Eyelid Surgery (Blepharoplasty)

The eyes are the part of the face people read first, and the eyelids are the part of the eye that ages first. The skin of the upper lid is the thinnest skin on the body; the fat behind both lids is held in by a thin membrane that slackens with the decades. The result is a familiar pair of complaints — a hood of skin sitting on the upper lash line, and a bag of fat bulging beneath the lower lid — that make a rested person look tired and an awake person look older than they are.

Blepharoplasty is the surgical answer to those two specific problems, and it is worth being precise about what they are. The upper lid is a skin-and-fat problem: too much skin, sometimes enough to drape over the lashes and crowd the upper field of vision. The lower lid is usually a fat problem: the under-eye fat pads have herniated forward, casting the shadow people call a bag. These are different anatomies and they are corrected differently.

The older approach to the lower lid was simply to remove the herniated fat. It worked in the short term and aged poorly — many patients who had fat scooped out in their forties looked hollow and skeletal by their sixties, the eye sunken into its socket. Modern lower-lid surgery treats fat as a resource to be redistributed rather than discarded. The same fat that bulges is often repositioned downward to fill the tear-trough groove beneath it, so the bag and the hollow are solved in one move.

At Colores the plan is built around what your lids actually show. Upper, lower, or both; skin removed or fat repositioned; an external scar or a hidden one — these are decisions made from your anatomy at consultation, not from a default operation applied to everyone.

Blepharoplasty is performed under local anesthesia with sedation or under general anesthesia, and typically takes 1–3 hours depending on whether one pair of lids or all four are treated. Surgery takes place in our AAAASF-accredited facility.

Upper blepharoplasty. A measured ellipse of excess skin is marked along the natural crease of the upper lid, where the resulting scar hides. The skin is removed, a thin strip of the underlying orbicularis muscle is often taken with it, and a conservative amount of herniated fat is trimmed from the inner corner where it tends to pool. The incision sits in the crease and fades to near-invisibility in most patients. Measurement is everything here — remove too much skin and the lid cannot close.

Lower blepharoplasty: two roads in. The lower lid is reached one of two ways. The transcutaneous (subciliary) route runs just below the lashes and allows excess skin and muscle to be addressed along with fat. The transconjunctival route hides the incision inside the lid, on the conjunctiva, leaving no external scar; because it does not divide the lid-supporting muscle, it carries a lower risk of the lower lid being pulled down (as the Cleveland Clinic describes). The transconjunctival approach suits patients whose problem is bulging fat rather than loose skin.

Fat repositioning versus removal. Rather than discarding lower-lid fat, the surgeon can release and slide it down over the bony rim to fill the tear-trough hollow — a technique studied extensively in the peer-reviewed literature. This treats the bag and the groove together and avoids the long-term sunken look that fat removal alone can produce. Where there is true excess and no hollowing, conservative removal remains appropriate.

Good candidates for blepharoplasty typically meet the following criteria:

• A true eyelid problem, not a brow problem. Upper-lid hooding caused by excess lid skin is corrected here. Hooding caused by a low, heavy brow is not — that needs a brow lift. The two are distinguished at consultation, because removing lid skin to chase a brow problem can pull the brow even lower.
• Under-eye bags from herniated fat. Visible lower-lid puffiness from forward-bulging orbital fat is the classic indication for lower blepharoplasty. Dark pigment and fine crepey texture are different problems with different treatments.
• Healthy eyes and an adequate tear film. A pre-operative eye assessment is part of candidacy. Significant dry-eye disease, poor lid tone, or prior eye surgery change the plan and sometimes the answer.
• Non-smoker. Nicotine impairs healing of the delicate eyelid skin. Full cessation for at least 4 weeks before and after surgery is required.
• Controlled blood pressure. Uncontrolled hypertension raises the risk of bleeding behind the eye, the rare but serious complication of this surgery.
• Realistic expectations about scope. Blepharoplasty rejuvenates the lid itself. It does not lift the brow, erase crow’s-feet, or lighten under-eye pigment — those need their own treatments.
• A driver and quiet help for the first day. Vision is blurry from ointment and swelling immediately after surgery; you will not drive yourself home.

Candidacy is assessed in full at your consultation. Your lid anatomy, brow position, tear film, and goals determine the plan — not a general checklist.

Eyelid recovery is quicker than most facial surgery but front-loaded with bruising and swelling around the eyes. The first week looks worse than it feels; the refinement that follows is gradual.

The timeline above is a general reference. Your written post-operative instructions, provided at discharge, are the authoritative guide. Every milestone is confirmed at follow-up appointments, not assumed.

All surgery carries risk. Eyelid surgery has a particular risk profile shaped by the delicacy of the lid tissues and the proximity of the work to the eye itself. Understanding these risks in detail is part of informed consent.

Dry eye and irritation. The most common complaint after blepharoplasty is temporary dryness, grittiness, and watering, because the surgery briefly disrupts the lids’ tear-spreading mechanics. A pre-operative tear-film assessment identifies patients at higher risk, and lubricating drops manage it. In most patients it settles within weeks.

Lower-lid malposition. The lower lid can be pulled down (ectropion) or rounded out if too much skin is removed or the lid is left under tension — more a concern with the external, transcutaneous approach. Choosing the transconjunctival route where appropriate, conservative skin removal, and supportive lid-tightening maneuvers reduce this risk.

Asymmetry and over- or under-correction. The two sides do not begin symmetric, and healing is rarely perfectly even. Removing too much upper-lid skin can impair lid closure; removing too little leaves residual hooding. Careful measurement and a conservative philosophy guard against the more consequential of the two.

Visible scarring and milia. Upper-lid and subciliary incisions are placed to hide in the crease and lash line and usually fade well, but they are present. Small white cysts (milia) can form along the incisions and are easily treated.

Retrobulbar hemorrhage. Bleeding behind the eye is the rare but serious complication of this surgery, because pressure on the eye can threaten vision. It is why blood pressure is controlled, blood thinners are held, and any sudden pain, pressure, or vision change after surgery is treated as an emergency. Its rarity does not lower the seriousness of the warning.

Risks are discussed in full at your consultation. No minimizing, no alarmism.

The figures and techniques described here are consistent with the following independent medical sources. They are references, not endorsements.

• Cleveland Clinic — Blepharoplasty (eyelid surgery): details, approaches, and recovery
• American Society of Plastic Surgeons — Eyelid surgery (blepharoplasty) overview
• American Academy of Ophthalmology (EyeWiki) — Upper eyelid blepharoplasty and brow evaluation
• NIH / StatPearls — Upper eyelid blepharoplasty, anatomy and technique
• PubMed — Lower blepharoplasty: transconjunctival fat repositioning

Want to dig deeper? For independent, non-commercial medical information on cosmetic and plastic surgery, see MedlinePlus, published by the U.S. National Library of Medicine, and the patient education resources of the American Society of Plastic Surgeons.

At Colores you may also want to read about Facelift and Facial & Neck Liposuction, meet our board-certified surgeons, or request an itemized written quote.