Home / Procedures / Blepharoplasty

Blepharoplasty (Eyelid Surgery)

💰 $4,000–$7,500
🏥 Outpatient
⏱️ 1–2 hours

Overview

Blepharoplasty is a surgical procedure that removes excess skin, muscle, and sometimes fat from the upper and/or lower eyelids. It can be performed for cosmetic reasons or to improve vision when drooping upper eyelids obstruct sight.

The procedure addresses:

  • Drooping upper eyelids that may impair vision
  • Excess skin on upper eyelids
  • Bags under the eyes
  • Puffiness in the eyelids
Functional vs. Cosmetic
When blepharoplasty is performed to correct vision obstruction, it is considered "functional" and may be covered by insurance. When performed solely for appearance, it is considered "cosmetic" and typically not covered.

Benefits

Clinical research and patient-reported outcomes demonstrate high satisfaction rates with blepharoplasty:

97%
Worth it rating
97%
Would recommend
20%
Visual field improvement
10+
Years of results

Functional Benefits

  • Improved peripheral and superior visual field
  • Reduced fatigue from straining to see
  • Elimination of brow strain and associated headaches

Cosmetic Benefits

  • More youthful, rested appearance
  • Improved eyelid contour and symmetry
  • Reduction of under-eye bags and puffiness

Procedure Types

Blepharoplasty can be tailored to your specific concerns. Your surgeon will recommend the approach that best addresses your goals.

Upper Blepharoplasty

⏱️ 45 min – 1 hour 💰 Often insurance-covered if functional

Removes excess skin from the upper eyelids. This is the most common type of blepharoplasty and is often performed to improve vision when drooping skin obstructs sight.

Best For
Hooding, heavy upper lids, vision obstruction, tired appearance
Incision
Hidden in the natural eyelid crease — virtually invisible once healed

Lower Blepharoplasty

⏱️ 1 – 1.5 hours 💰 Usually cosmetic (not covered)

Addresses bags under the eyes, excess skin, and puffiness. The incision can be made just below the lash line or inside the eyelid, depending on your anatomy.

Best For
Under-eye bags, puffiness, excess lower lid skin
Incision Options
Transcutaneous: Below lash line (allows skin removal)
Transconjunctival: Inside eyelid (no visible scar)

Four-Lid Blepharoplasty

⏱️ 2 – 2.5 hours 💰 Upper may be covered; lower typically not

Combines upper and lower blepharoplasty in a single procedure. Provides comprehensive rejuvenation with one recovery period and one anesthesia session.

Best For
Patients with concerns in both upper and lower lids who prefer single recovery
Considerations
Longer procedure and recovery; may have more swelling initially

Asian Blepharoplasty

⏱️ 1 – 1.5 hours 💰 Usually cosmetic (not covered)

Specialized technique to create or enhance the upper eyelid crease while respecting ethnic characteristics. Requires a surgeon with specific expertise in this technique.

Best For
Patients seeking crease creation or enhancement while maintaining natural appearance
Considerations
Seek surgeon experienced with Asian eyelid anatomy

Combined Procedures

Blepharoplasty is often combined with other procedures for more comprehensive facial rejuvenation:

  • Brow lift — Addresses sagging brows that contribute to upper eyelid heaviness
  • Facelift — Comprehensive lower face and neck rejuvenation
  • Fat transfer — Restores volume to hollow areas around the eyes
  • Laser resurfacing — Improves skin texture and fine wrinkles
  • Botox — Addresses crow's feet and brow position
Discuss Your Goals
Your surgeon can help determine whether combining procedures would better achieve your goals, or if staging them separately is safer or more effective.

Anesthesia Options

Blepharoplasty can be performed under different levels of anesthesia. Discuss your preferences with your surgeon.

Local Anesthesia with Sedation

Most common choice. You receive IV sedation to relax you, then local anesthetic is injected into the eyelids. You're comfortable and won't remember much of the procedure.

Pros
Safer than general, quick recovery from anesthesia
Cons
Some awareness during procedure, requires IV

Local Anesthesia Only

Just numbing injections in the eyelids. You're fully awake. Some patients prefer this to avoid sedation effects.

Pros
Fastest recovery, lowest risk, can drive home sooner
Cons
Must remain calm and still, aware of procedure

General Anesthesia

You're completely asleep. Typically used when combining with other procedures or for patients who prefer it.

Pros
No awareness, easier for anxious patients
Cons
Higher risk, longer recovery from anesthesia, higher cost

Procedure Steps

Understanding what happens during surgery can help you feel more prepared.

1
Marking
While you're sitting upright, your surgeon marks the areas of excess skin to be removed. This is done before anesthesia so natural eyelid position is preserved.
2
Anesthesia
Sedation administered (if used), followed by local anesthetic injected into the eyelids. You'll feel pressure but not pain.
3
Incision
For upper lids, incision made in natural crease. For lower lids, either below lash line or inside the eyelid (transconjunctival).
4
Tissue Removal or Repositioning
Excess skin removed, fat pads addressed (removed or repositioned to fill hollows), muscle tightened if needed.
5
Closure
Fine sutures or skin glue used to close incisions. Antibiotic ointment applied. Incisions are designed to heal into natural creases.

Total procedure time varies: approximately 45 minutes for upper lids only, 1–1.5 hours for lower lids, and 2–2.5 hours for four-lid surgery.

Results

Even when surgery is performed perfectly without any complications, aesthetic outcomes can vary. Understanding what results are possible — both favorable and unfavorable — helps set realistic expectations.

What Results Can Look Like

Both examples below show surgery completed without complications. The difference is the aesthetic outcome.

Favorable Result
Before
Before surgery - favorable case
→
After
After surgery - favorable result
  • Natural, refreshed appearance
  • Good symmetry between eyes
  • Scars hidden in natural creases
  • Results match patient's goals
Unfavorable Result
Before
Before surgery - unfavorable case
→
After
After surgery - unfavorable result
  • Asymmetry between eyes
  • Over-correction or under-correction
  • Unnatural appearance
  • Results don't match expectations
Important Distinction
Unfavorable results are different from complications. A surgery can be technically successful — no infection, no bleeding, no nerve damage — but still leave you unsatisfied with how it looks. This is why setting realistic expectations before surgery is critical.

Factors That Affect Your Results

Skin Quality
Thinner skin may show more contour irregularities. Sun-damaged skin may not tighten as well.
Facial Anatomy
Bone structure, fat distribution, and natural asymmetry affect what's achievable.
Age
Younger skin has more elasticity. Older patients may have more excess but less ability to tighten.
Healing
Individual healing varies. Scarring tendency, swelling duration, and tissue response differ by person.
Surgeon Technique
Experience and aesthetic judgment significantly impact outcomes. Discuss your surgeon's approach.
Your Expectations
Realistic expectations aligned with what's achievable lead to higher satisfaction.

What If You're Not Satisfied?

If your results don't meet your expectations, discuss concerns with your surgeon during follow-up visits. Minor asymmetries often improve as swelling resolves over several months. If concerns persist after full healing (6–12 months), revision surgery may be an option. See the Concerns & Revisions section for more information.

Risks

All surgical procedures carry risks of medical complications. Understanding these helps you make an informed decision and recognize problems early if they occur.

Complication Frequency How It Might Present
Bruising & swelling Expected Normal part of healing; resolves in 1–2 weeks
Dry eyes Common Gritty sensation, need for artificial tears
Temporary blurred vision Common From ointment and swelling; resolves quickly
Difficulty closing eyes Uncommon Inability to fully close eyelids; usually temporary
Ectropion (lower lid pulling away) Uncommon Lower lid turns outward, causing dryness
Infection Rare Increasing redness, warmth, discharge
Bleeding (hematoma) Rare Significant swelling, pressure, vision changes
Vision loss Very Rare Sudden vision changes — emergency
Seek Immediate Care If You Experience
Sudden vision changes, severe pain not relieved by medication, significant bleeding, or signs of infection (fever, increasing redness, discharge). These require immediate medical attention.

Risk Factors

Certain conditions may increase your risk of complications or affect your results. Discuss these with your surgeon:

Medical Conditions

  • Dry eye syndrome — May worsen after surgery
  • Thyroid eye disease (Graves' disease) — Requires special considerations
  • Diabetes — May affect healing
  • High blood pressure — Increases bleeding risk
  • Bleeding disorders — Or use of blood thinners

Lifestyle Factors

  • Smoking — Significantly impairs healing; you must quit before surgery
  • Certain medications — Aspirin, NSAIDs, supplements that increase bleeding

Anatomical Factors

  • Previous eyelid surgery — May complicate the procedure
  • Prominent eyes — Higher risk of exposure issues
  • Lower lid laxity — May require additional procedures

Limitations

Blepharoplasty is effective for specific concerns, but it cannot address everything. Understanding what the procedure will not do helps set realistic expectations.

Blepharoplasty Will Not Improve

  • Crow's feet — Wrinkles at the outer corners of the eyes (consider Botox)
  • Dark circles — Pigmentation under eyes (may need other treatments)
  • Drooping eyebrows — May need a brow lift instead
  • Fine wrinkles — On the eyelid skin itself (consider laser resurfacing)
  • Midface sagging — Cheek descent contributing to under-eye appearance
Setting Expectations
If your primary concern is crow's feet or brow position, discuss with your surgeon whether blepharoplasty alone will achieve your goals, or if additional or alternative procedures would be more effective.
Stage 2
Your Consultation

Choosing a Specialist

Eyelid surgery requires precision and specialized training. Look for:

Qualifications

  • Board certification — In ophthalmology, plastic surgery, or facial plastic surgery
  • Oculoplastic fellowship — Additional specialized training in eyelid surgery (ideal)
  • Hospital privileges — Ability to perform the procedure at an accredited facility

Experience

  • High volume of blepharoplasty procedures performed annually
  • Before/after photos of patients with similar concerns to yours
  • Experience with revision surgery (indicates handling of complications)

Red Flags

  • Unwillingness to discuss risks or unfavorable outcomes
  • Pressure to decide immediately or "special pricing"
  • No board certification or unclear training background
  • Inability to show before/after photos
  • Dismissive of your questions or concerns

Questions to Ask

Bring these questions to your consultation. A good surgeon will welcome them.

About the Surgeon

  • What is your training and board certification?
  • How many blepharoplasty procedures do you perform per year?
  • Can I see before/after photos of patients with similar concerns?
  • What is your revision rate?

About Your Procedure

  • Am I a good candidate for this procedure?
  • Do you recommend upper, lower, or both?
  • What technique will you use, and why?
  • What results can I realistically expect?
  • Will this be functional or cosmetic? Will insurance cover any portion?

About Results & Risks

  • What could go wrong aesthetically (even without complications)?
  • What are the most common complications you see?
  • How do you handle results that don't meet expectations?
  • What is your policy if I need a revision?

About Recovery

  • What will recovery look like for me specifically?
  • When can I return to work? Exercise? Wear makeup?
  • What follow-up appointments will I need?

About Logistics

  • What is the total cost, including facility and anesthesia fees?
  • What payment options are available?
  • Who do I contact if I have concerns after surgery?
Stage 3
Scheduling

Appointments

After deciding to proceed, you'll schedule several appointments before your surgery date:

1
Pre-operative consultation
Review surgical plan, sign consent forms, take pre-operative photos. Usually 1–2 weeks before surgery.
2
Medical clearance
Visit your primary care physician for clearance. Blood work and EKG may be required depending on your age and health.
3
Visual field test (if functional)
Required for insurance coverage. Documents that drooping eyelids obstruct your vision.

Clearances

Depending on your health status and age, you may need:

  • Medical clearance from your PCP — Required for most patients
  • Cardiology clearance — If you have heart conditions
  • Blood work — CBC, metabolic panel, coagulation studies
  • EKG — Typically required for patients over 50
Allow Enough Time
Schedule your clearance appointments at least 2 weeks before surgery. Abnormal results may require follow-up, and you don't want to delay your surgery date.

Costs & Insurance

Understanding the financial aspects helps you plan appropriately.

Typical Costs

  • Surgeon's fee — $3,000–$5,000 per eyelid pair
  • Facility fee — $500–$1,500
  • Anesthesia fee — $500–$1,000
  • Total — $4,000–$7,500 (varies by location and extent)

Insurance Coverage

Functional blepharoplasty may be covered if:

  • Visual field testing documents obstruction
  • Photos document eyelid position
  • Prior authorization is obtained

Cosmetic blepharoplasty is not covered by insurance.

Get Pre-Authorization
If seeking insurance coverage, ensure pre-authorization is obtained before scheduling surgery. Your surgeon's office should handle this process.
Stage 4
Pre-Op

Preparation Timeline

2 Weeks Before

Stop smoking
Smoking impairs healing and increases complication risk. Stop at least 2 weeks before and after surgery.
Stop blood thinners
Aspirin, ibuprofen, fish oil, vitamin E, and other supplements that increase bleeding. Confirm with your surgeon.
Complete medical clearances
Ensure all required clearance appointments are done and results sent to your surgeon.
Fill prescriptions
Get pain medication, antibiotic ointment, and artificial tears before surgery day.

1 Week Before

Arrange transportation
You cannot drive yourself home. Arrange for someone to pick you up and stay with you the first night.
Prepare recovery supplies
Cold compresses, gauze, sunglasses, pillows to elevate your head.
Plan time off
Most patients take 1–2 weeks off work, depending on job demands and healing.

Night Before

Nothing to eat or drink after midnight
Required for anesthesia safety. You may take approved medications with a small sip of water.
Wash your face thoroughly
Remove all makeup and use gentle cleanser. Do not apply any creams or lotions in the morning.
Set out comfortable clothing
Button-front shirt (nothing that pulls over your head), comfortable pants, slip-on shoes.

Medications

Stop Taking (2 weeks before)

  • Aspirin and aspirin-containing products
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Fish oil and omega-3 supplements
  • Vitamin E
  • Ginkgo biloba, garlic, ginger supplements

Continue Taking

  • Blood pressure medications (with sip of water morning of surgery)
  • Other prescribed medications unless specifically instructed to stop
Prescription Blood Thinners
If you take Coumadin, Plavix, Eliquis, or other prescription blood thinners, discuss with both your surgeon and prescribing physician. Do not stop these without medical guidance.

Home Preparation

Set up your recovery space before surgery:

Recovery Area

  • Recliner or bed with extra pillows to keep head elevated
  • Side table within reach for medications, water, supplies
  • Good lighting that's not too bright
  • Entertainment that doesn't require much reading (podcasts, audiobooks)

Supplies to Have Ready

  • Cold compresses or gel eye masks (keep in freezer)
  • Artificial tears (preservative-free recommended)
  • Clean gauze pads
  • Prescribed medications
  • Sunglasses (for light sensitivity and going outside)
  • Button-front shirts

Food & Meals

  • Prepare or purchase easy meals in advance
  • Soft foods are easier for the first few days
  • Stay hydrated — have water and non-caffeinated beverages available

What to Bring

Required

  • Photo ID and insurance card
  • List of current medications
  • Signed consent forms (if not already on file)
  • Payment for any remaining balance

Recommended

  • Dark sunglasses
  • Lip balm (operating rooms are dry)
  • Hair tie if you have long hair
  • Warm socks (facilities can be cold)

Leave at Home

  • Jewelry, watches, piercings
  • Contact lenses (wear glasses instead)
  • Makeup, lotions, perfume
  • Valuables
Stage 5
Surgery Day

What to Expect

Here's how your surgery day will unfold:

1
Arrival (30–60 min before)
Check in at the front desk. You'll complete paperwork, change into a gown, and have vital signs taken.
2
Pre-operative preparation
IV placed (if sedation used). Your surgeon marks your eyelids while you're sitting upright. You'll meet the anesthesia provider.
3
The procedure (1–2 hours)
You'll be positioned comfortably. Sedation administered if used, then local anesthetic. The surgery itself is typically painless — you may feel pressure but not pain.
4
Recovery and discharge
Rest in recovery area with cold compresses. Once stable, you'll receive instructions and be discharged with your companion.

Total time at the facility is typically 3–4 hours from arrival to discharge.

Recovery Room

After surgery, you'll spend 30–60 minutes in recovery:

  • Nurses will monitor your vital signs
  • Cold compresses will be applied to reduce swelling
  • Your vision may be blurry from ointment — this is normal
  • You may feel groggy from sedation
  • Mild discomfort is normal; significant pain is not — tell the nurse

Your companion will be brought back to sit with you and receive discharge instructions.

Discharge

Before leaving, you'll receive:

  • Written post-operative instructions
  • Prescriptions (if not already filled)
  • Emergency contact numbers
  • Follow-up appointment date
You Cannot Drive
Even if you feel fine, you cannot drive yourself home. Your vision is impaired and you've received sedating medications. Have your companion drive you home.

Plan to go directly home and rest. Have someone stay with you at least the first night.

Stage 6
Post-Op

Recovery at Home

First 24–48 Hours

  • Keep head elevated, even when sleeping
  • Apply cold compresses 20 minutes on, 20 minutes off
  • Take pain medication as prescribed
  • Apply antibiotic ointment as directed
  • Use artificial tears frequently
  • Rest — avoid reading, screens, or straining your eyes

First Week

  • Swelling and bruising will peak around days 2–3, then improve
  • Continue cold compresses as helpful
  • Keep incisions clean and apply ointment
  • Avoid bending over, heavy lifting, or straining
  • Sleep on your back with head elevated
  • Wear sunglasses when outside

Weeks 2–4

  • Most bruising and swelling resolves
  • Sutures removed (usually around day 5–7)
  • Gradually return to normal activities
  • May return to work (timing varies by individual)

Recovery Milestones

Here's what to expect as you heal:

Visual Healing Timeline

Every patient heals differently, but this shows typical progression. Swelling and bruising may look alarming early on — this is normal and temporary.

Day 1 post-op appearance
Day 1
Significant swelling and bruising. Eyes may be difficult to open fully.
Day 3 post-op appearance
Day 3
Peak swelling. Bruising darkens. This is often the worst day visually.
Day 7 post-op appearance
Day 7
Sutures removed. Bruising turning yellow/green. Swelling improving.
Day 14 post-op appearance
Day 14
Most bruising resolved. Presentable in public with makeup if desired.
Month 1 post-op appearance
Month 1
Looking normal. Subtle swelling may persist. Scars still pink.
Month 3 post-op appearance
Month 3
Final results emerging. Scars fading into natural creases.
Timeframe What to Expect
Days 1–3 Maximum swelling and bruising. Eyes may be difficult to open. Blurry vision from ointment. Some discomfort.
Days 4–7 Swelling begins to subside. Bruising turns yellow/green. Sutures removed. Vision clearing.
Week 2 Most bruising resolved. May feel comfortable going out in public. Still some swelling.
Week 3–4 Looking more normal. Fine to return to most activities. Minor swelling may persist.
Months 2–3 Final results becoming apparent. Scars fading into natural creases.
Month 6+ Final results. Scars should be well-hidden. Full sensation returned.

Warning Signs

Call Immediately (Day or Night) If You Experience
  • Sudden vision changes — Decreased vision, seeing flashes, or loss of vision in either eye
  • Severe pain — Not controlled by prescribed medication
  • Significant bleeding — More than slight oozing
  • Increasing swelling — Especially if one side is much more swollen than the other
  • Fever over 101°F

Normal vs. Concerning: Know the Difference

Use these visual comparisons to help determine if what you're experiencing is part of normal healing or requires medical attention.

Symptom
Normal
Call Your Surgeon
Bruising
Normal bruising
Symmetrical bruising on both sides, gradually fading from purple to yellow over 1–2 weeks
Hematoma requiring attention
Rapidly expanding bruise, severe asymmetry, or bruising that suddenly worsens after improving
Swelling
Normal swelling
Both eyes swollen similarly, worst at days 2–3, gradually improving, better in morning
Concerning swelling
One eye dramatically more swollen, swelling that increases after day 3, or swelling with vision changes
Redness
Normal redness
Pink along incision lines, mild redness around bruising, decreasing over time
Signs of infection
Spreading redness beyond incision, increasing warmth, red streaks, or redness with fever/discharge
Incision
Normal incision healing
Clean incision line, minimal crusting, edges coming together, light oozing day 1
Wound separation or infection
Edges separating, thick yellow/green discharge, opening wound, persistent bleeding

Contact the Office (During Business Hours) For

  • Questions about medications
  • Concerns about normal vs. abnormal healing
  • Redness, warmth, or discharge from incisions
  • Sutures that come loose before scheduled removal
  • Dry eye symptoms not relieved by artificial tears

Emergency Plan

Keep this information accessible:

Surgeon's Office

Phone: [Your surgeon's number]
After-hours emergency line: [Emergency number]

Nearest Emergency Room

[Hospital name and address]
Inform them you recently had eyelid surgery

When in Doubt, Call
It's always better to call with a concern that turns out to be normal than to wait on something that needs attention. Your surgeon's team expects post-operative questions.

Activity & Restrictions

Bathing & Hygiene

  • Showering: OK after 24 hours. Keep eyes closed, don't let water directly hit your face.
  • Hair washing: OK after 48 hours. Tilt head back to avoid water running into eyes.
  • Face washing: Gently, avoiding the eye area, until sutures are removed.

Driving

  • Do not drive for at least 1 week
  • Wait until vision is clear and you're off pain medication
  • Your surgeon will clear you at your follow-up appointment

Exercise

  • Week 1: Light walking only
  • Week 2: Light activity, no bending or straining
  • Week 3–4: Gradual return to exercise
  • Week 4+: Resume full activity as tolerated

Work

  • Desk work: 5–7 days (longer if extensive screen use)
  • Public-facing work: 10–14 days (when bruising is mostly resolved)
  • Physical work: 2–3 weeks minimum

Other Activities

  • Makeup: Avoid eye makeup for 2 weeks
  • Contact lenses: Wait at least 2 weeks, or until cleared
  • Swimming: Avoid pools, hot tubs, ocean for 3–4 weeks
  • Sun exposure: Protect with sunglasses and SPF for 3–6 months
Stage 7
Follow-Up

Appointments

Typical follow-up schedule:

1
5–7 days post-op
Suture removal, check healing, address any concerns.
2
2–3 weeks post-op
Assess healing progress, clear for more activities.
3
3 months post-op
Evaluate results as swelling resolves.
4
6–12 months post-op
Final results assessment, post-operative photos.

Wound Care

Before Suture Removal

  • Apply antibiotic ointment as directed (typically 2–3 times daily)
  • Keep incisions clean and dry
  • Don't pick at scabs or crusting
  • Gently clean with water or saline if needed

After Suture Removal

  • Continue ointment for 1–2 more weeks or as directed
  • May transition to scar cream/gel after incisions fully closed
  • Protect scars from sun (SPF and sunglasses)
  • Scars will be pink initially, then fade over 3–6 months
Scar Optimization
Incision lines are placed in natural creases to minimize visibility. Sun protection is the single most important thing you can do to ensure scars heal as inconspicuously as possible.

Concerns & Revisions

Most patients are satisfied with their results. However, if you have concerns:

Normal Healing Concerns

Many things that look worrying early in recovery resolve on their own:

  • Asymmetry — Sides often heal at different rates. Wait 3–6 months before judging.
  • Lumps or firmness — Scar tissue softens over time.
  • Numbness — Sensation typically returns within weeks to months.
  • Visible scars — Continue to fade for up to a year.

When Revision May Be Considered

In rare cases, additional surgery may be needed:

  • Persistent asymmetry after healing is complete
  • Under-correction (not enough tissue removed)
  • Over-correction (too much tissue removed)
  • Eyelid position issues (ectropion, ptosis)
  • Unsatisfactory aesthetic result despite no complications

Revision surgery, if needed, is typically not performed until at least 6–12 months after the original procedure to allow complete healing.

Discuss Early
If you have concerns about your results, discuss them with your surgeon during your follow-up visits. Many concerns resolve with time, but your surgeon should know what you're experiencing.