Eye lift surgery, medically called blepharoplasty, is a procedure that removes excess skin, fat, or both from the upper eyelids, lower eyelids, or both. It’s one of the most common facial cosmetic surgeries, performed to reduce hooding, puffiness, and under-eye bags. In some cases, it’s not purely cosmetic: when drooping upper eyelid skin blocks your peripheral vision or makes it hard to read and drive, the procedure qualifies as functional and may be covered by insurance.
Upper vs. Lower Eyelid Surgery
Upper and lower blepharoplasty target different problems and involve different techniques, though some people have both done in the same session.
In an upper blepharoplasty, the surgeon trims away drooping skin that creates a hooded appearance over the eye and removes small pockets of fat causing puffiness. The incision follows the natural crease of your eyelid, so the scar eventually becomes nearly invisible once it heals. This is the version most likely to be considered medically necessary, since heavy upper lids can genuinely obstruct your field of vision.
A lower blepharoplasty addresses the area below the lash line: puffy bags, loose skin, and the kind of hollowing that makes you look perpetually tired. The surgeon removes or repositions fat deposits and tightens the skin. For younger patients whose main issue is puffiness without much loose skin, a technique called a transconjunctival approach is often used. The incision is made on the inside of the lower eyelid, leaving no visible scar at all. This approach is also a good option for people prone to thick or raised scarring.
What Happens During the Procedure
Blepharoplasty is typically performed as a day surgery, meaning you go home the same day. Most procedures use local anesthesia (numbing injections around the eye area) combined with light sedation to keep you relaxed but conscious. General anesthesia is less common for eyelid surgery alone, though it may be used if you’re combining it with other facial procedures.
The operation itself takes roughly an hour and a half on average, though this varies depending on whether one or both sets of lids are being treated. For upper lids, the surgeon marks the excess skin, makes the incision along the crease, removes tissue, and closes with fine sutures. For lower lids, the approach depends on whether the incision is made just below the lash line or on the inner surface of the eyelid.
Recovery Timeline
The first few days after surgery are the most uncomfortable. Your eyelids will be swollen and bruised, and your vision may feel blurry from ointment applied to protect your eyes. Cold compresses and keeping your head elevated help manage the swelling during this phase.
Stitches come out between seven and ten days after surgery, which is also when most people feel comfortable returning to work or light daily activities. By weeks two and three, the majority of visible bruising and swelling fades. At the one-month mark, most patients feel and look like themselves again, with results becoming noticeably apparent.
That said, the final result takes patience. Subtle swelling can linger for several months before the full outcome is visible. Scars along the eyelid crease continue to fade and flatten over that same period.
Risks and Complications
Blepharoplasty is generally considered safe, but it carries risks like any surgery. The most commonly studied complication is dry eye, which has been reported in up to 26.5% of patients in some studies. This can range from mild irritation that resolves on its own to a persistent issue requiring ongoing eye drops. If you already have dry eyes, this is worth discussing with your surgeon beforehand.
Other possible complications include infection, bleeding, asymmetry between the two sides, and difficulty closing the eyes completely. In lower blepharoplasty, removing too much skin can cause the lower lid to pull downward, a condition called ectropion. Surgeons minimize this risk by being conservative with how much skin they take.
Certain medical conditions raise your risk significantly. Thyroid eye disease, which causes the eyes to bulge forward, is a particular concern because it can lead to serious corneal damage after surgery. Uncontrolled diabetes, bleeding disorders, and glaucoma are also factors that may make you a poor candidate or require extra precautions.
How to Prepare
In the weeks before surgery, you’ll need to stop taking anything that increases bleeding risk. This includes common blood thinners like warfarin and heparin, but also supplements many people take daily: ginkgo biloba, ginseng, and St. John’s wort all affect clotting. Aspirin and ibuprofen typically need to be paused as well. Your surgeon’s office will give you a specific timeline, usually one to two weeks before the procedure.
You’ll also need someone to drive you home after surgery and ideally stay with you the first night, since the sedation and swelling make it difficult to see clearly.
When Insurance Covers It
If your upper eyelid skin droops enough to block your vision, the surgery may be classified as functional rather than cosmetic. Insurance companies and Medicare generally require documented evidence: you’ll need to show that the drooping interferes with daily activities like reading or driving. A visual field test measures how much of your peripheral vision is blocked. For a related condition called ptosis, where the eyelid muscle itself is weak, a specific measurement of the distance between your pupil and eyelid margin must fall at or below 2.0 millimeters.
Purely cosmetic blepharoplasty is paid out of pocket. The average surgeon’s fee is $3,359 for upper eyelid surgery and $3,876 for lower eyelid surgery, according to the American Society of Plastic Surgeons. These figures don’t include anesthesia, facility fees, prescriptions, or pre-surgical testing, which can add substantially to the total.
Non-Surgical Alternatives
Not everyone needs or wants surgery. For mild skin laxity or early signs of aging around the eyes, several non-surgical options can produce noticeable improvements with less downtime and lower risk.
- Laser skin resurfacing tightens loose skin by stimulating collagen production. It works well for mild sagging but won’t address significant excess skin or deep fat pockets.
- Dermal fillers can fill hollows beneath the eyes and even create a subtle lift below the brow. Results are temporary, typically lasting six months to a year.
- Radiofrequency devices use heat energy to firm the skin around the eyes. The treatment is minimally invasive with little downtime, though the degree of tightening is modest compared to surgery.
These alternatives work best for people with early or moderate changes who aren’t ready for surgery. For significant hooding, heavy bags, or vision obstruction, blepharoplasty remains the most effective and lasting solution. Surgical results typically last a decade or more, while non-surgical treatments require maintenance sessions to sustain their effects.