includes:

• Your medical history. Your care provider will ask about previous surgeries. Your provider may also ask about past or current conditions such as dry eyes, glaucoma, allergies, circulatory problems, thyroid problems and diabetes. Your provider will also ask about your use of drugs, vitamins, herbal supplements, alcohol, tobacco and illegal drugs.
• Your goals. A discussion of what you want from the surgery will help set the stage for a good outcome. Your care provider will discuss with you whether the procedure is likely to work well for you.

Before your eyelid surgery, you'll likely have a physical exam and the following:

• Complete eye exam. This might include testing tear production and measuring parts of the eyelids.
• Visual field testing. This is to see if there are blind spots in the corners of the eyes (peripheral vision). This is needed to support an insurance claim.
• Eyelid photography. Photos from different angles help with planning the surgery, and documenting whether there's a medical reason for it, which might support an insurance claim.

And your provider will likely ask you to do the following:

• Stop taking warfarin (Jantoven), aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and other drugs or herbal supplements that can increase bleeding. Ask your health care provider how long before surgery to stop taking these drugs. Take only drugs approved by your surgeon.
• Quit smoking several weeks before surgery. Smoking can reduce the ability to heal after surgery.
• Arrange for someone to drive you to and from surgery if you are having outpatient surgery. Plan to have someone stay with you for the first night after returning home from surgery.

What you can expect

Before the procedure

Blepharoplasty is usually done in an outpatient setting. You might be given drugs such as injections into the eyelids to numb them and drugs through an IV to help you relax.

During the procedure

For upper eyelids, the surgeon cuts along the fold of the eyelid. The surgeon removes some excess skin, muscle and possibly fat. Then the surgeon closes the cut.

On the lower lid, the surgeon makes a cut just below the lashes in your eye's natural crease or inside the lower lid. The surgeon removes or redistributes excess fat, muscle and sagging skin. Then the surgeon closes the cut.

If your upper eyelid droops close to your pupil, your surgeon may do blepharoplasty combined with a procedure called ptosis (TOE-sis). Ptosis is designed to lift the eyelid as well as remove excess eyelid skin.

After the procedure

After surgery you spend time in a recovery room where staff members monitor you for complications. You can leave later that day to heal at home.

After surgery you might temporarily have:

• Blurred vision from the lubricating ointment applied to your eyes
• Watering eyes
• Light sensitivity
• Double vision
• Puffy, numb eyelids
• Swelling and bruising similar to having black eyes
• Pain or discomfort

Take the following steps to help you recover from surgery unless your surgeon gives you different instructions.

Do:

• Use ice packs on your eyes for 10 minutes every hour the night after surgery. The following day, use ice packs on your eyes 4 to 5 times throughout the day.
• Use prescribed eye drops or ointments.
• Sleep with your head raised higher than your chest for a few days.
• Apply cool compresses to reduce swelling.
• Wear dark sunglasses to protect the skin of your eyelids from sun and wind.
• If needed, use acetaminophen (Tylenol, others) to control pain.

Don't:

• Do anything strenuous for a week — no heavy lifting, swimming, jogging or aerobics.
• Smoke.
• Rub your eyes.
• Wear contact lenses for about two weeks.
• Take aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and other drugs or herbal supplements that can increase bleeding.

As instructed, return to the care provider's office to have stitches removed, if needed.

Seek medical attention immediately if you have any of the following symptoms:

• Shortness of breath
• Chest pain
• An unusual heart rate
• Severe new eye pain
• Bleeding
• Vision problems

Results

Many people who have blepharoplasty say they feel more self-confident and feel they look younger and more rested. For some people, surgery results may last a lifetime. For others, droopy eyelids can recur.

Bruising and swelling generally lessen slowly in about 10 to 14 days. Scars from the surgical cuts may take months to fade. Take care to protect your delicate eyelid skin from sun exposure.