The eyelid lift, also known as blepharoplasty, is a plastic surgery procedure designed to rejuvenate and reshape an aging upper and/or lower eyelid. The eyelid lift can improve the appearance of bagginess along the upper eyelids and puffiness below the lower eyelids. The surgery may be performed on the upper eyelids, the lower eyelids, or on both. When a combined upper and lower blepharoplasty (called a ‘quad bleph’) is performed, it may be described as periorbital rejuvenation.

Good candidates for the eyelid lift include healthy men and women who are bothered by aging changes of the upper and/or lower eyelids. The eyelid lift may not be appropriate for individuals with chronic tearing of the eye, dry eye, eye muscle weakness (ptosis), or other vision problems that may negatively impact the healing process.

Upper blepharoplasty candidates include individuals who are concerned with heaviness of the upper eyelids or a loss of definition of the upper eyelid crease resulting from excess skin. Excess fat is typically not a concern with the upper eyelids. Female patients will often express difficulty with makeup application along the upper eyelid. In severe cases, there may be some loss of peripheral vision caused by excess skin hanging over the lid.

Patients who are considering upper blepharoplasty will need to have the eyebrow position thoroughly assessed during consultation. Upper eyelid heaviness may indeed be a result of excess eyelid skin, in which case an upper eyelid lift is appropriate. Heaviness caused by drooping of the brow will require a brow lift.

Lower blepharoplasty candidates include individuals with unwanted bags or puffiness along the lower eyelids. These patients often note the appearance of dark shadows or dark circles under the eyes. These abnormalities are typically the result of the aging process which may include pseudoherniation, or bulging, of fat beneath the eye, skin laxity, muscle weakness, and hollowing between the lower eyelid and cheek. One or more of these finding are usually present in lower blepharoplasty patients.

Dr. Hilinski performs most eyelid lift in an outpatient surgery setting. When performing just an upper eyelid lift, the procedure can also be performed in the office setting.

Upper eyelid lifts may be performed with just local anesthesia. Lower eyelid lifts and combined upper and lower eyelid lifts require at least some form of sedation.

For both upper and lower eyelid lifts, the patient’s eyelids will be carefully marked while they are sitting upright or standing. This ensures the proper location of the eyelid skin, muscle and fat that will be addressed and the amount of change that will be made. For upper blepharoplasty, an incision is made across the upper eyelid within a natural skin crease. In most cases, the underlying orbicularis oculi muscle will be conservatively reshaped by removing a very narrow strip of muscle or by contouring the muscle with a bipolar cautery instrument. Any excess upper eyelid fat this is present will be meticulously removed. Fine sutures are then used to close the incisions.

For a transconjunctival lower blepharoplasty, a hidden incision is made along the inside surface of the eyelid. Excess fat is then removed with careful surgical technique and the incision is closed with an absorbable stitch. Any slight skin excess and/or fine wrinkling present after fat removal through the transconjunctival approach can be addressed with a resurfacing technique such as laser skin resurfacing or a chemical peel. These will help to tighten the excess skin, remove wrinkles, and provide a smoother and more youthful appearance to the lower eyelid skin.

For a subciliary lower blepharoplasty, an incision is made just below the eyelashes and extending into the natural skin crease at the corner of the eye. Excess fat is removed and the muscle is typically lifted and tightened. In some cases, the canthal tendon may also be tightened. Excess skin is removed and the incision is closed with very fine sutures. Narrow strips of tape are applied across the lower eyelids to ensure a tighter, more shapely lower eyelid contour.

Patients with excess shadowing due to a loss of tissue volume between the eyelid and cheek (along the nasojugal groove), may benefit from fat transfer or injectable fillers combined with lower lid blepharoplasty. This helps to smooth out the transition from the lower lid to the cheek.

Upper blepharoplasty takes approximately one to one and a half hours to complete while lower blepharoplasty takes approximately one and a half to three hours to complete.

The location of the incisions will depend upon the technique used. For upper blepharoplasty, an incision is placed within the natural skin crease of the upper eyelid, resulting in a scar that is essentially invisible. In some cases where excess skin extends to the side of the upper eyelid, the incision may extend a short distance away from the crease. There are two different approaches for lower blepharoplasty. For a transconjunctival lower blepharoplasty, the incision is hidden on the inside of the lower eyelid. This technique addresses excess fat but not excess skin. For a subciliary lower blepharoplasty, in which excess fat, excess skin and muscle may be addressed, an external incision measuring 1 to 3 millimeters is made just below the eyelashes with a short extension into the natural skin crease at the corner of the eye.

The incisions made for the eyelid lift do result in scars, though they tend to be well-concealed. For an upper eyelid lift the incision is made within the natural skin crease of the upper eyelid, which results in a scar that is essentially invisible. For a transconjunctival lower eyelid lift, the incision and resulting scar are completely hidden on the inside of the lower eyelid. For a subciliary lower eyelid lift, a small incision is made just below the eyelashes with a short extension into the natural skin crease at the corner of the eye, resulting in a well-concealed scar.

Patients may experience some pain or discomfort after the eyelid lift, though this can be controlled with low-dose prescription narcotic medication.

Swelling and bruising may occur after the eyelid lift. Patients should sleep with the head slightly elevated at a 30 degree angle for the first few days to help minimize the swelling. It’s also recommended that ice compresses or small bags of frozen peas be applied for twenty minutes on and then twenty minutes off during the first three to four days to control swelling and bruising. Any pain that patients experience is well controlled with low-dose prescription narcotic medication. Patients will be seen within four to seven days after surgery for suture removal. Most patients are presentable in public within seven to ten days after surgery. In general, the upper eyelids tend to recover more quickly than the lower eyelids.

Patients are usually able to return to work within seven to ten days after the eyelid lift, or sooner if they are not bothered by the tape and bandages.

Aerobic activity can usually be resumed within ten to fourteen days after the eyelid lift while more strenuous activities like resistance workouts may be resumed within three to four weeks.

The stitches are removed within four to seven days after the eyelid lift.

As with any and all types of surgery, there are potential risks associated with blepharoplasty. Risks may include infection, bleeding, and excess skin removal, but the overall X Trusted Source Eyelid Surgery (Blepharoplasty): Risks / Benefits Cleveland Clinic Go to Source risk of complications from blepharoplasty is very low. Your risks may be X Trusted Source Complications of Blepharoplasty: Prevention and Management Oestreicher J, Mehta S Go to Source minimized when you choose a qualified surgeon who is experienced in successful blepharoplasty procedures.

The eyelid lift is generally not covered by insurance when performed solely for cosmetic purposes. Some coverage may be available in cases where drooping upper eyelids interfere with vision. Patients should be sure to talk with their own insurance carrier.