Refresh and Brighten Your Eyes: What to Know About Blepharoplasty
As a plastic surgeon, one of my favorite things about eye rejuvenation surgery is how transformative yet subtle it can be. It’s amazing how a small change around the eyes can help you look more rested and vibrant—and feel like the best version of yourself.
What is Eye Rejuvenation Surgery?
The word “blepharoplasty” (or bleph, if you want to sound like a pro!) comes from the Greek words "blepharon" meaning "eyelid" and "-plasty" meaning "surgery or repair." This procedure refers to surgery to correct excess skin and improve contour around the eyes. It is one of the most common ways to rejuvenate the eye area, whether you’re bothered by upper eyelid heaviness or lower eyelid hollowing or puffiness.
Blepharoplasty addresses concerns like excess skin on the upper eyelids, puffiness or bags under the eyes, and a tear trough deformity (the hollow area where the lower lid meets the cheek).
Not only does it have cosmetic benefits—helping you look younger, less tired, and more refreshed—but it can also improve function. In some cases, excess upper eyelid skin can obstruct vision, and if tear trough deformities are very severe, makeup can settle in this crease and become nearly impossible to cover.
1. Upper bleph treasts excess skin in the upper lid.
Image Source: Neil Modi Opthalmic Surgeon
2. Lower bleph treats tear trough deformity.
Image Source: Dr Kim Booysen Aesthetic Treatments
Who is a Good Candidate for Blepharoplasty?
Good candidates for blepharoplasty are generally healthy individuals who do not have severe dry eye (or have their dry eye managed by an ophthalmologist) and whose concerns cannot be fully addressed with non-surgical options like fillers or neurotoxins. Ideal candidates must also be healthy enough to undergo general anesthesia and should not be smoking.
Patients often come to me sharing things like:
“I feel like I always look tired.”
“People keep asking me if I’m OK or if I’m getting enough sleep.”
“I struggle with dark circles or hollowness under my eyes that I can’t cover with makeup.”
Some patients with upper eyelid heaviness also mention difficulty applying eye makeup or feeling like their eyes look less open.
During your consultation, I will evaluate not just your eyelids but also the surrounding structures—like your brows and forehead. This is SO important because the eyes are a complicated area with many factors at play. It is crucial to see a surgeon with both aesthetic and surgical judgment, as well as the ability to diagnose other conditions like ptosis of the eyebrows (when the brows droop) or ptosis of the upper lids (when the eyelids droop) that could be contributing to an aged appearance of the periorbital area, or the tissues surrounding the eyes. Treating one issue without recognizing the full picture will not give you the outcome that you’re hoping for.
For example, many patients think they need an upper blepharoplasty when the real issue is a sagging brow. Think of the eyebrows as the curtain rod and your upper eyelid skin as the curtain. If the rod is sitting too low, it can make the curtain (eyelids) look heavy, even if there is not as much excess skin as you might think.
How Does the Procedure Work?
Upper Eyelid Surgery
For upper blepharoplasty, I remove excess skin through a small incision hidden in the natural crease of the upper eyelid. This incision heals beautifully with time! Some patients may also need a small amount of fat removed in the medial aspect of the upper lid close to the nose (near the inner corner of the eye). I typically avoid removing muscle in this area to preserve as much natural support and anatomy as possible.
Lower Eyelid Surgery
Lower blepharoplasty is done through one of two surgical approaches—either an incision inside the eyelid (a transconjunctival approach) or just beneath the lash line (a subciliary approach). For patients with extra skin or muscle, I typically recommend the subciliary approach.
A key component of lower eyelid surgery is removing, or repositioning, the fat in the lower lid. If too much fat is removed, it can cause a hollowed-out appearance. I take a conservative approach to fat removal and often reposition or “repurpose” fat to correct hollowing without creating an overly hollow or aged appearance.
Two Ways to Enhance Your Eyelid Results
Fat grafting – A true star! Fat grafting, also called fat transfer, involves taking a small amount of fat from your abdomen or thighs and injecting it deeply just above the cheekbone. This helps smooth and soften the contour of the tear trough and brings a refreshed look to the lower eyelid-cheek junction. I LOVE incorporating this into lower eyelid surgery.
Laser resurfacing – For patients who have crepey skin texture or fine lines under the eyes, I often recommend adding laser resurfacing during lower blepharoplasty. This can make a big difference in rejuvenating the delicate skin of the lower eyelid area.
What is Recovery Like?
Most patients experience swelling and bruising for 1-2 weeks after surgery, with swelling continuing to improve over the following weeks. Stitches from upper eyelid surgery are typically removed one week after your procedure.
Recovery tips:
Sleep with your head elevated (think: a couple of pillows) to help reduce swelling.
Cooling eye masks can be a lifesaver! These help minimize swelling and make you more comfortable.
Keep your eyes well-lubricated with the recommended eye drops after your surgery.
Hold off on intense workouts and heavy lifting for at least 2 weeks post-op.
My Approach to Eye Rejuvenation Surgery
With any surgery, balance is key. Too aggressive and you risk complications like poor scarring or a malpositioned eyelid. Too conservative, and you might not feel like you achieved the change you were hoping for.
Here’s how I find that “just right” approach for your unique goals:
Safety first, always. I stay conservative where it matters most, ensuring we prioritize your safety while still optimizing your results.
In-depth consultation. I take a comprehensive look at the periorbital region and your face as a whole, so we can choose the treatment—or combination of treatments—that will best meet your goals.
I want to understand what bothers you most and hear about your goals firsthand. Before we meet, we’ll take pre-consultation photos to guide our discussion, help us visualize the changes, and personalize a surgical plan that fits YOU.
We’ll review your photos together and map out a plan tailored to your unique anatomy and preferences.
Frequently Asked Questions
“How long do the results last?”
With any aesthetic surgery, it's important to remember that we can turn back the clock... but the clock keeps ticking! Upper eyelid surgery results typically last a minimum of 5-10 years but can last forever, depending on how you take care of your skin and how you age. Lower eyelid surgery has the potential to last forever if done properly! Because the fat is being repositioned and no excess skin is removed it creates an incredibly long-lasting result.
“What are the risks?”
Risks include dry eye, asymmetry, poor scarring such as ectropion (where the lower lid pulls downward), hematoma (a collection of blood), difficulty closing the eye, changes in vision or blurred vision, or the rare need for revision surgery.
“Is there a best age for this surgery?”
There’s no specific “best” age. It’s about how you feel, as each person's anatomy and aging are unique and aging happens at different rates. When your eyelids are bothering you enough to consider surgery and you’re ready for a long-lasting solution—that’s the right time.
It’s also important to note that while noninvasive treatments like fillers and neurotoxins absolutely have their place, they often aren’t the right solution for concerns around the eyes. Many issues—such as significant skin laxity, drooping, or under-eye hollowness—are best addressed with surgery to achieve a more effective and lasting result.
TL;DR
Upper eyelid surgery removes extra skin through a tiny incision in the crease—hello, minimal scarring.
Lower eyelid surgery often involves repositioning fat to smooth the under-eye area without making things look hollow.
Fat grafting and laser resurfacing are two incredible add-ons that can enhance your results even further.
Recovery is pretty straightforward: expect 1–2 weeks of swelling and bruising. Some TLC (including eye drops, cooling eye masks, and elevating your head when sleeping) helps with recovery.
And nope—there’s no “perfect” age! When the issue is bothering you and you're ready for a lasting fix, that's the right time.
To learn more about personalized options for your aesthetic goals, book your consultation with Dr. Meredith Kugar, today.
