Eyelid Surgery (Blepharoplasty)

1. What Is Eyelid Aesthetic Surgery (Blepharoplasty)?

Eyelid aesthetic surgery (blepharoplasty) is a surgical procedure that addresses:

• Excess skin on the upper and/or lower eyelids,
• Puffiness,
• Protruding fat pads,
• Laxity and sagging,

in order to:

• Make the gaze look more refreshed, open and youthful,
• Create a brighter, more open appearance around the eyes.

The aim is not to change the person’s expression, but to reduce the tired, droopy and puffy look and give the patient a fresher version of their own natural appearance.

2. In Which Situations Is Eyelid Surgery Preferred?

Eyelid surgery is generally preferred when:

On the upper eyelids:

• Excess skin causes eye make-up to disappear,
• The natural eyelid crease has descended,
• The eyes look small and tired,

On the lower eyelids:

• Puffiness and bags are present,
• Persistent swelling and dark circles are visible morning and evening,
• Sagging of the eyelids starts to narrow the upper part of the visual field,
• There is a constant “tired / sleep-deprived” appearance,
• Persistent bags and skin excess do not improve with skincare or non-surgical treatments.

In some patients, restriction of the visual field due to upper eyelid drooping can be as important a reason as cosmetic concerns.

3. Upper Eyelid Surgery

Upper eyelid surgery:

• Corrects excess skin, muscle laxity and, in some cases, protruding fat pads on the upper eyelid.

The aim is to:

• Recreate or emphasise the natural upper eyelid crease,
• Remove excess skin and, when needed, some muscle and fat,
• Achieve a lighter, more open and aesthetically pleasing upper eyelid.

Incision:

• Is planned along the natural upper eyelid crease,
• With time, the scar fades and blends into this natural fold and becomes less noticeable.

4. Lower Eyelid Surgery

Lower eyelid surgery is considered when there are:

• Bags,
• Protruding fat pads,
• Excess skin and wrinkles on the lower lids.

Main techniques include:

Transconjunctival blepharoplasty (scarless, from inside the lid):

• Preferred particularly in younger patients with minimal skin excess but prominent fat herniation,
• The incision is made from the inner surface of the lower eyelid; there is no visible external scar.

Lower eyelid blepharoplasty with skin incision:

• Preferred in patients who have both excess skin and bags,
• The incision is made just below the lash line,
• Excess fat and skin are addressed, and the incision is closed so that the scar blends with the lash line.

Because the lower eyelid skin is thin and the eyelid–cheek transition must look natural, planning is always highly individualised.

5. Who Is a Suitable Candidate for Eyelid Surgery?

Suitable candidates generally:

• Are in overall good health for surgery,
• Have persistent sagging, bags and a tired appearance of the upper and/or lower eyelids,
• Wish their eye area to look more rested,
• Expect not “completely different eyes” but fresher and more alert-looking eyes,
• Can tolerate bruising and swelling for about a week and a short period of social limitation.

For some systemic conditions (uncontrolled hypertension, advanced dry eye, uncontrolled diabetes, etc.) and disorders affecting intraocular pressure (such as glaucoma), coordination with relevant specialties may be required.

6. Preoperative Evaluation and Planning

Before surgery:

• The patient’s eye health, general health, medications and any previous eye surgeries are evaluated.

The upper and lower lids are examined:

• With the patient standing,
• With eyes open and closed,
• Under different lighting conditions.

The surgeon assesses:

• Skin thickness and elasticity of the eyelids,
• Degree of bagging,
• Muscle structure.

For the upper eyelid:

• How much skin can safely be removed,
• Where the eyelid crease should be positioned.

For the lower eyelid:

• Whether there is skin excess,
• Whether only fat herniation needs to be corrected.

Recommendations are given regarding blood thinners, certain herbal supplements and smoking (to stop or reduce use before surgery).

The goal is to create a balanced and safe plan, both functionally and aesthetically.

7. How Is Eyelid Surgery Performed?

Blepharoplasty is usually performed under local anaesthesia with sedation, and under general anaesthesia when combined with more extensive procedures.

a) Upper Eyelid

• The natural eyelid crease is marked,
• The anticipated excess skin is carefully measured; if needed, a small amount of muscle and fat is also adjusted,
• Excess tissues are removed and bleeding is controlled,
• The incision is closed with fine aesthetic sutures,
• Stitches are usually removed between days 5 and 7.

b) Lower Eyelid

Transconjunctival technique (scarless from inside the lid):

• The incision is made from the inner surface of the lower eyelid,
• Protruding fat pads are adjusted and, when needed, redistributed,
• No external scar is visible; this technique is preferred especially in younger patients with minimal skin excess.

Lower eyelid with skin incision:

• A fine incision is made just beneath the lower lashes,
• Excess fat and skin are carefully removed or reshaped,
• The incision is closed with aesthetic sutures following the lash line.

Which technique or combination of techniques is used depends on the patient’s age, skin quality, degree of bagging and expectations.

8. Local Anaesthesia – Sedation – General Anaesthesia Options

Eyelid surgery:

• Can be performed very comfortably for most patients under local anaesthesia plus light sedation. In this case:
  1. The patient dozes or remains calm during the procedure,
  2. The eye area is fully numbed and no pain is felt.

For more extensive combined procedures (face–neck lift etc.) or based on patient preference, general anaesthesia may also be used.

The type of anaesthesia is decided jointly by the surgeon and anaesthesiologist, according to the patient’s medical condition and expectations.

9. The First Postoperative Days: Swelling, Bruising, Stinging and Dry Eye Complaints

In the first days:

• Swelling, bruising, tightness and mild burning / stinging sensations of the eyelids are normal.

During the first 48 hours in particular:

• Intermittent cold compresses can be applied around the eyes as directed by the surgeon to provide comfort.

Some patients may experience:

• Temporary dry eye sensation, tearing or light sensitivity; eye drops and ointments prescribed by the doctor should be used.

A mild feeling of tightness when fully closing the eyes is normal in the first days and is related to swelling and tension.

Typically:

• Stitches are removed on days 5–7,
• Bruising and swelling, although varying from person to person, decrease significantly within 7–10 days.

10. Staying in Istanbul, Follow Ups and Returning Home

For patients coming from abroad or other cities:

• A stay of about 3–5 days in Istanbul is usually sufficient for:
  1. The first dressing change and incision check,
  2. Monitoring periocular swelling and bruising,
  3. Explaining how to use the necessary medications and eye drops.

During this time, the patient receives instructions on:

• Cold compress applications,
• Sleeping position (head slightly elevated),
• Avoiding rubbing the eyes,
• When make-up and contact lenses can be used again.

On long flights, intermittent movement and fluid intake are recommended to support blood circulation.

11. Return to Social Life and Work

At home:

• The first 1–2 days are mostly for rest and cold compresses,
• From day 2–3 onwards, light household activities can typically be done more comfortably.

Return to work:

• If no other major procedures are performed, office workers are usually able to return to work within 3–5 days,
• For those working long hours at a screen, frequent breaks are recommended to prevent eye strain and dryness.

Return to social environments:

• Most bruising resolves within 7–10 days,
• It becomes easier to camouflage with light make-up,
• Many patients start to feel more comfortable socially after the first week.

The exact timing for contact lens use, intensive screen time and eye make-up is determined individually by the surgeon according to healing speed.

12. Scars, Crease Lines and a Natural Look

Upper eyelid:

• The incision is placed in the natural crease of the upper eyelid,
• In the first weeks, it appears as a pink–reddish line,
• Over time, it fades, becomes a fine line and blends into the crease.

Lower eyelid:

• In the transconjunctival (internal) technique, there is no external scar,
• In the skin-incision technique, the incision is placed very close to the lash line, and its visibility decreases over time.

The goal is not to over-tighten the eyelid but to:

• Preserve eyelid anatomy,
• Avoid changing the natural shape of the eye,
• Achieve a fresher, more rested look without a harsh or “operated” expression.

13. Possible Risks and Complications

As with any surgical procedure, eyelid surgery also carries certain risks:

• Bleeding, bruising, swelling,
• Infection,
• Delayed wound healing, wound dehiscence along the suture line,
• Temporary or, rarely, longer-lasting:
  1. Numbness,
  2. Changes in sensitivity,
  3. Dry eye complaints,
• Inappropriately selected cases or excessive tissue removal on the lower eyelid can lead to shape problems,
• Asymmetry, more or less tissue removal than expected,
• Very rarely, serious vision-related problems (patients are informed in detail about these risks and early warning signs).

To minimise these risks:

• Proper indication,
• A surgeon experienced in eyelid and periocular anatomy,
• Good preoperative preparation,
• Adherence to postoperative care and follow up instructions

are of great importance.

14. Results and Expectation Management

With eyelid surgery, the goals are:

• Lighter and more open upper eyelids,
• Smoother, more refreshed lower eyelids,
• Brighter and more energetic overall eye appearance.

In the first 1–2 weeks, bruising and swelling may obscure the final result.

• Within 2–3 weeks, the general appearance improves significantly,
• It takes about 3–6 months for the scars to mature and for the eye area to feel completely natural.

The most satisfactory results are seen in patients who:

• Have realistic expectations,
• Maintain a balanced lifestyle and weight,
• Do not neglect eye area care and follow up visits,
• Limit or quit smoking.