A blepharoplasty is a surgical procedure that removes or repositions excess skin, fat, and muscle from the eyelids. It’s one of the most common facial plastic surgeries, performed on the upper lids, lower lids, or both. Some people get it purely for cosmetic reasons, while others need it because drooping skin is blocking their vision.
Upper vs. Lower Eyelid Surgery
Upper and lower blepharoplasty address different problems and use different techniques, though they’re often done together in a single session.
Upper eyelid blepharoplasty targets the heaviness and hooding that develops as skin loses elasticity with age. The surgeon removes a crescent of excess skin and, in some cases, trims or repositions fat pads that sit beneath the muscle along the brow bone. The incision follows the natural crease of the eyelid, which is why scarring tends to be nearly invisible once healed. By one year after surgery, roughly 89% of patients report no visible scarring at all.
Lower eyelid blepharoplasty deals with under-eye bags, puffiness, and loose skin along the lower lid. These changes happen when the tissue that holds fat in place around the eye socket weakens, allowing fat to push forward and create a puffy, tired appearance. Surgeons can approach this from one of two directions. A transconjunctival incision is made inside the lower eyelid, leaving no visible scar on the skin surface. A subciliary incision is made just below the lash line and gives the surgeon wider access but carries a slightly higher risk of the lower lid pulling downward during healing. The choice between the two depends on how much correction is needed and whether excess skin also needs to be removed.
Rather than simply cutting away the bulging fat (the older technique), many surgeons now reposition it into the hollow beneath the eye, smoothing out the transition between the lower lid and the cheek. For patients who only have loose skin without fat bulging, a conservative “skin pinch” technique removes a small amount of redundant skin without disturbing the deeper tissue layers.
Cosmetic vs. Functional Blepharoplasty
The distinction between cosmetic and functional blepharoplasty matters most when it comes to insurance. A cosmetic procedure is elective. A functional one corrects a measurable vision problem, and insurance may cover it if specific criteria are met.
To qualify as medically necessary, you typically need to show that drooping eyelid tissue is blocking at least 12 degrees of your upper visual field. This is measured with an automated visual field test performed twice: once with the eyelid in its natural position, and once with the lid taped up out of the way. Taping the lid must improve the number of points you can see by 30% or more. Photos documenting the obstruction are also required. These guidelines apply to upper lid blepharoplasty and brow ptosis repair. Lower eyelid surgery is rarely considered medically necessary and generally doesn’t require visual field testing.
Beyond vision obstruction, functional blepharoplasty can also address corneal irritation caused by inward-turning lashes, chronic headaches from straining forehead muscles to lift heavy lids, and eyelid spasms.
What Recovery Looks Like
Expect bruising and swelling to be at their worst during the first three to four days. Cold compresses and keeping your head elevated help during this stage. If non-dissolvable stitches were used, they come out around days five through seven.
Most people return to desk work within 7 to 10 days. If your job involves heavy computer use or a lot of reading, plan for 10 to 14 days and take frequent breaks, since your eyes will tire easily. Physically demanding jobs or roles where your appearance matters to clients usually require two to three weeks off. Your results start to look natural around the six-month mark, with subtle refinements continuing for up to a year as the tissue fully settles.
Risks and Side Effects
The most talked-about risk after blepharoplasty is dry eye. The reported incidence ranges widely, from near zero in some studies to as high as 26.5% in a large retrospective review of 892 patients. Surgery changes the interaction between the eyelid, the tear film, and the surface of the eye. Removing muscle tissue can lead to scarring that affects how completely the eye closes during blinking, which in turn reduces the spread and stability of the tear film. This is why surgeons are cautious about how much tissue they remove.
Other potential complications include lagophthalmos (incomplete eyelid closure, which should resolve and measure less than 2 mm even with post-surgical swelling), ectropion (the lower lid pulling away from the eyeball), and visible scarring. Lower lid procedures carry higher risk of these positional problems, particularly when skin removal is aggressive. Post-surgical healing and scarring can pull the lower lid downward, so conservative tissue removal is standard practice.
Preparing for Surgery
In the weeks before your procedure, you’ll need to stop taking blood-thinning medications and supplements. This includes aspirin, ibuprofen, naproxen, warfarin, and herbal supplements that increase bleeding risk (fish oil, vitamin E, and ginkgo are common ones). Your surgeon will tell you exactly how far in advance to stop. You’ll also have a pre-operative eye exam, and if you’re pursuing a functional blepharoplasty, the visual field testing described above.
Cost and Longevity
According to the American Society of Plastic Surgeons, the average surgeon’s fee is $3,359 for upper blepharoplasty and $3,876 for lower blepharoplasty. Those figures cover only the surgeon’s time. Anesthesia, the operating facility, and any pre-operative testing add to the total. Geographic location and surgeon experience also shift the price considerably.
Results from upper eyelid surgery are long-lasting. Research tracking patients for up to five years has found sustained improvements in self-esteem, body image, and overall life satisfaction, suggesting people remain happy with their results well beyond the initial recovery. The skin will continue to age, of course, but most patients don’t feel the need for a repeat procedure for a decade or more. Lower eyelid results, particularly fat repositioning, also tend to hold up well over time because the underlying structural correction addresses the root cause of the puffiness rather than just tightening the surface.