The eyes that everyone tells you look tired. Without telling them why.
Eyelid Surgery
What it unlocks
The eyes are the first thing another person reads, and the first place the face shows fatigue. Heavy upper lids, puffy or shadowed lower lids, a perpetually tired look that no amount of rest changes, these are what eyelid surgery addresses. Done well, blepharoplasty does not change the eyes. It returns them to looking awake.
Our approach
The eyes carry identity more than almost any other feature, which is why restraint matters here above all. Take too much and the eyes change, or worse, look hollowed or pulled. The goal of eyelid surgery in this practice is conservative and exact: the same eyes, rested. Because a heavy brow can masquerade as an eyelid problem, the assessment always considers the brow too, so the real cause is treated rather than the symptom.
Every suture, every instrument, every decision, chosen for quality. Nothing here is an afterthought.
What to expect
- Setting
- Outpatient surgery
- Anesthesia
- Local anesthesia with sedation, or general anesthesia
- Duration
- One to two hours
- Recovery
- Seven to ten days for primary recovery. Final settling at three months.
- Downtime
- Most patients return to social engagements at ten to fourteen days.
- Candidacy
- Adults with excess upper eyelid skin, lower eyelid fat herniation, or both.
- Results timeline
- Initial result at two weeks. Final result at three months.
The procedure in detail
- How it’s performed
- Upper-lid skin removed through the natural crease; lower-lid fat repositioned through a transconjunctival or skin incision as anatomy requires.
- Preparation
- Stop blood-thinning medication and supplements for two weeks before surgery.
- Follow-up
- Suture removal at five to seven days. Follow-up at one month and three months.
- Expected outcome
- Rested expression with incisions hidden in the natural crease.
- Possible complications
- Bleeding, infection, dry eye, asymmetry, rare visual change.
Questions patients ask
What does blepharoplasty fix?
Blepharoplasty refines the eyelids: on the upper lid, it removes excess skin that creates heaviness and a hooded look; on the lower lid, it addresses puffiness, bags, and shadowing. The result is a more rested, awake appearance. It treats the tired look that persists regardless of how much sleep you get.
Will eyelid surgery change the way my eyes look?
The goal is the opposite, that your eyes look like themselves, rested. A conservative, precise approach refreshes the eyes without altering their shape or character. Overly aggressive eyelid surgery is what produces a changed or hollow look, which careful technique and judgment avoid.
Could my tired eyes actually be a brow problem?
Sometimes, yes. A descended brow can push down on the upper eyelid and create heaviness that looks like an eyelid issue but originates higher up. This is why the brow is always assessed alongside the eyelids, so the true cause is addressed. In some cases a brow lift, not eyelid surgery, is the right answer, or the two are combined.
Is there a visible scar?
Upper eyelid incisions hide in the natural crease of the lid. Lower eyelid surgery is often performed through an incision just below the lash line or, in suitable candidates, entirely inside the eyelid with no external incision at all. Eyelid skin heals exceptionally well, and scars are typically imperceptible.
What to expect
The consultation
The blepharoplasty consultation begins with a specific assessment that many patients do not expect: the brow. Before any discussion of the eyelid, the position of the brow is evaluated. Brow ptosis, the descent of the brow below the orbital rim, creates the appearance of heavy upper lids and lateral hooding that patients often attribute to excess eyelid skin. If brow ptosis is the primary cause and the eyelid alone is treated, the result will be incomplete and the brow will continue to descend. The consultation determines which structure is responsible for what the patient sees.
Upper eyelid assessment examines the amount and distribution of excess skin, the position of the lid crease, the presence of fat herniation medially, and the function of the levator muscle. Ptosis, a drooping of the lid margin itself caused by levator dysfunction, is distinguished from dermatochalasis, excess skin of the upper lid. These are different conditions with different treatments, and conflating them produces poor results.
Lower eyelid assessment evaluates the presence and character of fat herniation, the tone of the lower lid, the quality of the skin-cheek junction, and the degree of skin laxity. The approach to the lower lid, transconjunctival versus external, is determined by these findings.
The surgery
Upper blepharoplasty removes excess skin, and where appropriate, a conservative amount of herniated medial fat. The incision is placed in the natural lid crease, where it is invisible when the eye is open and requires no deliberate concealment. The amount of skin removed is determined precisely: too little leaves the concern unaddressed, too much causes lagophthalmos, the inability to fully close the eye, which is a serious and avoidable complication. The measurement is made with the patient in an upright position before surgery.
Lower blepharoplasty is approached transconjunctivally, through the inside of the lower lid, when the concern is primarily fat herniation with good skin quality. This approach leaves no external scar and addresses the fat directly. When skin laxity is also present, a subciliary external approach or a skin pinch is added. Fat in the lower lid can be removed or redistributed to fill the tear trough depression, which is a more sophisticated approach that avoids the hollow lower lid appearance that fat removal alone can produce.
Surgery is performed under sedation for upper-only procedures and under TIVA for combined upper and lower blepharoplasty or blepharoplasty combined with other procedures. Duration is one to two hours for isolated blepharoplasty.
Recovery
Day one through three: swelling and bruising around the eyes. Cold compresses reduce swelling. Reading and screen use are limited. Sleep with the head elevated.
Day four through seven: bruising yellows and begins to fade. Most patients are surprised by how presentable they are by day five. Sutures are removed at five to seven days.
Day ten to fourteen: presentable in most professional settings. Makeup is permitted over healed incisions. Contact lenses may be resumed at two weeks.
Month one: incisions are well-healed and becoming invisible. Residual swelling, which is minor at this stage, continues to resolve. The final result is visible.
Physical activity: walking immediately. Light exercise at one week. Strenuous exercise, heavy lifting, and contact sports at three weeks.
Are you a candidate?
Candidates for upper blepharoplasty have excess upper eyelid skin that rests on or near the lash line, creates lateral hooding, or impairs the visual field in extreme cases. The eyelid crease is obscured or absent. The appearance is one of heaviness or fatigue that does not reflect how the patient feels.
Before proceeding with upper blepharoplasty, brow position must be assessed. If the brow is significantly descended, a brow lift should be considered either instead of or alongside the blepharoplasty. Operating on the upper lid without addressing a descended brow produces a result that is incomplete at best and that may pull the brow further down as the lid tightens.
Candidates for lower blepharoplasty have under-eye fullness, puffiness, or shadowing caused by fat herniation, skin laxity, or both. Patients with dark circles caused by pigmentation or vascular visibility, rather than structural shadow created by fat herniation, are assessed separately and may be better served by non-surgical treatment.
Dry eye is an important consideration for both upper and lower blepharoplasty. Patients with significant dry eye disease require careful preoperative assessment, because surgical changes to lid position and anatomy can worsen the condition. A dry eye questionnaire and, where appropriate, ophthalmology consultation is part of the preoperative workup.
Frequently asked questions
What is the difference between upper and lower blepharoplasty?
Upper blepharoplasty removes excess skin and occasionally fat from the upper eyelid to eliminate hooding and restore the lid crease. Lower blepharoplasty addresses fat herniation and skin laxity beneath the eye to reduce puffiness and improve the skin-cheek junction. The two address different structures with different techniques and different recovery profiles. They are frequently performed together, but each can be performed independently when only one area requires treatment.
How do I know if my heavy upper lids are an eyelid problem or a brow problem?
This is one of the most important questions in upper facial surgery and one that is frequently missed. The test is simple: place your fingertips lightly on your brow and lift it to where it was in your thirties. If the heavy upper lid appearance significantly improves, brow ptosis is contributing. If it does not, the excess skin is genuinely in the eyelid. Many patients have both, requiring both a brow lift and an upper blepharoplasty for a complete result. Treating only the eyelid in a patient with significant brow ptosis produces a result that is incomplete and that may appear to worsen over time as the brow continues to descend.
Will blepharoplasty change the shape of my eyes?
Upper blepharoplasty removes excess skin and creates or restores a lid crease. It does not change the shape of the eye itself, the opening between the lids, or the character of the eye. The eye looks more open and less heavy because the obscuring skin is gone, not because the eye has been altered. Lower blepharoplasty removes or repositions fat beneath the eye. It does not change the eye shape or position. Patients who want a change in eye shape, whether more almond-shaped, more defined, or a different character, are not candidates for blepharoplasty alone.
Can blepharoplasty be combined with other procedures?
Yes. Blepharoplasty is frequently combined with brow lift, deep plane facelift, and rhinoplasty in a single operative session. The combination is discussed during consultation based on what the patient's anatomy requires and what they are seeking to address. Combining procedures means one anesthetic and one recovery. Not every patient is a candidate for combination surgery; the decision depends on the total operative time and the patient's overall health.
How long do blepharoplasty results last?
Upper blepharoplasty results are long-lasting. The skin that is removed does not grow back, and the lid crease that is created or restored remains. Aging continues, and over years the remaining eyelid skin will continue to develop laxity. Most patients are satisfied with the result for ten to fifteen years before further changes prompt them to reconsider treatment. Lower blepharoplasty for fat herniation is similarly long-lasting: the fat that is removed or repositioned does not return. Skin changes continue with time.
Do Dr. Saman and Dr. Ahmedli both perform blepharoplasty?
Yes. Dr. Saman and Dr. Ahmedli both perform upper and lower blepharoplasty. The assessment, technique, and standard of care are the same. Patients who have no preference between surgeons are scheduled based on availability.
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