Blepharoplasty is surgery that removes excess skin, fat, or muscle from the eyelids. It’s one of the most common facial procedures performed in the U.S., done either to improve vision blocked by drooping upper lids or to reduce the puffy, sagging appearance that develops around the eyes with age. The surgery targets upper eyelids, lower eyelids, or both, and typically takes one to two hours.
Upper vs. Lower Blepharoplasty
Upper and lower blepharoplasty address different problems using different techniques, even though they share a name.
In upper blepharoplasty, the surgeon makes an incision along the natural crease of the eyelid, then removes a carefully measured amount of skin, muscle, and sometimes fat before closing the cut. The incision is shaped so that more tissue is taken from the outer corner of the eye, where sagging tends to be worst. Because the cut sits in the eyelid’s existing fold, the scar becomes nearly invisible once healed. In some cases, instead of simply removing fat, the surgeon repositions it to fill hollow areas above the eye that contribute to a tired look.
Lower blepharoplasty deals with the bags, puffiness, and loose skin beneath the eye. Surgeons use one of two main approaches. A subciliary incision is made just below the lash line on the outside of the lid, giving the surgeon wide access to remove or reposition fat and tighten skin. A transconjunctival incision is made on the inside of the lower lid, leaving no visible scar at all. The inside approach works best when the main problem is excess fat rather than loose skin, and it carries a lower risk of scarring and complications. However, it provides more limited access, so surgeons reserve it for less extensive corrections.
Cosmetic vs. Functional Reasons
The distinction between cosmetic and functional blepharoplasty matters most when it comes to insurance. Cosmetic blepharoplasty is done purely to improve appearance, and insurance almost never covers it. Functional blepharoplasty corrects drooping upper lids that physically obstruct your peripheral vision, particularly in the upper and outer parts of your visual field.
To qualify for insurance coverage of functional blepharoplasty, you’ll generally need documentation showing measurable visual field loss. This requires a preoperative eye exam, visual field testing, and often photographs showing how far the skin droops over the lid margin. Medicare and most private insurers require this documentation before approving the procedure. The specific thresholds vary by insurer, so your surgeon’s office will typically handle the prior authorization process.
What the Surgery Feels Like
Most blepharoplasty is performed under local anesthesia with sedation, meaning you’re awake but relaxed and feel minimal discomfort. This approach has a practical advantage: the surgeon can ask you to open your eyes during the procedure to check symmetry and lid position in real time, which is difficult to assess when a patient is fully under.
General anesthesia is an option if the idea of being awake during eye surgery feels unmanageable. The trade-off is that the surgeon loses the ability to make those real-time assessments, which slightly increases the chance of uneven results. You’ll also need to fast beforehand and will take longer to recover from the anesthesia itself. For most straightforward blepharoplasty cases, local with sedation is the standard choice.
Recovery Week by Week
The first few days after surgery are the most uncomfortable. Expect swelling, bruising, and a tight sensation around the eyes. Cold compresses and keeping your head elevated help manage both. By days three and four, bruises start shifting from deep purple to green and yellow.
Stitches come out around days five to seven. At this point, swelling is softening and bruising is lighter. If you have a desk job or work remotely, many people feel comfortable returning to work near the end of the first week, though visible bruising may still be present. By week two, bruising is often faint enough to cover with makeup, and you can begin light activity like casual walking or gentle stationary cycling if your surgeon clears you.
Weeks three and four mark the point where most social bruising is gone. You can gradually add light resistance training during this window. Full, unrestricted exercise, including heavy lifting and high-intensity cardio, is typically cleared between weeks six and eight. The final results continue to refine over several months as residual swelling resolves completely.
How Long Results Last
Blepharoplasty results typically last 10 to 15 years, and for some people the results are essentially permanent. Your skin will continue to age after surgery, but it does so from the improved baseline, so you’ll still look better than you would have without the procedure. Factors like sun exposure, smoking, and genetics influence how long your results hold. Repeat surgery is possible but rarely needed within the first decade.
Risks and Complications
Dry eye is the most discussed complication. Studies have found dry eye rates ranging from near zero to about 27% of patients, with the highest rates occurring when upper and lower lids are done at the same time (around 31% in one large study of nearly 900 patients). Upper-only procedures carry a lower risk, closer to 13%. Symptoms include dryness, burning, a gritty or sandy feeling, light sensitivity, and excessive tearing. For most people, these symptoms are temporary and improve over weeks to months as the eyelids heal and blink mechanics return to normal.
More serious but less common complications include ectropion, where the lower lid pulls away from the eye, and lagophthalmos, where the eyelids can’t fully close. Both result from removing too much tissue and can require corrective surgery. This is one reason conservative skin removal, especially on the lower lid, is considered a best practice. Scarring from the healing process can also contribute to lid pulling over time.
Infection, excessive bleeding, and significant asymmetry are rare but possible. Contact your surgeon promptly if you experience worsening pain, vision changes that don’t improve, or unusual swelling after the first few days.
How to Prepare
Your surgeon will ask you to stop taking blood-thinning medications and supplements before the procedure, typically two weeks prior. This includes aspirin, ibuprofen (Advil, Motrin, Aleve and similar anti-inflammatory painkillers), vitamin E, garlic supplements, and prescription blood thinners like warfarin. These all increase bleeding risk during and after surgery. If you take a prescription blood thinner, coordinate the timing with both your surgeon and the prescribing doctor.
Smoking constricts blood vessels and slows healing, so most surgeons require you to stop well in advance of surgery. You’ll also need to arrange a ride home, since you won’t be able to drive after sedation. Stock up on cold compresses, lubricating eye drops, and easy meals so your first few days of recovery are as low-effort as possible.
Cost Ranges
According to the American Society of Plastic Surgeons’ 2024 data, surgeon fees for upper blepharoplasty range from $3,000 to $5,500, while lower blepharoplasty runs $3,709 to $6,500. These figures reflect surgeon fees only. Your total cost will also include the operating facility fee, anesthesia, and any pre-surgical testing, which can add $1,000 to $2,000 or more depending on your location and the surgical setting. Having both upper and lower lids done together costs more than either alone, but less than having them as two separate procedures. Geographic location plays a significant role in pricing, with major metro areas generally at the higher end of the range.