For better or worse, our eyes communicate a great deal without us having to say a word. They help us develop meaningful relationships by revealing our true emotions and feelings. On the flip side, though, they can also reveal our stress level and how well (or poorly) we may have slept the night before. This may be why the blepharoplasty, a.k.a an eyelid lift, is consistently ranked among the top five cosmetic surgical procedures in the U.S.
"I think the most common things people say are 'my eyes make me look tired' or 'I feel like they look aged,'" says Carolyn Chang, MD, a San Fransisco-based board-certified plastic surgeon, of her patients. "Those are the words people like to use: tired, baggy, and wrinkly."
A quality blepharoplasty can accomplish much more than simply lifting the eyes, though. It can also tighten crepe-y lids, remove excess skin, reduce the appearance of undereye puffiness and, in some cases, even improve formerly impaired vision — all within an hour. We asked plastic surgeons to break down everything we need to know when considering eyelid surgery.
- Carolyn Chang, MD, FACS, a board-certified plastic surgeon in San Francisco.
- David Rosenberg, MD, a board-certified facial plastic and reconstructive surgeon in New York City.
- Karen Horton, MD, a San Fransisco-based board-certified plastic surgeon.
- Melissa Doft, MD, a New York City-based double board-certified plastic surgeon and clinical assistant professor of surgery at the Weill Cornell Medical College.
- Lara Devgan, MD, a New York City-based board-certified plastic surgeon and founder of skin-care line Dr. Devgan Scientific Beauty.
What is a blepharoplasty?
In short, a blepharoplasty is an eyelid lift, explains Dr. Chang. "The goal is to remove all of the extra skin that might have accumulated on the eye as a result of aging, gravity, and loss of elasticity."
There are two kinds of typical blepharoplasties — one for the upper eyelid and one for the lower While their goals and recoveries are similar, they are two totally separate surgeries technique-wise, although many patients opt to get an upper and lower surgery within the same appointment. It's most common to do the upper eyelids first before modifying the lower, or having both performed within the same surgery, says Dr. Chang. She adds that the upper eyelid surgery tends to be a simpler procedure, usually performed under local anesthesia, making it "a little bit easier" to recover from.
It should be mentioned that a variation of this surgery is also a highly popular procedure amongst those with monolids (eyelid that does not have a crease), which includes many people in the Asian community. Melissa Doft, MD, a New York City-based double board-certified plastic surgeon and clinical assistant professor of surgery at the Weill Cornell Medical College, says her Asian patients who are seeking blepharoplasty are often seeking this specific type, which differs from a traditional upper blepharoplasty.
According to Dr. Doft, this is often referred to as an Asian blepharoplasty, or a procedure that produces an eyelid crease rather than reshaping the eyelid by removing skin. This is achieved by making an incision and incorporating the underlying muscle into the skin closure so the muscle will attach to the skin, forming a permanent crease.
Who's a candidate for a blepharoplasty?
Historically, the average blepharoplasty patient have been in their mid-40s, according to Dr. Chang. But recently, she's been seeing more and more patients in their 30s who wish to swap their liquid brow lifts in favor of something more permanent and preventative. This new wave of younger patients have ushered in the advent of "mini blephs," meaning the patient isn't displaying significant laxity or fat pocket, therefore they don't require more extensive excisions or fat removal.
Dr. Chang notes that undereye bags are these patients' primary complaint, and can be addressed with this conservative technique for a lower blepharoplasty — and Dr. Chang's go-to method — that requires goes behind the eye to "just remove the fat and you leave all of the anterior structures above it intact," she says. "This way, the eye has a lot more support, the healing is faster, it's less invasive and it's perfect for a lot of the younger patients." This technique can also be tweaked for older patients who want a less-is-more approach to trim loose skin.
Anyone with eye issues that could potentially be exacerbated by a blepharoplasty — like Graves' disease or excessively dry eyes — aren't good candidates, as their corneas could be compromised during the excision process.
Dr. Chang says the very best candidate, though, is one who has realistic expectations of what a blepharoplasty can resolve and what it cannot. "A blepharoplasty is usually thought of as more of a reduction surgery: you're removing skin, you're removing fat, you're tightening by removing," explains Dr. Chang. "Eyelid surgery itself will not fix dark circles because that is the result of loss of volume," although, she adds, that a blepharoplasty can be supplemented with fat grafting or dermal fillers to restore volume to hollowed areas.
How is a blepharoplasty performed?
"Think of the eye as three layers: skin, muscle and fat," says David Rosenberg, MD, a New York City-based board-certified facial plastic surgeon. He notes that to modify a lower eyelid, you have to address the aging changes of all three layers, but an upper eyelid surgery is more straightforward: your provider will focus on the removal of droopy skin that has folded over the eyelid crease over time. An upper bleph, as the docs call it, leaves most of the fat in place to prevent a hollowed-out look, says Dr. Chang.
Because the lower eyelid addresses all three layers and not just the skin, it is a more involved procedure, performed under IV sedation. This process lifts the skin with the muscle, "then you can also go back and get those fat pads, too," explains Dr. Chang. "Then you re-drape the skin, tightening it a little bit, trim the extra skin off and close it."
Blepharoplasty before-and-after photos
While blepharoplasties were the fifth most popular surgery in 2022 (and up 13% from 2019), according to the American Society of Plastic Surgeons annual trends report, it's important to keep in mind that all plastic surgery is elective and certainly not a necessity. That said, here are some examples of what a patient's eyes look like before and after both upper and lower blepharoplasties as performed by Lara Devgan, MD, a board-certified plastic surgeon in New York City.
What is blepharoplasty recovery like?
Leaps in plastic surgical techniques in general have "allowed for less swelling and bruising, shorter scars and less downtime," explains Karen Horton, MD, a Bay Area-based, board-certified plastic surgeon. In fact, according to Dr. Rosenberg, severe bruising is a thing of the past with blepharoplasties, thanks to new-age lasers, like the Vbeam, which can zap and neutralize any bright discolorations that appear post-operatively. Another one of Dr. Rosenberg's tricks to soften bruising is to mix the blood-controlling agent tranexamic acid, or TXA, into the local anesthetic, which will "reduce bruising tremendously," he says, adding that he uses it for every operation.
In general, "an upper eyelid surgery is an easy thing to go through," assures New York City-based double-board certified plastic surgeon Melissa Doft, MD. "It's not so painful, and a lot of skin tightens by week four or five." New York City board-certified plastic surgeon Lara Devgan, MD, always tells her blepharoplasty patients that they're "going to look a little worse than they feel" and to have loads of ice ready to help with swelling. Because the eye area is so delicate and vision may be blurred, both Drs. Devgan and Rosenberg like to send patients home with a private nurse for the first night. "The surgery is very anxiety-producing for patients, and I just think it makes for a smoother recovery," says Dr. Rosenberg.
Dr. Chang cautions that a lower eyelid procedure "can take a little longer to resolve, just because the swelling can be a little bit more significant in those cases." Dr. Rosenberg adds that for the upper eyelids, you'll see "a magnificent result within three weeks," and for the lower lids, he estimates six weeks max until your eyes look as back to normal. During the three to six months post-op, your eyelids will look "crisper and crisper and crisper," says Dr. Chang, as the skin will tighten even more as the healing continues.
What risks are associated with blepharoplasties?
Both upper and lower blepharoplasties are widely considered to be one of the safer cosmetic procedures when performed by an experienced board-certified plastic surgeon. Physical complications, like dry eye or visual acuity, are usually temporary but can be permanent in the rare patient. An overly taut sensation, as if the lid was pulled too tight, "isn't uncommon" according to Dr. Chang, and will correct itself in a very short period of time.
The more serious risk, according to Dr. Rosenberg, is improper patient selection, which can lead to unnecessarily invasive treatment. "Sometimes the doctor suggests a blepharoplasty when the patient really needs a brow lift," he says, and sometimes even both to achieve their desired result. "It's important to remember that it's not just the eyelid skin, but often the brow as well, that has changed over time."
Cheek and undereye fillers can also be stubborn foes and can thwart a patient consultation, especially to an untrained eye. "I always ask my patients if they've had filler in the past, and even if it was eight years ago, I'm going to use a melting agent to dissolve that old filler," says Dr. Rosenberg, who notes that sometimes, it's the only procedure a patient needs. "I'm customizing what I'm seeing and treating them based on one: is it fat bags from aging or is it filler that was placed a long time ago that doesn't look right?" he explains, “and two, is it the brow or the upper eyelid skin? This is not cookie-cutter care."
How much does a blepharoplasty cost?
Just like any surgical procedure, cost depends on location and surgeon skill, but a New York City patient can expect to drop at least $8,000 for an upper eyelid procedure and $9,000 for a lower one, according to Dr. Devgan. "Some patients require fat grafting, and others require internal tightening and so forth," she says. "[Cost] really just reflects the complexity of the surgery, as well as different little maneuvers that can be done to customize results."
More info about common cosmetic procedures:
- The First FDA-Approved Injectable for Cellulite Is Here
- More Black People Are Getting Fillers and Botox Than Ever
- The Truth About Those "Temporary Nose Jobs"
Now, watch a dermatologist's entire routine:
