Upper eyelid surgery

What does the procedure involve?

Upper eyelid surgery (upper blepharoplasty) removes excess upper-lid skin and, if needed, a narrow strip of the orbicularis muscle and a small amount of bulging fat, most often in the inner part of the lid. The incision is placed in the natural eyelid crease, so once healed the scar is usually hard to see with the eyes open.

The extent is planned individually. For one person removing a few millimetres of skin is enough; another also needs fat contouring. The aim is not to “open” the eye at all costs, but to restore a natural lid shape that suits your face.

Indications

• excess skin forming a fold over the eye or resting on the lashes,
• difficulty applying make-up, mascara printing on the lid skin,
• heavy lids and tired eyes by the end of the day,
• habitually raising your brows to see better, with forehead tension or headaches,
• the upper field of vision blocked by hanging skin.

Cosmetic or medical?

If excess skin is large enough to block your field of vision, the indication is functional. The doctor may then order a visual field test, which objectively shows how much the lid limits your vision. With purely cosmetic indications, the main goal is a fresher appearance.

Important: hanging skin is not the same as a drooping lid margin. When the edge of the lid covers the pupil, the cause is usually ptosis – a weak eyelid-lifting muscle – and removing skin alone will not fix it. Low brows, in turn, push skin down onto the lid, and a brow lift or a combination of both procedures may work better. Telling these problems apart is one of the key tasks of the consultation.

Qualification and preparation

At the consultation the doctor assesses the amount of excess skin, brow and lid-margin position, levator muscle strength, symmetry and the surface of the eye. People with dry eye need particular care, as removing too much skin can make symptoms worse.

Before surgery:

• prepare a list of your medication and supplements,
• discuss any pause in blood thinners with your prescribing doctor (never stop them yourself),
• stop or cut down smoking – nicotine impairs healing,
• plan a few days of rest and, if travelling, accommodation near the clinic.

The operation

The surgeon marks the incision lines with your eyes open and closed, then gives local anaesthesia. The operation usually takes about an hour (up to 2 hours for larger corrections). The wound is closed with a fine running or interrupted suture. Cold compresses are applied and, after a short observation, you go home.

Healing and scar

• days 1–3: swelling, bruising and tightness; cold compresses, sleep with your head raised,
• days 5–7: stitches removed at the follow-up visit,
• about 2 weeks: most bruising has faded, make-up allowed (with your doctor's approval),
• 3–6 months: the scar fades and softens, the lid reaches its final shape.

Read more in recovery after blepharoplasty.

Possible complications

Like any operation, upper eyelid surgery carries risks. The most common temporary issues are swelling, bruising, dry eye and watering. Less often: haematoma, infection, asymmetry, a visible or thickened scar, or difficulty closing the eyes fully in the first weeks. Very rarely, bleeding behind the eye occurs and needs urgent treatment. More on risks and contraindications.

Frequently asked questions