Blepharoplasty (eyelid surgery)

Our attention is inevitably drawn to a person’s eyes in any personal interaction. So the eyelids have a lot of work to do when it comes to nonverbal communication. If you are like most patients interested in a blepharoplasty, you may have had people ask you if you are tired or sleepy, even when you’re feeling as fresh as a daisy. Often this perception of tiredness is caused by aging of the eyelids which leads to bagginess and drooping. A blepharoplasty, or eyelid surgery, can effectively solve this problem, and make sure you look the way you feel.

Do upper and lower eyelids age differently?

The upper and lower eyelids are actually very different from each other in terms of how they work, and how aging affects them. The upper eyelids have to do a lot of work – they blink over 25,000 times each day. As a result, over time the thin skin of the upper eyelids loses its elasticity, begins to sag, and can even spill over the lashes and block your vision. The muscles inside both upper and lower lids lose their tone over time, and the deposits of fat underneath the muscles start to bulge out. This gives the appearance of baggy eyelids. Finally, the cheeks start to fall away from the lower eyelids, creating shadows that look like dark circles below the eyes.

Do you need upper and lower lid surgery?

Not all patients need both upper and lower lid surgeries. Eyelid surgeries have to be customized to your needs by determining which of the many facets of eyelid aging have occurred in your particular case. For example, lower eyelid surgery is often combined with face lift which can simultaneously improve your cheeks and jawline to complete rejuvenate the face. Similarly, it is important to evaluate the eyebrows when considering upper eyelid surgery, to ensure a brow lift is not needed.

Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco
Dr. Nagarkar on the blepharoplasty:

Blepharoplasties have some of the biggest bang for the buck in plastic surgery. Eyelid rejuvenation makes you look and feel like you just took a month-long vacation. At the same time, it is a surgery with a relatively quick recovery and incisions that are practically invisible. I prefer to approach eyelid surgery with a light hand. I don’t want to remove too much fat or skin because this can make your eyes hollowed. In fact, I often add fat to the lower lids to blend the eyelid and cheek into a youthful contour.

Who is a good candidate for a blepharoplasty:

Most patients who are in generally good health can be appropriate candidates for a blepharoplasty. High blood pressure, which affects so many people, must be well controlled before surgery. If you have recently had eye surgery (such as LASIK or cataract surgery), you should wait 6 months before undergoing a blepharoplasty to reduce risk of corneal problems. If you have other conditions that could affect the eyes, such as Grave’s disease, glaucoma, diabetes, you should definitely plan on discussing these with Dr. Nagarkar prior to surgery.

How to prepare for surgery:

Most patients will need to visit their primary care doctor for a pre-operative physical and get clearance for surgery. You must completely stop smoking and any nicotine-containing products (such as patches or gums) for 6 weeks before and after surgery. This is critical: smokers who undergo facial plastic surgery can have significant wound complications.

You should discuss with Dr. Nagarkar which medications and supplements you need to stop taking before surgery, and which ones you can continue. In general, blood-thinning medications such as Aspirin, Warfarin, Coumadin, Plavix, or Xarelto must be stopped for a few weeks before surgery. It is very important to provide complete information to prevent any post-operative problems. You will get detailed written instructions for pre- and post-operative care. In addition, you will receive any postoperative prescriptions you might need so that you can have them filled by your pharmacy in advance.

What to expect on the day of surgery:

Blepharoplasties require around 1 hour, but when combined with a facelift or brow surgery they will take longer. You should plan on having nothing to eat or drink after midnight the night before surgery. You should be able to go home after surgery unless you also had a face lift or another major procedure. Someone will need to drive you to and from the surgery, and to help around the house for a few days while you get your energy back.

What to expect after surgery:


Your surgery is designed to achieve the ideal and symmetric eyelid shape that is possible on the operating table. Significant swelling occurs after surgery, and this is often asymmetric in nature. This swelling will resolve slowly over the course of several weeks to reveal your final result. The anesthetic medicines used in surgery can cause your eyelids to be droopy for several days after surgery. This is temporary, and the effect may be asymmetric between your two eyes.

The first few days

It is very important for the first several days after surgery that you keep your head elevated to prevent swelling. You should avoid anything that causes your heart rate to become elevated or your blood pressure to increase – so no strenuous activity. This is important, as an increased heart rate or blood pressure increases the risk of bleeding. Dr. Nagarkar will call you the day after you go home to check in with you and to answer any questions you might have.


Narcotic pain medications are usually needed only for a day or so, and often not needed at all. Anti-inflammatory over the counter medications like Tylenol are generally adequate. You should not use blood-thinning medications like Aspirin or Ibuprofen for pain, as these increase the risk of bleeding.

Incision care

Your incisions will be closed with external, non-dissolving sutures. However, you can start showering two days after surgery. You should avoid baths, swimming, jacuzzis, etc. for 3 weeks after surgery. You will be given some eye drops to use for a couple of weeks after surgery. It is critical that you protect your incisions from sun exposure as they are very sensitive to sunlight for the first six months of the healing process.


Unless you had a face lift at the same time, you should not require drains.


You can return to your regular diet after surgery, but for the first day or two, stick with lighter meals. Anesthesia can make your digestion a bit sensitive, so having a double cheeseburger right after surgery is not recommended. It is very important to refrain from high-sodium foods because these will increase swelling and undo some of the improvement made by surgery.


Your swelling will be mostly resolved by about 2 weeks after surgery. You will be also able to wear eye makeup around the same time.


You will be able to go back to non-strenuous activities such as walking, using a computer, writing, and so on, immediately after surgery.


Aerobic exercise (yoga, running, barre, etc.), must be stopped for 3 weeks to allow the skin to heal and prevent bleeding complications. You should not lift anything over 10 lbs for the first 3 weeks.


You can resume driving once you are no longer taking narcotic medications, and when you feel that you are in full control of your car. This often takes a week or two.

Follow-up visits

You will see Dr. Nagarkar in the office usually around 7 days after surgery to remove sutures, examine the incisions, and ensure that you are healing appropriately. We will see you again at the 2-3 week mark for a brief checkup, and then again around 3 months, 6 months and 1 year after surgery.

To meet Dr. Nagarkar in person, schedule your consultation or call us.