Upper eyelid surgery (upper blepharoplasty)
Upper eyelid surgery (upper blepharoplasty) removes age-related excess skin and, where needed, fat from the upper lid through an incision placed in the natural lid crease. Before surgery it must be established whether the problem is truly excess skin, a drooping lid (ptosis) or a lowered brow.
What problem does it treat?
With age, upper eyelid skin thins, loses elasticity and becomes redundant. In this condition, called dermatochalasis, the skin folds over the lid crease and in advanced cases onto the lashes. In some people fat in the inner corner of the lid also bulges forward.
The change is noticed in two ways:
- Appearance: a tired or heavy look, eye make-up collecting in the crease.
- Function: narrowing of the upper visual field, forehead fatigue and headache from constantly raising the brows.
How it differs from ptosis and brow descent
A "drooping" upper lid can have three different causes, each treated differently:
- Excess skin (dermatochalasis): the lid margin is in place but the skin above it is redundant. The treatment is blepharoplasty.
- Lid ptosis: the muscle or tendon that lifts the lid has weakened and the lid margin drops towards the pupil. Removing skin does not correct ptosis; muscle surgery is needed.
- Brow descent: the brow has dropped and pushes skin onto the lid. Removing lid skin alone can pull the brow even lower. See brow ptosis and brow lift.
These can occur together, so the plan is made after lid height, lid muscle function and brow position have been measured.
Who is it suitable for?
People with marked upper lid skin excess, good general health and realistic expectations. The following need treatment or detailed assessment first:
- Significant dry eye or incomplete eye closure
- Uncontrolled thyroid eye disease
- Blood thinners (never stop these without the prescribing doctor's advice)
- Uncontrolled blood pressure or diabetes
How is the surgery done?
- Marking: with the patient sitting or lying, the natural lid crease and the amount of skin to remove are marked. Enough skin is left for the lid to close fully.
- Anaesthesia: usually local anaesthesia, with light sedation if needed.
- Tissue work: excess skin, where needed a strip of the thin muscle beneath it, and protruding fat are removed.
- Closure: the incision is closed with subcutaneous aesthetic sutures. The scar sits in the lid crease, hidden when the eyes are open.
The procedure usually takes 30–45 minutes and patients go home the same day.
Recovery
- First 48 hours: cold compresses and keeping the head raised reduce swelling.
- First week: bruising and swelling are visible; sutures are usually removed around day 5–7.
- Desk work: most people return within 3–4 days.
- Two to three months: remaining mild swelling resolves and the scar keeps fading.
Risks
- Bruising, swelling and temporary dry eye
- Mild asymmetry between the two lids
- Scar thickening or small cysts along the incision
- Incomplete eye closure if too much skin is removed
- Infection
- Very rarely, loss of vision from bleeding behind the eye; sudden pain, swelling or reduced vision after surgery must be reported immediately.
Frequently asked questions
Will there be a scar?
The incision sits in the natural lid crease, hidden when the eyes are open. Eyelid skin is the thinnest skin of the body, so the scar usually fades markedly within a few months; healing varies between individuals.
When can I return to work?
Most people return to desk work within 3–4 days. Most bruising and swelling settles within two weeks.
Are the results permanent?
Removed skin and fat do not come back, but ageing continues, so new changes can appear over the years.
References
This page is for general information only and does not replace a medical consultation. Anatomy and treatment plans differ from patient to patient.