Blepharoplasty

Drooping or sagging eyelids can make your eyes feel heavy, affect your vision, or leave you looking tired. For some people, extra skin can even partially block vision. Eyelid skin surgery, also known as blepharoplasty, is a common procedure that can help address these concerns, offering both functional and cosmetic benefits.

What is blepharoplasty?

Blepharoplasty is a procedure that removes excess eyelid skin, most commonly from the upper eyelids. As we age, the eyelid skin can stretch due to gravity, rubbing the eyes, contact lens use, or even sleeping on one side. This can create “hooding,” where skin rests on the lashes or weighs the eyelids downward. When this begins to interfere with the upper part of your vision, insurance may cover the procedure.

Sometimes the eyebrow and eyelid muscles—not just the skin—have stretched out over time. In these cases, an eyebrow and/or eyelid lift can be performed at the same visit to restore them to their proper position.

What are upper and lower eyelid blepharoplasties?

These procedures are very different. Upper eyelid blepharoplasty focuses on removing excess skin that obstructs vision or alters appearance. Lower eyelid blepharoplasty typically treats under-eye “bags,” which are essentially our natural eyelid fat that has become more noticeable as the fat changes with age and the overlying skin and tissues thin. In lower blepharoplasty, surgeons sculpt or reposition this fat and remove only a very small amount of skin. Removing too much can pull the eyelid downward, so precision and experience are essential.

Why do most people choose blepharoplasty?

The most common reason depends on the patient's age. Elderly patients typically have an upper eyelid blepharoplasty in conjunction with an eyelid lift or brow lift when the lids are obstructing the upper portion of their visual field. These patients may constantly be raising their eyebrows to improve their vision. Over time, that effort can lead to headaches, forehead wrinkles, and eye strain.

Many patients—typically those who are younger—also seek surgery for cosmetic reasons. An upper and lower eyelid blepharoplasty can create a rejuvenated facial appearance.

Is eyelid drooping more common in men or women?

Both men and women experience changes in their eyelids over time. Eyelid drooping and the development of excess eyelid skin affect both genders equally. Of note, the outer part of the eyebrow often droops more noticeably than the middle portion of the brow, since the forehead muscles that lift the brow are stronger in the center of the face than at the sides. This can lead to more excess skin buildup on the outer parts of the eyelid.

What is the blepharoplasty procedure like?

Blepharoplasty is an outpatient procedure. The eyelids are numbed with a small injection, similar to dental anesthesia, and patients who choose to be in the operating room may also receive light sedation. The surgeon measures the amount of skin to remove, makes an incision hidden in the natural eyelid crease, removes the excess skin, and closes the incision with fine sutures. The procedure typically takes about 15 minutes per eyelid.

What can patients expect during recovery?

Bruising and swelling are common for the first week; patients often describe looking like they’ve been in a boxing match. This is normal, as the skin in the eyelid rests directly over muscle instead of fat. Rest, head elevation, and frequent icing can help minimize swelling. Stitches are removed after one week. Due to residual swelling, many patients still may see asymmetric results one to two weeks after the procedure. The final results are usually evaluated two months after surgery when the majority of swelling has subsided.

What are the risks of a blepharoplasty procedure?

Risks include bleeding, infection, scarring, temporary numbness, and early asymmetry while the eyelids heal. Injury to nearby structures is rare, especially when the procedure is performed by a well-trained oculoplastic surgeon.

Do the results last?

Results are long-lasting, but the eyelids will continue to age naturally over time. People who undergo the procedure earlier in life may eventually experience changes again, but most patients require only one surgery.

Are there any steps people can take to prevent drooping eyelids?

You can reduce risk by avoiding rubbing your eyes, minimizing eyelid manipulation from putting in contact lenses, and trying not to sleep on the same side every night. However, genetics and natural aging play the largest roles.

In addition, unlike other muscles, the eyelid and eyebrow muscles don’t respond to strengthening exercises. In fact, overusing the forehead muscles by frequently raising the brows or eyelids can cause the skin to stretch over time, leading to the formation of wrinkles. Surgeons often compare this to stretching out a rubber band—the more it’s used, the looser it becomes.

What should someone know when considering surgery?

Come prepared to discuss your goals. Photos can be very helpful—especially images that show how your eyelids look at their droopiest. And choose a surgeon with the right training. Eyelid anatomy is delicate, so look for someone with oculoplastic expertise who is certified by the American Board of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Rupin Parikh, MD, an oculofacial plastic and reconstructive surgeon and assistant professor of Ophthalmology at Columbia, reviewed the content on this page. He offers blepharoplasty at ColumbiaDoctors.