October 2, 2022

Blepharoplasty

As the saying goes, the eyes are the windows to the soul. And with the new normal of constant mask-wearing, our eyes are getting more attention than ever. The dermatologists and plastic surgeons we’ve spoken with say the demand for eye-enhancing cosmetic procedures is booming in popularity like never before. Among one of the most popular? Blepharoplasty, aka eyelid surgery. Case in point: According to the American Society of Plastic Surgeons, eyelid surgery was the second most popular cosmetic surgery in 2020, just slightly trailing nose jobs in terms of number performed. Once typically something reserved for more mature patients, this has become a more and more popular procedure with the younger crowd, as it can address issues that aren’t even age-related. Here, New York City double board-certified plastic surgeon Dara Liotta, MD, and David Hartman, MD, a double board-certified plastic surgeon in Dover, Ohio, explain everything there is to know about blepharoplasty.

What Is Blepharoplasty?

“Blepharoplasty is an eyelid rejuvenation procedure that, in most cases, focuses on removing extra skin from the upper and/or lower eyelids, with the intention of restoring a youthful, more rested appearance,” says Hartman. While the broad-strokes goal of both is to essentially make your eyes look better, upper and lower blepharoplasties vary slightly. An upper blepharoplasty is performed when there’s excess skin that makes the eye appear hooded or droopy; the goal of a lower blepharoplasty is usually to remove the excess skin and fat that create the appearance of undereye bags, explains Liotta. She adds that these two surgeries can either be performed together or independent of one another.

Benefits of Blepharoplasty

Simply put, it’s a great way to refresh your entire face. “Upper eyelid blepharoplasty can help up open up your eyes and make you look more awake and youthful. Lower eyelid surgery can help smooth the undereye area and also make you look less tired, as well as less puffy,” says Liotta. As mentioned, while things such as sagging skin and those undereye bags are exacerbated with age, blepharoplasty can also address issues that may simply be genetic, such as more hooded lids, or congenital ptosis, aka drooping of the upper eyelid.

How to Prepare for Blepharoplasty

No matter whether it’s being performed on the upper or lower eyelid, a blepharoplasty is a surgery (more on that in a moment). As such, standard pre-op no-nos apply, including no smoking, no drinking, and no blood thinners for a week prior to surgery, says Liotta.

What to Expect During Blepharoplasty

This may vary from practice to practice, as well as your particular case. For example, Hartman says he performs them in-office, using laughing gas and lidocaine. Liotta says hers take place in an operating room, using IV sedation administered by a board-certified anesthesiologist so that the patient is completely asleep. How long it takes depends on whether you’re doing upper and/or lower lids, though even if your doctor is addressing both, it shouldn’t take more than a few hours.

Before & After

Surgical Blepharoplasty vs. Nonsurgical Options

“When there is significant excess skin around the eyes—either in the form of hooding of the upper eyelid, or excessive wrinkles under the eyes—I believe no other treatment can achieve the results that a simple blepharoplasty does,” says Hartman. That being said, there are some nonsurgical alternatives that can help, especially if your drooping or bags aren’t that extreme. Hartman says he relies on energy treatments such as radiofrequency microneedling or fractional lasers to help tighten and thicken the skin around the eye. (He also adds that he often uses these in tandem with the surgery as well.) Liotta cites cosmetic injectables as an option for both the upper and lower eye. “You can use neurotoxins, such as Botox, in the muscles around the eye to try to elevate the brow and increase the upper lid space. For the lower lid, filler can be used to help camouflage the puff of fat, adding volume around the bulge so that it looks flatter,” she says. Either way, results vary based on patient anatomy and won’t be as dramatic as surgery, nor are they permanent.

Potential Side Effects

Again, given that it is a surgical procedure—and one involving the delicate skin around your eyes at that—choosing a licensed, trained, experienced doctor is paramount. Potential problems include the eyes ending up looking hollow, or in extreme cases, not being able to close your eyes.

The Cost

As with pretty much any cosmetic procedure, the final price tag can vary greatly, based on where you live and your doctor. For reference, Liotta says the total cost of an upper eyelid blepharoplasty in her practice ranges from $9,000 to $12,000, and a lower eyelid blepharoplasty ranges from $9,000 to $15,000, as these can sometimes be more complicated.

Aftercare

Whether for upper or lower lids, the aftercare is pretty simple and straightforward. Liotta says she has her patients ice the area for the first 48 hours post-surgery, applying ice for 20 minutes every hour that they’re awake. Keep in mind that some swelling is likely for the first few days, and some possible bruising can last a week or more, adds Hartman.

An upper blepharoplasty does require a small incision in the upper eyelid crease; stitches will stay in place for five to seven days, and you’ll have to apply an antibiotic ointment, says Liotta. However, you can use makeup on the stitches once you’re 48 hours post-surgery. A lower blepharoplasty is often performed through an incision inside the eyelid, so there won’t be any stitches, but you likely will be given eye drops that you need to use twice daily for a week, says Liotta.

The Final Takeaway

For hooded, drooping upper eyelids and/or prominent undereye bags or excess skin wrinkling, a blepharoplasty can be a highly effective solution, much more so than any non-surgical option. It is a surgery, so do your due diligence when it comes to finding the right doctor, as well as practicing proper pre- and post-care. But it is worth noting that, for some people, an upper blepharoplasty may not be a permanent solution. Lower ones typically don’t have to be repeated. But, especially if you undergo the surgery when you’re younger, you may need to have another upper eyelid blepharoplasty in five to seven years, given that skin naturally starts to sag and lose volume with aging.