Blepharoplasty Surgery Details

Blepharoplasty or Eyelift Surgery is a plastic surgical procedure that is used for correcting defects, deformities, and disfigurations of {the} eyelids, and more recently, it has been used for achieving aesthetic modification of {the} periorbital region of {the} face.

Surgery involves removal or repositioning of excess tissue as well as reinforcement of surrounding muscles and tendons to reshape {the} upper eyelid, lower eyelid or both. The operation typically takes one to three hours to complete, depending on {the} technique and extent of surgery done.

What are {the} Types of Blepharoplasty?

Based on desired results, blepharoplasty can be done either for functional or cosmetic purposes.

  • Functional or Reconstructive Blepharoplasty: Done to restore peripheral vision by removing excess skin, muscle and fat which blocks {the} visual axis.
  • Cosmetic Blepharoplasty: Done to accentuate {the} appearance of {the} eyes at {the} patient’s request and is not done to improve peripheral vision.

Anatomically, blepharoplasty can be done on either {the} UPPER or LOWER eyelids, or BOTH eyelids.

  1. Upper eyelid Blepharoplasty ("eye lift"): Reduces excess skin and fat in {the} upper eyelids.
  2. Lower Eyelid Blepharoplasty: Lower eyelid blepharoplasty is almost always done for cosmetic reasons - to improve puffy lower eyelid "bags" or to reduce wrinkling of skin.
  3. Combined Upper and Lower Blepharoplasty: Involves removal of excess skin and fat in both {the} upper as well as lower eyelids with smoothing of {the} muscle and other tissues.

The blepharoplasty surgical details

  • Blepharoplasty is done either under local anaesthesia or under general anaesthesia as per {the} preference of {the} surgeon and {the} patient.
  • Blepharoplasty is performed through external incisions made along {the} natural skin lines of {the} eyelids, such as {the} creases of {the} upper lids and below {the} lashes of {the} lower lids, or through {the} inside surface of {the} lower eyelid.
  • The surgeon then trims away any excess skin that is obstructing vision or contributing to a droopy or tired appearance. Excess fat is then trimmed and muscles are repositioned. The remaining skin is lifted and reattached for a more youthful look. Finally, {the} incisions are closed with fine sutures.
  • After {the} procedure, {the} initial swelling and bruising takes one to two weeks to resolve. Subsequently, several months elapse before {the} final result becomes obvious. The results of a blepharoplasty procedure lasts for about 5 to 7 years or until age supersedes {the} corrective measures.
  • Depending upon {the} scope of {the} procedure, {the} operation takes one to three hours to complete.

Stepwise description of Blepharoplasty

  1. Marking Incision Sites: This is perhaps {the} most important part of {the} procedure as it dictates {the} outcome of {the} procedure. Meticulous marking of incision sites is done prior to {the} surgery.
  2. Local Anaesthesia: Once marking is done, blepharoplasty is done under local or modified local anaesthesia and patient co-operation is absolutely essential for a symmetrical surgical outcome.  Local anaesthesia is injected for each eyelid.
  3. Incision Design: The design of {the} blepharoplasty incision depends on {the} patient’s eyelid, facial and eyebrow contours. The incision should be made along {the} eyelid creases or traverse transconjunctivally to ensure that {the} incision sites are not obvious or in plain sight.

    Blepharoplasty is usually performed through external incisions made along {the} natural skin lines of {the} eyelids, such as {the} creases of {the} upper lids and below {the} lashes of {the} lower lids. Incisions could be made from {the} inside surface of {the} lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a chemical peel or carbon dioxide laser could be performed simultaneously. This allows for a faster recovery process.

  4. Skin Excision: The initially incision is at {the} eyelid crease and cuts through {the} skin and orbicularis oculi muscle but avoiding {the} levator muscle just below {the} skin. The second incision is along {the} curvilinear superior aspect where deep incision is possible. The third incision is {the} lateral extent of {the} eyelid, from {the} lateral canthus towards {the} lateral eyebrow.
  5. Orbital Septum Excision: A strip of septum is removed across {the} entire upper eyelid to gain access to {the} underlying fat pads.
  6. Fat Removal and Redistribution: Excess fat is meticulously removed or redistributed to obtain a smooth and younger-looking surface in {the} upper eyelid, above {the} cheek and under {the} eyes. Muscle laxity is also corrected by sutures that make it taut. Fat can also be redistributed or dermal fillers applied to hollow areas for a plump, healthy looking face to correct sunken eyes.
  7. Achieving Haemostasis: It is very important to stop bleeding during a blepharoplasty as it can lead to retroorbital haematoma and loss of vision. The most common site of bleeding is {the} Orbicularis oculi muscle which is extremely vascular.
  8. Closing {the} Incision Sites: Blepharoplasty incision sites are closed using interrupted absorbable or non-absorbable sutures perpendicular to {the} lateral canthus. Scarring is negligible with meticulous wound closure and timely suture removal at 7 to 8 days following surgery.

Recovery after eyelid surgery

  • After blepharoplasty, there will be discoloration bruising and swelling for up to 7 days but several months are needed until {the} final result becomes stable. Ice, restricted activity, and an elevated head position can all promote rapid, uneventful recovery from blepharoplasty.
  • The effects of blepharoplasty are consolidated over a few months and could last for several years, and for some lucky patients, they could even last for a lifetime.


The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until {the} final result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.

Expectations after surgery

The anatomy of {the} eyelids, skin quality, age, and {the} adjacent tissue all affect {the} cosmetic and functional outcomes. Factors which are known to cause complications include:

  • dry eyes - which could become exacerbated by disrupting {the} natural tear film
  • laxity (looseness) of {the} lower lid margin (edge) - which predisposes to lower lid malposition
  • prominence of {the} eye in relation to {the} malar (cheek) complex - which predisposes to lower lid malposition

Below is a surgical video demonstrating an actual upper eyelid blepharoplasty



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