Blepharoplasty, commonly known as eyelid surgery, is a highly refined cosmetic and reconstructive surgical procedure designed to rejuvenate the appearance of the areas surrounding the eyes. As we age, the delicate skin around our eyes can lose its elasticity, leading to drooping upper eyelids and puffy bags beneath the lower eyes. These changes can make you look tired, sad, or older than you feel. In some cases, severely sagging upper eyelid skin can even impair your field of vision.

Blepharoplasty corrects these issues by meticulously removing or repositioning excess skin, muscle, and fat from the upper and/or lower eyelids. The goal is not to change the fundamental shape of your eyes, but to restore a smoother, firmer, and more naturally youthful contour. When performed by a skilled surgeon, the results are transformative yet subtle, creating a brighter and more rested appearance that enhances your entire facial harmony.

What is Blepharoplasty? (Types of Eyelid Surgery)

Blepharoplasty is not a one-size-fits-all procedure. It is a highly customized surgery tailored to the unique anatomy and aesthetic goals of each patient. The surgery can be performed on the upper eyelids, the lower eyelids, or both at the same time. The primary techniques are:

1. Upper Blepharoplasty:

This procedure specifically addresses the upper eyelids. It is designed to correct:

• Excess Skin and Hooding: The surgeon makes a fine incision within the natural crease of the upper eyelid. This placement is crucial as it ensures the resulting scar is well-hidden when the eyes are open. Through this incision, a precise amount of excess skin and, if necessary, a small strip of underlying muscle, is removed.
   
• Puffiness or Fullness: If there is a protrusion of the orbital fat pad in the upper eyelid, the surgeon can carefully remove or sculpt this fat to create a smoother contour.
  The result is a more defined eyelid, a brighter and more open appearance to the eyes, and in cases of significant hooding, an improved field of vision.

2. Lower Blepharoplasty:

This procedure targets the area beneath the eyes and is primarily used to correct:

• Under-Eye Bags: Caused by herniated orbital fat.
• Excess Skin and Fine Wrinkles: The loose, crepe-like skin on the lower eyelid.
• Dark Circles: In some cases, by smoothing the transition between the cheek and the eyelid, blepharoplasty can improve the appearance of shadows that contribute to dark circles.

There are two main surgical approaches for lower blepharoplasty:

• Transcutaneous (Subciliary) Blepharoplasty: The surgeon makes an incision just below the lower lash line. This approach allows the surgeon to remove a pinch of excess skin and to access the underlying fat pads. The fat can be either removed or, in a more advanced technique called fat repositioning, moved into the hollow tear trough area to create a smooth, seamless transition from the eyelid to the cheek.
   
• Transconjunctival Blepharoplasty: This is an ideal technique for younger patients whose primary concern is puffy under-eye bags with little to no excess skin. The surgeon makes an incision on the inside of the lower eyelid (the conjunctiva). This approach leaves no visible external scar. Through this hidden incision, the surgeon can remove or reposition the protruding fat pads to eliminate the bags.

3. Combination Procedures:

For comprehensive facial rejuvenation, blepharoplasty is often performed in conjunction with other procedures such as a brow lift (to address a sagging forehead), a facelift, or non-surgical treatments like laser resurfacing or chemical peels to improve the texture and fine lines of the surrounding skin.

When is Blepharoplasty Recommended? (Ideal Candidacy)

The decision to undergo eyelid surgery is a personal one. You may be an ideal candidate for blepharoplasty if you are bothered by the appearance of your eyelids and meet the following criteria:

• Specific Aesthetic Concerns: You have droopy or hooded upper eyelids, or puffy bags and excess skin under your eyes.
• Functional Concerns: Your upper eyelid skin is so lax that it hangs over your eyelashes and obstructs your peripheral vision. In this case, the procedure is considered medically necessary.
• Good Physical Health: You are in good overall health and do not have any medical conditions that could increase surgical risk or impair healing. Conditions like uncontrolled high blood pressure, diabetes, and thyroid eye disease must be well-managed.
• Healthy Eyes: You should not have serious eye conditions such as glaucoma or retinal detachment. Chronic dry eye must be evaluated carefully, as the surgery can sometimes temporarily worsen this condition.
• Non-Smoker: Smoking severely restricts blood flow and can lead to significant healing complications. You must stop smoking for several weeks before and after surgery.
• Realistic Expectations: You understand what the surgery can and cannot achieve. Blepharoplasty can create a dramatically refreshed appearance, but it will not eliminate crow's feet, lift a sagging brow, or fundamentally change your ethnic eye characteristics. You must also accept that the procedure will result in fine, permanent scars.

Understanding the Causes of Eyelid Aging

The delicate skin and tissues around our eyes are often the first areas to show visible signs of aging. This is due to a combination of anatomical factors:

• Skin Elasticity Loss: The skin of the eyelids is the thinnest on the entire body. With age, and due to sun exposure and genetics, the production of collagen and elastin—the proteins that provide skin with firmness and elasticity—declines dramatically. This causes the skin to become thin, stretched, and redundant.
• Muscle Weakening: The orbicularis oculi muscle, a thin sheet of muscle that encircles the eye, can weaken and stretch over time, contributing to the sagging appearance.
• Orbital Septum Weakening: The orbital septum is a thin, fibrous membrane that acts like a retaining wall, holding the protective orbital fat pads in place around the eyeball. As we age, this septum weakens and thins, allowing the fat to bulge or herniate forward, creating the appearance of puffiness and bags.

These age-related changes, combined with the effects of gravity, result in the tired, heavy appearance of the eyes that blepharoplasty is designed to correct.

Our Specialists

The success of a blepharoplasty depends immensely on the artistic eye and technical precision of the surgeon. It is a surgery of millimeters, where every detail matters. Our team includes board-certified plastic, aesthetic, and reconstructive surgeons with extensive experience in facial and oculoplastic surgery.

Dr. Richie Gupta

SENIOR DIRECTOR & HOD PLASTIC SURGERY | Fortis Shalimar Bagh

Dr. Rashmi Taneja

DIRECTOR PLASTIC SURGERY | Fortis Vasant Kunj

Dr. A.B. Prabhu

ADDITIONAL DIRECTOR PLASTIC SURGERY | Fortis Mohali

Dr. Nitin Sethi

ADDITIONAL DIRECTOR PLASTIC SURGERY | Fortis Ludhiana

Patient Stories

“For years, people would ask me if I was tired, even when I felt perfectly rested. It was the puffiness and bags under my eyes that gave me a perpetually exhausted look. I opted for a lower blepharoplasty. The recovery involved some bruising and swelling, but it was manageable. Now, a few months later, the results are incredible. The bags are gone, the area under my eyes is smooth, and I look as refreshed as I feel. It's such a subtle change, but it has made a huge difference in my confidence”.   .— A. Mehra, 48, Delhi

“The skin on my upper eyelids had become so heavy that it was actually resting on my lashes and making it difficult to see clearly, especially when I was driving. My ophthalmologist referred me for a functional blepharoplasty. The surgery not only removed the excess skin and restored my full field of vision but also had the wonderful cosmetic benefit of making my eyes look more open and youthful. It has improved my life both functionally and aesthetically”.  — R. Khanna, 65, Gurugram

The Blepharoplasty Procedure: A Detailed Walkthrough

The Initial Consultation:

This is the most critical step. Your surgeon will conduct a thorough evaluation, including a detailed medical and ocular history. They will assess your facial anatomy, skin quality, and muscle tone. It is essential to have an open and honest discussion about your goals and to listen carefully to the surgeon's assessment of what is realistically achievable.

Preparing for Your Surgery:

• You will be given instructions to stop taking any medications that can increase bleeding, such as aspirin, anti-inflammatory drugs, and certain vitamins or herbal supplements, for about two weeks before your surgery.
• You must stop smoking completely for at least four weeks before and after the procedure to ensure proper healing.
• Arrange for someone to drive you home after the surgery and to stay with you for at least the first night.
• Prepare your recovery space at home with extra pillows for elevation, cold compresses (gel packs or bags of frozen peas), and any prescribed eye drops or ointments.

The Day of the Surgery:

1. Anesthesia: Blepharoplasty is often performed under local anesthesia with intravenous sedation, meaning the area is numb and you are in a deeply relaxed, twilight state. In some cases, or if combined with other procedures, general anesthesia may be used.
2. Surgical Markings: The surgeon will make very precise markings on your eyelids with a surgical pen while you are sitting up. This is a crucial step to ensure the correct amount of skin is removed and the incisions are symmetrical.
3. The Incisions and Tissue Removal: The surgeon will make the incisions along the pre-marked lines. For the upper eyelid, this is in the natural crease. For the lower eyelid, it is just below the lash line or inside the eyelid. The surgeon will then meticulously remove the excess skin and remove or reposition the underlying fat pads to create a smooth, natural contour.
4. Closure: The incisions are closed with very fine, delicate sutures. Sometimes, surgical glue may be used. The sutures are placed in a way that minimizes tension and promotes the finest possible scar.

After the Procedure: Recovery and Follow-Up

The First Week:

• Swelling and Bruising: This is expected and will be most prominent in the first 48-72 hours.
• Discomfort: Pain is usually mild and is easily controlled with prescribed oral pain medication.
• Home Care: You will need to keep your head elevated at all times (even while sleeping) and apply cold compresses regularly to reduce swelling. You will be given a lubricating eye ointment and eye drops.
• Activity: Rest is crucial. Reading and watching television are fine, but avoid strenuous activities. You may experience temporary blurry vision or light sensitivity.
• Suture Removal: Sutures are typically removed in the clinic about five to seven days after surgery.

Weeks Two to Four:

• Most of the bruising and swelling will have resolved. You will start to look and feel much more normal.
• You can typically return to work (if non-strenuous) and social activities. You may be able to wear makeup to conceal any remaining discoloration.
• You can usually resume light exercise, but avoid anything that increases pressure to the head.

One to Three Months and Beyond:

• Your final aesthetic results will become apparent as all residual swelling subsides.
• The incision lines will continue to heal and fade. It is absolutely essential to protect the delicate scars from sun exposure by wearing sunglasses and using sunscreen to prevent them from darkening. The scars can take up to a year to fully mature and become as inconspicuous as possible.

Myths vs Facts

Take the Next Step

If you feel that your eyes project an image of tiredness or age that doesn't reflect your inner vitality, blepharoplasty may be an excellent option for you. Restoring a smooth, natural contour to your eyelids can have a profound impact on your overall appearance and self-confidence.

The key to a successful outcome is a thorough understanding of the procedure and a realistic alignment of your goals with what the surgery can achieve. A personal consultation with a board-certified plastic surgeon is the essential first step on your journey to a more refreshed and youthful appearance.

Frequently Asked Questions

1. How long does the blepharoplasty procedure take?

Ans. The surgery typically takes one to three hours, depending on whether you are having your upper eyelids, lower eyelids, or all four done.

2. What type of anesthesia is used?

Ans. It is most commonly performed under local anesthesia with intravenous sedation. This means you are technically awake but deeply relaxed and comfortable, and you will not remember the procedure. General anesthesia may be used if the blepharoplasty is combined with other more extensive surgeries.

3. When can I go back to work?

Ans. Most patients with a desk job feel comfortable returning to work within 7 to 10 days, once the initial swelling and bruising have subsided and sutures have been removed.

4. When can I wear contact lenses again?

Ans. You should wait at least two weeks, or until your surgeon gives you clearance, before wearing contact lenses to avoid irritating the eyes and incision lines.

5. Will the scars be very noticeable?

Ans. Your surgeon will make every effort to place the incisions in natural creases and lines to make the scars as inconspicuous as possible. For the upper eyelid, the scar is hidden in the natural crease. For the lower eyelid, it is just below the lashes or completely hidden inside the eyelid. With proper care, the fine scars fade significantly over time.

6. What are the risks of dry eyes after surgery?

Ans. Some patients experience temporary dry eye symptoms after a blepharoplasty, which are managed with lubricating eye drops. If you have pre-existing chronic dry eye, it is very important to discuss this with your surgeon, as the procedure can sometimes worsen the condition.

7. How much does a blepharoplasty cost?

Ans. The cost varies depending on the extent of the surgery (upper, lower, or both) and other factors. You will be provided with a detailed cost estimate after your consultation.

8. Is blepharoplasty covered by insurance?

Ans. If the blepharoplasty is performed for purely cosmetic reasons, it is not covered by insurance. However, if the sagging skin on the upper eyelids is severe enough to be considered a functional problem that obstructs your vision, insurance may cover a portion of the upper eyelid procedure. This requires documentation, including a visual field test.