“I’m so glad I went to Dr. Armstrong for an upper and lower blepharoplasty! I had the procedure under local anesthesia and was amazed at how quick and painless it was. Every time I look in the mirror I’m so happy I went to Dr. Armstrong.”

– Katherine Bevington

As we grow older, our eyes begin to appear saggy, dark circles become visible, and the surrounding regions appear noticeably hollower in appearance. In addition to revealing age, this can also hamper one’s ability to see. Many different approaches can be taken to alter the appearance of one’s eyelids. The medical terminology used to describe eyelid surgery, both cosmetic and medically necessary is called a Blepharoplasty.

The main goal, regardless of the specific surgical approach involved, is to remove extra fat or additional skin surrounding the eyes in order to rejuvenate the overall appearance of an individual’s eyelids.

This procedure is performed on patients in their thirties through eighties. There is no ideal in a Blepharoplasty- skin type, ethnic background, degree of skin elasticity, individual healing, basic bone structure, as well as a realistic attitude are factors that should be discussed prior to surgery.

The procedure is performed with a combination of mild sedatives & local anesthesia or under general anesthesia in the operating room. With either approach, patients should not feel any pain during the procedure itself.

Depending on the extent of the surgery, the process can take anywhere from 2 to 3 hours.

We can either perform the procedure in-office under local anesthesia with an accompanying oral sedative or the procedure can be performed under general anesthesia at Stony Point Surgery Center (depending on patient preference).

Repair of the eyelids may be covered by insurance or Medicare if your ophthalmologist documents that it is medically necessary; however, most patients are motivated to undergo a Blepharoplasty for strictly cosmetic reasons.

Fees could range anywhere from $2,650 to approximately $7,000 depending on whether your procedure is done in our office or under anesthesia at Stony Point Surgery Center.

Lower Blepharoplasty

Bulging fat can be removed through a small incision that is completely hidden inside the eyelid. Excess skin is usually removed through an incision hidden just below the eyelashes.

Upper Blepharoplasty

When the primary problem is excess skin in the upper eyelids, the surgeon removes a sliver of skin and sews it back together such that the scar is well hidden within the natural crease of the upper eyelid. Often a portion of not only skin, but also muscle & fat are removed in patients who have unusually heavy upper eyelids.

Asian Heritage Blepharoplasty

People with Asian heritage commonly request a more defined eyelid crease. Asian eyelids characteristically are fuller and have an “epicanthic fold” that covers the inside corner of the eye (medial canthus).  The fold of skin often rests at the lash line, even in young women. Frequently referred to as a “double eyelid surgery,” a blepharoplasty designed to make the eyelids look more western creates a new crease distinguishing the upper half of the lid from the mobile lower half.  The surgeon makes a cut at the level of the desired crease and sutures the skin to the eyelid ligament (levator aponeurosis) so that the lid folds precisely at the upper border of the eyelid cartilage (tarsal plate) when the eye is open. This leaves the lower portion of the eyelid visible, for application of mascara and eye shadow.

Alternative Interventions for Aging Eyelids

Which additional procedures are usually recommended in conjunction with a Blepharoplasty?

Besides a standard Blepharoplasty, there are an array of procedures that can help rejuvenate the appearance of one’s eyelids:

  • Botulinum Toxin
  • Fillers
  • CO2 Laser
  • Forehead or Eyebrow Lift

Botulinum Toxin

Botox and Xeomin can temporarily relax the muscles that pull your eyebrows down, allowing them to drift upward, improving the appearance of your eyelids in the process.  This is referred to as a chemical brow lift.


Press upward with your fingers under the cheek bone to hold the cheek in place while you relax your smile.  If any of these maneuvers improve your lower eyelid, you may wish to consider a filler such as Sculptra, Radiesse, Belatero or Juvéderm.  Fillers can often be injected in a few minutes, with immediate improvement.

CO2 Laser

If you have thin, skin with crepe paper wrinkles in the lower lid, CO2 laser resurfacing may improve your appearance without surgery.

Forehead or Eyebrow Lift

If heaviness of the eyebrows is a problem, lift your forehead straight up with the palm of your hand while looking in the mirror.  If this improves the appearance of your eyelids, your surgeon may also recommend a forehead lift or endoscopic brow lift.

Risks of Blepharoplasty

Certain medical conditions such as glaucoma, dry eyes, thyroid disease, diabetes, hypertension, and the use of blood thinners, can increase the risks of eyelid surgery. Please discuss your entire medical history with your provider to make sure you are a candidate for surgery.

Vision disturbances are possible risks of surgery and can include the following: blindness, double vision, tearing, dry eye, and distortion of one’s eyelid.

Chemosis, also known as the swelling of the eye surface, and dry eyes are both common risks of a Blepharoplasty. It is important that you discuss all eye drop medications that you are taking and any symptoms of dry eyes that you may already have prior to surgery.

Soreness and bruising are expected for 2-3 weeks.

Infection is rare, however, always a possibility. It is important to follow all post-operative instructions regarding wound care.

Numbness, tingling or altered sensation can occur near the skin incision site.

Scars will be placed as discretely as possible.

Anesthesia in an otherwise healthy individual has risks comparable to those of operating an automobile.

Before your Surgery

Things you may need:

  • Comfortable button-down or zippered shirts
  • Non-irritating baby shampoo & body soap
  • Prescription pain medication (if prescribed)
  • Bendable straws, disposable dishes, & microwavable meals
  • Ready to eat, healthy snacks (low sodium & high fiber to reduce additional swelling or constipation due to pain medications)

Prepare a designated resting-space where you can spend your first few days of recovery. Here are some items to include:

  • A comfortable chair that can recline
  • Clear path to the bathroom
  • TV, laptop, or audiobook for entertainment

Additional actions to take in preparing for your recovery:

  • Stock your fridge & finish all laundry
  • Place all food items, toiletries, clothes, etc. above waist level to prevent the need to bend over
  • Check your calendar
  • Pay your bills
  • Get someone to help with pets or children

The person who will care for you during the initial recovery period should be able to do the following:

  • Read, write, and follow instructions
  • Safely drive
  • Help with physical task(s)
  • Provide emotional support if needed

Things to organize for your caregiver prior to surgery:

  • Important contact numbers – close family, medical provider(s), & employer
  • Pharmacy address of choice
  • Location of prescriptions, ice packs, dressings, or other recovery materials
  • Instructions from surgeon
  • Any specific home care related instructions (alarm code, pet’s schedule, etc.)

Avoid using any agent that may induce bleeding or bruising beginning 1 week prior to treatment  (unless medically necessary).

Arrange to bring a designated driver to your appointment as rebound swelling might affect your vision.

Avoid getting a haircut since longer hair will provide better camouflage in the early post-operative period.

Day of Surgery

Getting ready tips – Shower the morning of your procedure and wash your hair twice. Do not wear any earrings. Make sure your face is clean and completely free of any makeup. Wear a comfortable top that is easy to wash & that doesn’t need to be removed over the head.

Arrive as instructed by SPSC for procedures that will take place in the operating room.

Your designated driver must arrive to the facility with you for check-in process.

After your Surgery

Things to Remember

Keep head elevated as much as possible to minimize swelling.

Wash hair with non-irritating shampoo (Ex. baby shampoo).

Opt for cold or lukewarm water when cleaning & lower heat hair dryer setting.

Wear sunglasses when outside to prevent scarring.

Acetaminophen or Ibuprofen for discomfort.

Fever, Chills, Blistering, oozing, yellow/cloudy drainage, or pain that is not relieved by Acetaminophen are not expected & need to be addressed.

Recovery Timeline

Keep head elevated and apply cool compresses as often as possible to minimize pain, swelling, and bruising. It is expected to see visible bruising and swelling for at least 3 weeks after surgery.

You are permitted to take a bath or shower 24 hours after the procedure; however, avoid getting your eyes wet until after Day 3. Whenever you wash your eyes, make sure to use gentle soap, lukewarm water, & lightly pat the area dry.

You should not drive for at least the first 48 hours after your procedure, due to expected swelling and bruising that may impede your vision temporarily. You will need a driver to take you home after the procedure, even if you have not had sedation.

Although some patients return to work as early as 3-5 days after blepharoplasty, it would be ideal if you have no responsibilities or obligations for the first week. You may work from home on the computer as early as 72 hours after the procedure.

Some of the sutures will be dissolvable; however, the other sutures will need to be removed at the end of week 1.

May apply makeup after the sutures are removed.

Do not perform high impact aerobic activity or heavy lifting for at least 1 week.

Scars will be red for about 2 months, but will quickly fade into the crease above the eyelid or in the shadow under the lower eyelashes.