An upper blepharoplasty is a surgical procedure that removes excess skin from the upper eyelids. It’s one of the most commonly performed facial surgeries, done for both cosmetic and functional reasons. Some people want a more refreshed, open-eyed appearance, while others need the surgery because drooping skin has started blocking their vision.
Why People Get Upper Blepharoplasty
As you age, the skin on your upper eyelids stretches, the muscles supporting them weaken, and fat deposits can shift or bulge. The medical term for this excess upper eyelid skin is dermatochalasis. For many people, it’s purely a cosmetic concern: the lids look heavy or tired, and the natural crease above the eye disappears under a fold of skin.
For others, the problem goes further. Significant drooping can create lateral hooding, where skin hangs over the outer corners of the eyes and narrows the visual field. This forces you to raise your eyebrows constantly to see clearly, which can lead to persistent tension-type headaches. In more advanced cases, the excess skin presses directly on the eyelashes or pushes them into the eyeball, causing irritation and even wounds on the eyelid surface from skin folding on itself.
Cosmetic vs. Functional: How Insurance Decides
When upper blepharoplasty is done purely for appearance, you pay out of pocket. When it’s done to restore vision, insurance may cover it, but you’ll need to meet specific clinical criteria. Medicare, for example, requires documentation of both physical signs and measurable visual field impairment. One key measurement is the margin reflex distance, which is the gap between the center of your pupil and the edge of your upper eyelid. If that distance is 2.5 mm or less with your brow relaxed, it meets the threshold for functional impairment. Your doctor will also test how much of your peripheral vision the drooping skin blocks, typically using a visual field test performed with and without the eyelid skin taped up.
If you’re considering the surgery for cosmetic reasons, the average surgeon’s fee is about $3,359, according to the American Society of Plastic Surgeons. That figure doesn’t include anesthesia, facility fees, or other related costs, so the total is typically higher.
What Happens During the Procedure
The surgeon marks the skin to be removed while you’re sitting upright, since gravity changes the position of eyelid tissue when you lie down. The lower mark follows your natural eyelid crease (or where the surgeon wants the new crease to sit). The upper mark defines how much skin will come off. These markings stay within specific boundaries: they don’t extend past the inner corner of your eye on the medial side or beyond the bony rim of your eye socket on the outer side.
The incision is placed right in the eyelid crease, which is why the scar becomes nearly invisible once healed. The natural fold of your eyelid drapes over the incision line and conceals it. The surgeon removes the marked strip of skin, and depending on your anatomy, may also address small pockets of fat that contribute to puffiness. Sutures close the incision, and in some cases the surgeon will anchor the closure to deeper tissue to create a well-defined crease.
Anesthesia and Setting
Upper blepharoplasty doesn’t require general anesthesia in most cases. In one study of nearly 100 patients, 66% had the procedure done under local anesthesia alone in the surgeon’s office, 11% had local anesthesia with sedation, and only 23% had general anesthesia in an operating room. Outcomes were comparable across all three groups. Local anesthesia means you’re awake but your eyelids are completely numb. If the idea of being awake during eyelid surgery makes you anxious, sedation is always an option, though it adds cost and requires an anesthesiologist.
Recovery Timeline
The first few days after surgery involve the most swelling and bruising. Cold compresses and keeping your head elevated help. Your eyes may feel tight and slightly sore, but the discomfort is generally mild. Stitches come out between seven and ten days after surgery.
Most swelling and bruising fade by the second to third week. Many people feel comfortable returning to work and social activities within 10 to 14 days, though some residual puffiness can linger longer. You’ll want to avoid anything that raises your blood pressure or heart rate for the first couple of weeks, as this can worsen swelling or cause bleeding at the incision site.
How Long Results Last
Upper blepharoplasty results typically last five to seven years, and for some people they last a lifetime. Your skin will continue to age naturally, so some degree of laxity will eventually return. Factors like genetics, sun exposure, and skin quality influence how long you enjoy the results. Repeat surgery is possible but rarely needed for many years.
Risks and Complications
The most discussed complication is dry eye. For upper blepharoplasty alone, about 13% of patients experience dry eye symptoms afterward. The rate climbs to around 31% when upper and lower blepharoplasty are done at the same time. This happens because surgery disrupts the delicate relationship between the eyelid, the tear film, and the surface of the eye. Scar formation can subtly change your blink mechanics, leading to incomplete blinks or a slight inability to fully close the eyelid (called lagophthalmos). Both reduce how effectively tears coat your eye.
Postoperative swelling in the eyelid and the tissue lining the eye can also damage the cells responsible for keeping tears stable, creating a cycle where dryness feeds more inflammation. For most people, these symptoms are temporary and resolve as healing progresses. For those with pre-existing dry eye, the risk is higher, so it’s something to discuss before scheduling surgery.
Other possible complications include visible scarring, asymmetry between the two eyelids, and over-removal of skin, which in rare cases can make it difficult to close the eyes completely. Choosing a surgeon experienced in eyelid anatomy reduces these risks significantly.
Preparing for Surgery
You’ll need to stop taking blood-thinning medications and supplements before the procedure, typically about two weeks ahead. The most common ones to avoid include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and any prescription blood thinners like warfarin. Herbal supplements that increase bleeding risk, particularly ginkgo biloba, ginseng, and St. John’s Wort, should also be stopped. Your surgeon will give you a specific timeline and may ask you to get clearance from your primary care doctor if you take blood thinners for a medical condition.
If you wear contact lenses, plan to switch to glasses for the first couple of weeks after surgery. Having lubricating eye drops on hand before the procedure is a good idea, since your eyes will likely feel drier than usual during early recovery.