Eyelid surgery

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

The aim is to improve 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.

You can also read Is cosmetic surgery right for me? before making your decision.

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 with sedation or under general anaesthetic.

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

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.

An upper blepharoplasty may take about 1 hour. Surgery on the lower lid may take up to 2 hours. Most patients can go home the same day.

Recovery

It's advisable to take about 1 week off work to recover from eyelid surgery.

It may be obvious for a little longer than a week that you've just had eyelid surgery.

You will not be able to drive for a number of days after the operation. Bruises, scaring and redness may take several weeks to fade.

You will probably 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
• hold a cold pack to your eye for a few days – 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 another prescribed painkiller to relieve any mild 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 at night
• irritated, sensitive or watery eyes – this may last a few weeks
• bruising that looks like a black eye
• scars – these eventually fade to almost be invisible

What could go wrong

Eyelid surgery can occasionally result in: 

• temporary blurred or double vision
• your eyes looking slightly uneven (asymmetrical)
• a pool of blood collecting under the skin (haematoma) – this usually disappears on its own after a few weeks
• noticeable scarring

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)
• the lower eyelid becoming pulled down and showing the white of the eye below the iris (eyelid retraction)
• visual impairment – though this is extremely rare and many people find that their vision improves 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, patients 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.

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 contact 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
• Royal College of Surgeons: cosmetic surgery