Eyelid surgery

Eyelid surgery (blepharoplasty) is cosmetic surgery to remove excess skin or fat from the eyelids.

The surgery changes the look of hooded or drooping eyelids or eye bags.

Before you go ahead, be sure about your reasons for wanting eyelid surgery. Bear in mind the cost, the risks, and the fact the results cannot be guaranteed. 

It's a good idea to discuss your plans with a GP first. There might be a medical condition affecting your eyelids or a reason why the operation is not appropriate for you.

Before you make a decision, you can also read Is cosmetic surgery right for me?

How much does it cost?

In the UK, blepharoplasty may cost anywhere between £2,000 and £6,000. You should also factor in the cost of any consultations, further surgery or follow-up care that may be needed.

Where do I go?

If you're looking in England, check the Care Quality Commission (CQC) website for treatment centres that can perform eyelid surgery. 

All independent clinics and hospitals that provide cosmetic surgery in England must be registered with the CQC. The CQC publishes inspection reports and performance ratings to help people choose care.

Also, research the surgeon or ophthalmologist who is going to do the surgery. All doctors must, as a minimum, be registered with the General Medical Council (GMC).

Check the register to see the doctor's fitness to practise history. You may also want to find out:

• how many operations they've performed where there have been complications
• what sort of follow-up you should expect if things go wrong

Read more about choosing who will do your cosmetic procedure.

What does it involve?

A blepharoplasty can be done under local anaesthetic or under general anaesthetic.

The surgeon will need to know if you are taking any medicines to reduce your risk of blood clots, such aspirin, warfarin or apixaban.

Surgery on the upper eyelids generally involves:

• making a cut (incision) along the eyelid crease in the natural skin fold of the eyelid
• removing excess skin, fat or muscle
• closing the incision – the scar will usually be hidden in the natural fold of the eyelid

Surgery on the lower eyelids generally involves:

• making an incision either just below the lower eyelashes or on the inside of the lower eyelid
• repositioning or removing fat from the bags under the eyes, and sometimes also a small amount of skin
• supporting the muscles and tendon of the eyelid if necessary
• closing the incision

The surgeon will usually apply thin, sticky strips called suture strips to support the eyelids after surgery. These are usually removed up to 1 week later.

Eyelid surgery may take around 45 minutes to 2 and a half hours. Most people can go home the same day.

Recovery

Most people take about 2 weeks off work to recover from eyelid surgery, depending on their job.

You will not be able to drive for a number of days after the operation. Bruises and redness may take several weeks to fade. Scarring may be visible and feel tight for a few months.

To help with your recovery, you'll need to follow the advice given by your surgeon. You may need to:

• prop your head up with pillows for a couple of days, when resting, to reduce swelling
• gently clean your eyelids using prescribed ointment or eyedrops
• apply a cold pack to your eyelid to help reduce swelling – try a packet of frozen peas wrapped in a tea towel
• wear sunglasses to protect your eyes from the sun and wind
• take paracetamol or any painkillers you were given after the surgery to relieve pain

You should avoid:

• strenuous activity and swimming for a few days
• smoking, as smoke can irritate your eyes
• wearing contact lenses or rubbing your eyes

Side effects to expect

It's common after eyelid surgery to temporarily have:

• puffy, numb eyelids that are difficult to close
• irritated, sensitive or watery eyes – this may last a few weeks
• bruising
• scars – these should eventually fade to almost be invisible

What could go wrong

Eyelid surgery can occasionally result in: 

• blurred or double vision
• your eyes looking uneven (asymmetrical)
• noticeable scarring
• reduced or increased sensation in the eyelids

Rarely, it can result in more serious problems, including: 

• injury to eye muscles
• the lower eyelid drooping away from the eye and turning outwards (ectropion)
• bleeding into the eye socket
• visual impairment – though vision may improve in the long term

Also, any type of operation carries a small risk of:

• excessive bleeding
• developing a blood clot in a vein
• infection
• an allergic reaction to the anaesthetic

The surgeon should explain how likely these risks and complications are, and how they would be treated if they happen.

Occasionally, people find the desired effect was not achieved and feel they need another operation.

What to do if you have problems

Cosmetic surgery can sometimes go wrong, and the results may not be what you expected.

You should contact the clinic where the operation was done as soon as possible if you have severe pain or any unexpected symptoms. You can also call NHS 111 or get help from NHS 111 online.

If you're not happy with the results, or you think the procedure was not done properly, you should take up the matter with the surgeon who treated you.

If you have concerns about your care, you should make a complaint to the CQC.

If necessary, you can raise a concern about a doctor to the GMC.

The Royal College of Surgeons has more information and advice about what to do if things go wrong with cosmetic surgery

More information

• British Oculoplastic Surgery Society (BOPSS): treatment of common eyelid conditions
• Care Quality Commission (CQC): choosing cosmetic surgery
• Royal College of Surgeons: cosmetic surgery