Upper eyelid surgery, known medically as upper blepharoplasty, is a procedure that removes excess skin, muscle, or fat from the upper eyelids. It’s one of the most common facial plastic surgeries in the United States, with roughly 120,000 procedures performed each year. People pursue it for cosmetic reasons, to look more rested and alert, or for functional reasons when sagging skin actually obstructs their vision.
What the Surgery Actually Does
As you age, the skin of your upper eyelids stretches, the muscles beneath it weaken, and fat that normally cushions the eye from above can bulge forward. The result is that heavy, hooded look that can make you appear tired or older than you feel. In more advanced cases, the excess skin folds over your lash line and blocks your upper field of vision.
Upper blepharoplasty corrects this by making an incision along the natural crease of the upper eyelid. That placement is intentional: once healed, the scar sits inside the fold where it’s essentially invisible. Through that incision, the surgeon removes the amount of tissue needed to restore a more open, refreshed eyelid. The scope of what gets removed varies by patient. Some people only need excess skin taken out. Others also need a strip of the underlying muscle removed, or herniated fat pads trimmed from the inner corner, outer corner, or both. A newer, more conservative approach repositions fat rather than removing it, shifting a pad of tissue from one area to another to restore lost volume in the eyelid without creating a hollow appearance.
Blepharoplasty vs. Ptosis Repair
It’s worth understanding the difference between these two procedures, because they address different problems that can look similar from the outside. Blepharoplasty deals with the skin and soft tissue draped over the eyelid. If your eyelid itself opens fully but is simply buried under extra skin and fat, blepharoplasty is the right surgery.
Ptosis, on the other hand, means the eyelid muscle itself has weakened or detached, so the lid physically can’t open all the way. The main muscle responsible for lifting the eyelid is the levator. In ptosis repair, the surgeon tightens this muscle with permanent internal sutures so the lid lifts properly again. Some patients need both procedures at once: ptosis repair to restore the lid’s lifting power, plus blepharoplasty to remove the extra skin on top.
What Happens During the Procedure
Upper eyelid surgery is typically performed under local anesthesia with optional intravenous sedation. The anesthetic is injected just under the skin along the eyelid crease. General anesthesia is an option but is usually reserved for patients who are having multiple procedures at the same time or who have strong anxiety about being awake. The surgery itself generally takes between 45 minutes and an hour for both eyelids.
If you take blood thinners, including common over-the-counter options like ibuprofen, naproxen, fish oil, vitamin E, or herbal supplements like ginkgo biloba, you’ll likely be asked to stop them before surgery to reduce bleeding risk. Your surgeon will give you a specific timeline for when to pause and resume these.
Who Should Be Cautious
There are no absolute disqualifications for upper blepharoplasty, but several conditions require extra caution. Existing dry eye disease is a significant consideration, since the surgery can worsen it. About 26.5% of patients report dry eye symptoms after cosmetic blepharoplasty, so starting with already-dry eyes raises that risk further.
Graves’ disease (thyroid eye disease) is a more complex situation. The heavy, hooded appearance of the lids can look like a straightforward blepharoplasty case, but the underlying disease causes inflammation of the tear gland, lid retraction, and protruding eyes. Removing the hooding skin can actually make the eye protrusion more visible and worsen dryness. People with a history of cold-triggered hives or swelling may experience increased post-operative swelling, since cold compresses are a standard part of recovery. Anyone who has a compromised blink, meaning you already can’t fully close your eyelids, needs careful evaluation because further tissue removal could make that gap worse.
Recovery Week by Week
The first few days after surgery involve the most swelling and bruising. Cold compresses and keeping your head elevated help during this phase. You’ll want to avoid bending over or lifting anything heavy.
Sutures typically come out within the first week. During the first two weeks, you should avoid strenuous activity entirely, including exercise, heavy lifting, and anything that raises your blood pressure. By the two-week mark, swelling and bruising have decreased significantly, and you’ll start to see the results taking shape, with your eyes looking more open and refreshed.
By week four, most people can return to their full exercise routines, including weightlifting. Keep in mind that while the major healing is done by this point, subtle swelling can linger for a few months, and the final result continues to refine over that time.
Risks and Complications
Upper blepharoplasty is considered a safe procedure, but it does carry risks. Dry eye is the most common complaint, affecting roughly one in four patients. This is usually temporary, lasting weeks to months, and often manageable with lubricating eye drops. Chemosis, a swelling of the clear membrane covering the white of the eye, occurs at a similar rate (about 26%) and typically resolves on its own.
More serious but less common complications include hematoma (a collection of blood under the skin), infection, and asymmetry between the two eyelids. The most concerning risk, though rare, is removing too much skin, which can prevent the eyelid from fully closing. This condition, called lagophthalmos, exposes the surface of the eye and can lead to chronic dryness and irritation.
How Long Results Last
Results from upper eyelid surgery typically last 10 to 15 years. The skin that was removed doesn’t grow back, but your remaining skin continues to age. Over a decade or more, gravity, sun exposure, and the natural loss of skin elasticity will gradually recreate some degree of hooding. Lifestyle factors like smoking, sun damage, and genetics influence how quickly this happens. A small number of patients eventually choose to have the procedure repeated.
Cost
The average surgeon’s fee for upper blepharoplasty ranges from $3,000 to $5,500, according to the American Society of Plastic Surgeons. This figure covers only the surgeon’s fee. Facility costs, anesthesia fees, and post-operative care add to the total. When the surgery is purely cosmetic, insurance won’t cover it. However, if your drooping eyelids are documented to obstruct your vision (usually confirmed through a visual field test), many insurance plans will cover the procedure as medically necessary. Your surgeon’s office can help you navigate this distinction before scheduling.