Blepharoplasty
Also known as eyelid surgery
Blepharoplasty is a surgical procedure that corrects drooping eyelids, removes excess skin, and reduces puffiness caused by fat deposits around the eyes. The procedure can be performed on the upper eyelids, lower eyelids, or both simultaneously. Upper blepharoplasty addresses sagging skin that can hang over the eyelash line and obstruct peripheral vision, while lower blepharoplasty targets under-eye bags, puffiness, and wrinkled skin beneath the eyes.
Eyelid surgery is one of the most commonly performed facial plastic surgery procedures, with approximately 120,000 blepharoplasties performed annually by ASPS member surgeons in the United States [1]. The procedure is popular among both men and women, typically those aged 35 and older who are experiencing age-related changes to the eyelids. Blepharoplasty may be performed for cosmetic reasons, functional improvement, or both.
When excess upper eyelid skin obstructs the superior visual field, the procedure is considered functional or reconstructive and may be covered by medical insurance [1]. A formal visual field test is typically required to document the functional impairment before insurance authorization is granted.
Overview
The skin of the eyelids is the thinnest in the body, making this area among the first to show visible signs of aging [2]. Over time, the muscles supporting the eyelids weaken, skin loses elasticity, and fat deposits shift forward or accumulate, creating a tired, aged, or puffy appearance. Genetics, sun exposure, allergies, and lifestyle factors all contribute to the rate at which eyelid aging progresses.
Upper blepharoplasty involves removing or repositioning excess skin, muscle, and sometimes fat from the upper eyelids. The incision is placed within the natural crease of the upper eyelid, rendering the scar virtually invisible once healed. For patients of East Asian descent, upper blepharoplasty may include creation of a supratarsal fold (double eyelid surgery), a procedure that requires specialized cultural sensitivity and anatomical understanding.
Lower blepharoplasty addresses the under-eye area and can be performed through an external incision just below the lash line (subciliary approach) or through an incision inside the lower eyelid (transconjunctival approach). The transconjunctival approach leaves no visible external scar and is preferred when the primary concern is fat herniation (bags) without significant excess skin [1]. When both excess fat and skin need to be addressed, the subciliary approach may be more appropriate.
Blepharoplasty is frequently combined with other facial rejuvenation procedures for comprehensive results. Brow lift addresses forehead sagging that can contribute to heavy upper eyelids. Facelift and skin resurfacing treatments complement eyelid surgery by addressing adjacent areas of facial aging. Non-surgical treatments such as Botox for crow's feet and dermal fillers for tear trough hollowing may enhance the results of blepharoplasty.
The procedure has an excellent safety profile when performed by qualified surgeons. Recovery is relatively brief compared to more extensive facial procedures, and most patients return to normal activities within 10 to 14 days [1].
Techniques & Approaches
Upper blepharoplasty begins with careful marking of the skin to be excised while the patient is sitting upright. The surgeon determines the amount of skin to remove by pinching the excess tissue with forceps, ensuring that sufficient skin remains to allow complete eyelid closure. The incision follows the natural eyelid crease, and excess skin, orbicularis muscle, and protruding fat are removed or repositioned. The incision is closed with fine sutures or skin adhesive, and the resulting scar is concealed within the crease.
The transconjunctival lower blepharoplasty involves an incision on the inner surface of the lower eyelid, providing direct access to the orbital fat compartments responsible for under-eye bags. Fat can be removed or, more commonly in modern practice, repositioned to fill the tear trough depression and create a smoother transition between the lower eyelid and cheek. This approach is ideal for younger patients with good skin elasticity and primarily fat-related concerns.
The subciliary lower blepharoplasty uses an incision just below the lower lash line, allowing the surgeon to address excess skin and muscle in addition to fat. After fat repositioning or removal, redundant skin is conservatively trimmed and the incision is closed with fine sutures. Care is taken to avoid removing too much skin, which can result in lower eyelid retraction or ectropion (outward turning of the eyelid).
Adjunctive techniques such as fat grafting to the tear trough area, laser resurfacing to improve skin texture, and canthopexy or canthoplasty to tighten or reposition the lower eyelid support are sometimes incorporated to optimize results and prevent complications.
Who Is a Good Candidate?
Ideal Candidates
Ideal candidates for blepharoplasty are adults with excess skin, puffiness, or bags affecting the upper or lower eyelids. Candidates should be in good general health, non-smokers, and free of serious eye conditions. Most patients are 35 years of age or older, though individuals with hereditary eyelid concerns may benefit at a younger age. Candidates should have realistic expectations and understand that blepharoplasty improves the eyelid area but does not address brow position, crow's feet, or dark circles caused by pigmentation.
Not Suitable For
Blepharoplasty may not be appropriate for patients with uncontrolled glaucoma, severe dry eye syndrome, thyroid eye disease (Graves ophthalmopathy), or detached retina. Patients with cardiovascular disease, uncontrolled hypertension, or bleeding disorders face elevated surgical risks. Unrealistic expectations about the degree of rejuvenation achievable through eyelid surgery alone may lead to dissatisfaction. Patients whose eyelid heaviness is primarily due to brow ptosis rather than eyelid skin excess may benefit more from a brow lift procedure.
Risks & Benefits
Benefits
Blepharoplasty produces a more rested, alert, and youthful appearance around the eyes with relatively minimal surgery and recovery. The procedure can dramatically reduce the tired or aged look caused by heavy upper eyelids, puffy lower lids, and under-eye bags. For patients with functional upper eyelid obstruction, surgery can meaningfully improve the peripheral visual field, enhancing safety during activities such as driving and reading.
The procedure has a high satisfaction rate due to its noticeable yet natural-looking results. Because the eyes are the focal point of facial communication and expression, even subtle improvements in this area can significantly enhance overall facial aesthetics. Scars are well-concealed within natural creases and are typically imperceptible once fully healed.
The relatively short recovery and the option to perform the procedure under local anesthesia with sedation make blepharoplasty accessible and appealing to a broad range of patients.
Risks & Considerations
Blepharoplasty is generally safe, but potential risks include bleeding, infection, dry eyes, temporary blurred or double vision, swelling, bruising, and asymmetry. Overcorrection, particularly removal of too much skin from the upper or lower eyelids, can result in difficulty closing the eyes (lagophthalmos) or ectropion of the lower eyelid [2], both of which may require revision surgery.
Temporary dry eyes and increased tearing are common in the early postoperative period and typically resolve within a few weeks. Patients with pre-existing dry eye syndrome should inform their surgeon, as blepharoplasty can exacerbate this condition. Retrobulbar hematoma, a collection of blood behind the eye, is an exceedingly rare but serious complication that requires immediate treatment to prevent vision loss [2]. The overall complication rate for blepharoplasty is low, estimated at 2 to 5 percent across published studies [1].
Alternative Procedures
Non-surgical alternatives to blepharoplasty include injectable treatments and energy-based devices. Dermal fillers, particularly hyaluronic acid-based products, can be injected into the tear trough to reduce the appearance of under-eye hollows and create a smoother lower eyelid-cheek junction. Botox or similar neuromodulators can soften crow's feet and slightly elevate the brow for a more open-eyed appearance. These treatments are temporary, lasting 6 to 18 months, and cannot address excess skin or significant fat herniation.
Radiofrequency and ultrasound skin tightening devices such as Thermage and Ultherapy may produce modest tightening of periorbital skin but cannot replicate the results of surgical blepharoplasty. Fractional laser resurfacing can improve eyelid skin texture and mild crepiness but does not remove excess skin.
For patients with functional upper eyelid impairment who are not surgical candidates, ptosis repair (addressing a drooping eyelid muscle) or brow lift may be considered depending on the specific cause of visual obstruction.
Preparation & Recovery
Pre-Surgery Preparation
Preparation for blepharoplasty includes a comprehensive eye examination and assessment of eyelid anatomy, skin quality, and degree of fat herniation. If functional blepharoplasty is planned, visual field testing is typically performed to document the degree of peripheral vision obstruction. Patients should provide a complete list of medications and supplements to their surgeon and discontinue blood thinners, aspirin, ibuprofen, vitamin E, and fish oil at least two weeks before surgery [2].
Contact lens wearers should switch to glasses for several days before and after surgery. Patients should arrange for transportation home and plan for someone to assist them for the first 24 hours. Having cold compresses, lubricating eye drops, dark sunglasses, and prescribed medications ready before surgery day is recommended.
Post-Surgery Care
After blepharoplasty, cold compresses are applied to the eyes intermittently for the first 48 hours to minimize swelling and bruising. Lubricating eye drops or ointment are used to prevent dryness. Patients should sleep with their head elevated on two to three pillows for at least one week. Sutures are typically removed three to five days after surgery.
Dark sunglasses should be worn outdoors for the first few weeks to protect sensitive eyelid skin from sun and wind. Contact lenses should not be worn for at least two weeks after surgery. Strenuous activities, heavy lifting, and swimming should be avoided for two to three weeks. Eye makeup can typically be resumed two weeks after surgery. Most patients return to work and normal activities within 7 to 10 days, though residual bruising may be present and can be concealed with makeup.
Recovery Timeline
1-2 days
Cold compresses, significant swelling and bruising, eyes may feel tight
3-5 days
Sutures removed, swelling begins to decrease, mild discomfort
1 week
Most bruising begins to fade, able to resume reading and light screen use
10-14 days
Most patients return to work and social activities, residual swelling
2-3 weeks
Bruising fully resolved, final suture scars fading
4-6 weeks
Scars becoming less visible, full activity resume
3-6 months
Final results visible, scars matured and well-concealed
Expected Results
Blepharoplasty produces visible improvement almost immediately, with results becoming increasingly apparent as swelling and bruising resolve over the first two to three weeks. The eyes appear more open, alert, and youthful. Upper blepharoplasty reveals more of the upper eyelid skin, creating a refreshed appearance and, in functional cases, improved peripheral vision.
Results of blepharoplasty are considered long-lasting, typically persisting for 10 to 15 years or more for upper blepharoplasty and 10 to 15 years for lower blepharoplasty [1]. The aging process continues naturally, and some patients may eventually develop recurrent upper eyelid laxity. Repeat upper blepharoplasty is possible when indicated. Lower blepharoplasty results tend to be more permanent because the repositioned fat does not typically recur.
Patient satisfaction rates for blepharoplasty are very high, consistently exceeding 90 percent in published studies [1]. The procedure is often cited as one of the most impactful cosmetic procedures relative to its brief recovery time and moderate cost.
Frequently Asked Questions
Does insurance cover eyelid surgery?
Insurance may cover upper blepharoplasty when it is performed for functional reasons, specifically when excess upper eyelid skin obstructs the peripheral visual field to a degree that impairs daily activities. Documentation typically requires a formal visual field test demonstrating significant obstruction, standardized photographs, and a letter of medical necessity from the surgeon. Lower blepharoplasty is almost always considered cosmetic and is not covered by insurance. Cosmetic upper blepharoplasty is also not covered. Check with your insurance provider for specific coverage criteria and pre-authorization requirements.
Source: ASPS, Mayo Clinic
How long do blepharoplasty results last?
Upper blepharoplasty results typically last 10 to 15 years, and lower blepharoplasty results can last even longer, often 10 to 20 years or more. The longevity of results depends on genetics, skin quality, lifestyle factors, and continued aging. Some patients eventually develop recurrent upper eyelid laxity and may benefit from repeat surgery. Lower eyelid fat repositioning results tend to be more permanent. Sun protection, non-smoking, and good skincare practices can help extend the life of results.
Source: ASPS, Cleveland Clinic
Can upper and lower blepharoplasty be done at the same time?
Yes, upper and lower blepharoplasty are frequently performed together during the same surgical session. Combining both procedures is safe, efficient, and provides comprehensive rejuvenation of the entire eye area. The combined procedure typically takes 1.5 to 2 hours and recovery is similar to having either procedure done alone. Many patients also combine blepharoplasty with other facial procedures such as brow lift or facelift for more complete facial rejuvenation.
Source: ASPS, Mayo Clinic
Sources & References
- Eyelid Surgery — American Society of Plastic Surgeons (ASPS) Accessed March 2026
- Blepharoplasty — Mayo Clinic Accessed March 2026
- Blepharoplasty (Eyelid Surgery) — Cleveland Clinic Accessed March 2026
Content last reviewed: March 11, 2026
Medical Disclaimer
Blepharoplasty addresses eyelid concerns only and does not treat brow ptosis, crow's feet, or dark circles from pigmentation. Patients with dry eye syndrome face increased risk of symptom worsening and should discuss this with their surgeon.
Not Medical Advice. The information on this page is provided strictly for educational and informational purposes. It is not intended to be, and must not be taken as, medical advice, a medical diagnosis, or a recommendation for any specific treatment or procedure. This content does not establish a physician-patient relationship.
Consult a Qualified Professional. Always seek the advice of a board-certified plastic surgeon or other qualified healthcare provider before making any decisions about medical treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this website.
Individual Results Vary. The outcomes, recovery timelines, complication rates, and cost estimates described here are general approximations based on published medical literature and may differ significantly based on your individual anatomy, health status, surgeon experience, geographic location, and other factors. No specific results are guaranteed or implied.
Sources and Currency. Content is informed by peer-reviewed medical literature and professional society guidelines, last reviewed March 11, 2026. Medical knowledge evolves continuously, and this information may not reflect the most current research or clinical practice at the time you read it.
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Quick Facts
Cost Information
Average cost range in the US
Factors affecting cost:
The cost of blepharoplasty depends on whether upper eyelids, lower eyelids, or both are treated. Upper blepharoplasty alone is generally less expensive than lower blepharoplasty, and treating both upper and lower lids together costs more but is typically less than having them done separately. Surgeon expertise, geographic location, and facility fees all influence pricing.
If the procedure is performed for functional reasons (documented visual field obstruction), insurance may cover the upper blepharoplasty component. Patients should verify coverage and obtain pre-authorization before scheduling surgery. Cosmetic lower blepharoplasty is not covered by insurance. Anesthesia type (local with sedation versus general anesthesia) also affects total cost.
Note: Costs vary by location, surgeon experience, and specific patient needs. Always get personalized quotes during consultations.
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