Indications for eyelid surgery include drooping, hooded upper lids and puffy bags and/or extra skin below the eyes. Eyelid surgery can correct these conditions, but it does not eliminate crow's feet, raise the eyebrows or completely remove dark circles under the eyes. Eyelid surgery can be performed alone or in combination with other procedures such as a facelift.

Eyelid surgery consists of removing excess fat, skin and muscle from above and/or below the eyes. The surgery may be performed in an outpatient setting under local anesthesia with sedation or general anesthetic. The duration of the procedure is usually one to three hours, depending on whether all four lids are done.

Tightness of the lids is a normal side-effect after eyelid surgery, and some discomfort is likely. You will experience bruising and swelling, particularly at the corners of the lids, that may persist for two to three weeks. Dryness, itching and burning may last about as long, and you may have temporary eyesight problems, such as double or blurred vision. Excessive tearing and sensitivity to light and wind are common, but should disappear within a few weeks. Tiny whiteheads, called milia, may appear, but they are easily removed, and often disappear on their own.

As with any invasive procedure, there is always the risk of infection. Occasionally the tightness of the lids will prevent you from closing your eyes completely, but this problem nearly always resolves with time. Ectropion (a pulling-down and turning outward of the lower lids) is a rare complication that could require further surgery to correct.

After eyelid surgery, you must refrain from wearing contact lenses for at least two weeks. Eyedrops may be necessary to lubricate dry eyes. Most people can go back to work after a week or 10 days and resume strenuous activities in about 4 weeks.

The effects of eyelid surgery will last for several years, and in some people, they are permanent.

If upper-lid surgery is done to improve vision, the procedure may be covered by insurance, so it is important to maintain excellent documentation. Many insurance carriers require preauthorization, preoperative assessment of visual fields and photo documentation. We can discuss this at your consultation.

Procedural Steps

First, Anesthesia is induced

Medications are administered for your comfort during the surgical procedure. This procedure is usually done under local with IV sedation or general anesthesia.

The incisions

Saline Implant

The incision lines for eyelid surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region.

The upper eyelid can be corrected through an incision within the natural crease on the eyelid. This allows for removal or repositioning of fat deposits, tightening of muscles, and removal of excess skin.

Saline Implant

Puffiness and excess skin can be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelid is removed. The excess fat can be repositioned or removed.

An alternate technique is the transconjunctival approach. In this technique, an incision is made on the inside of the lower eyelid. The fat that is causing the puffiness below your eyes can then be redistributed or removed. With the tranconjunctival approach no skin is removed.

Closing the incisions

Eyelid incisions typically are closed with removable sutures and steri-strips.

Eyelid surgery recovery

During your eyelid surgery recovery cold compresses and head elevation are important for the first 24-48 hours after surgery to decrease swelling and bruising. You will be given specific instructions that may include how to care for your eyes, specific concerns to look for at the surgical site and when to follow-up in the office.

Eyelid surgery risks and safety information

The decision to have surgery is personal, and you’ll have to decide if it will achieve your goals, and if the potential risks of eyelid surgery are acceptable.

Eyelid surgery risks include:

  • Anesthesia risks
  • Swelling and bruising
  • Bleeding from the incision lines
  • Dryness to the eyes
  • Sensitivity to sun or other bright light
  • Difficulty closing your eyes
  • Ectropion, an outward rolling of the eyelid
  • Infection
  • Lid lag, a pulling down of the lower eyelid may occur and is often temporary
  • Temporary or even permanent change in vision, and very rare chance of blindness
  • Changes in skin sensation
  • Pain, which may persist
  • Poor wound healing
  • Possible need for revision surgery
  • Unfavorable scarring

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions prior to surgery.