A belly pooch can be deftly hidden with an untucked shirt or a baggy tee, and a box of hair color will whisk gray away in a matter of minutes. But some signs of aging are harder to conceal. Take our eyes, for example. The passage of time and sun damage can leave us with loose, saggy skin around our eyelids or under-eye baggage.
One solution: blepharoplasty. “Bleph,” as some call it for short, is an outpatient procedure that involves trimming excess tissue (that includes skin, muscle and fat) from around the eyelids. It can be performed by an ophthalmologist, oculoplastic surgeon, plastic surgeon, oral or maxillofacial surgeon, or ear, nose and throat surgeon.
Blepharoplasty is popular; according to the American Society for Aesthetic Plastic Surgery (ASAPS), it was one of the top five cosmetic procedures for men and women, with more than 115,000 performed in the U.S. during 2018.
Sometimes it's a purely cosmetic procedure, intended to create a more youthful appearance. Other times, it's done to improve eyesight. If extra skin weighs down the upper eyelid, it can droop low enough to impair the upper half of your vision. When the issue is under the eye, the surgeon may perform a lower blepharoplasty, removing or repositioning fat (and sometimes a little extra skin, as well) below the lower lid, around the eye socket.
"As you get older, fat pitches forward and bulges, and you get those airbags under the eyes,” says Andrea Tooley, M.D., an ophthalmology resident at the Mayo Clinic and clinical spokeswoman for the American Academy of Ophthalmology. Some patients may have surgery on both their upper and lower eyelids.
Here are a few things to consider before choosing the surgery.
Whether you're a good candidate
Before your procedure your surgeon will review your medical history and do a thorough eye examination to be sure that the surgery is appropriate for you. One of the things that will be evaluated is your eye's ability to produce tears, since dry eye can be a postoperative complication. “Almost everybody will feel a little dry for a couple weeks after surgery and then they'll be OK,” Tooley says. “But if someone already has severe dry eye and they're using tear drops many times a day, this procedure can make it much worse.”
Serious complications are “generally very rare,” she notes, but certain patients do need to exercise caution. Smokers, for example, are at increased risk for complications because they tend to heal more slowly. Also, those who take blood thinners to prevent blood clots; aspirin; nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve); or herbal supplements (gingko, among them) — all of which can lead to excessive bleeding before or after surgery — should talk with their doctor to see if they need to temporarily stop taking these medications a few weeks before surgery. “ Some surgeons stop the blood thinners, some don't, and some defer to the patient's primary or prescribing physician,” says Erin Shriver, an ophthalmologist and clinical associate professor in the Department of Ophthalmology and Visual Sciences at the University of Iowa.
What it'll cost
The price tag for the procedure can vary, depending on where you live, the surgeon doing the procedure and where the surgery is performed (say, a doctor's office versus an outpatient clinic). Prices range from about $2,000 for both upper eyelids (lower eyelids usually cost a little more) to $5,000 for surgery on all four eyelids.
Medicare or your private health insurance will usually cover a portion of functional blepharoplasty but won't pay for cosmetic eyelid surgery.
For functional surgery, insurance companies will want to know how much of your vision is hindered by excess skin and if there will be an improvement after the procedure. Photos will be taken of your eyes, and your surgeon will do a visual field test, first with the eyelids in a natural position and then with the skin taped up and elevated from your eyelids.
What the surgery and recovery are like
You'll be awake during the procedure. “The vast majority of the time, you'll be given a mild sedative to make you nice and relaxed for a numbing local anesthetic to be injected into the area around your eyes,” Tooley explains. (General anesthesia may be used if you're undergoing another cosmetic procedure, such as a face-lift, at the same time.)
Sometimes a blepharoplasty can be performed simultaneously with other skin-rejuvenating eye procedures (most commonly ptosis repair). Ptosis repair is done when the levator muscle, one of the muscles that lift the eye, becomes stretched out like an old rubber band and causes the upper eyelids to droop, Shriver says. “Ptosis repair is tightening muscle to actually elevate the height of the lid.”
After the surgery, the eye area will be swollen and bruised for a few days, Shriver says: “Stay home and keep your head elevated — even when sleeping — and apply cold packs frequently to help with swelling and bruising.”
It may take up to two weeks for the bruising to go away, she adds, and several weeks or up to two months for all of the swelling to subside. For two weeks you'll need to take it easy, steering clear of strenuous activity — no heavy lifting, bending or straining — to prevent the wound from opening up. And keep the incision out of the sun for six months. If you do venture outside, doctors suggest wearing sunglasses and a hat. When the incision has healed (usually around two or three weeks), apply physical sunblock, containing zinc oxide or titanium dioxide, around the area, safely avoiding the eyes.
As for how long your new look will last? Well, that varies. Tooley notes that most of her patients who have the procedure done in their 60s, 70s and 80s won't need it done again. For others, gravity may get the last word.
"With time, the tissue will stretch, and 10 to 15 years down the road, you may decide to have more tissue trimmed,” Shriver says. “But everyone has a different trigger point.”