Blepharoplasty
Written by: Dr. Akash Chandawarkar, Board Certified Plastic Surgeon, Mirror Plastic Surgery | Last updated: September 28, 2026
What This Eyelid Surgery Guide Covers
How upper and lower eyelid surgery address hooded lids, extra skin, and under-eye bags
Who makes a good candidate and when a different procedure is a better fit
What to expect before surgery, during recovery, and over the long term
Key risks, how experienced surgeons reduce them, and when to avoid surgery
How Mirror Plastic Surgery in St. Petersburg approaches eyelid surgery with a safety-first mindset
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Meet Dr. Akash Chandawarkar
Dr. Akash Chandawarkar completed his medical degree through the Harvard-MIT Division of Health Sciences and Technology, graduating from Harvard Medical School with Honors. He then completed a seven-year integrated plastic and reconstructive surgery residency at Johns Hopkins University, one of the most rigorous training programs in the world. After residency, he pursued a specialized aesthetic surgery fellowship at the Manhattan Eye, Ear and Throat Hospital (MEETH)/Lenox Hill Hospital, where focused facial training included blepharoplasty, brow lifts, facelifts, rhinoplasty, and neck lifts under leading experts.
Dr. Akash also completed the Stanford University Biodesign Innovation Fellowship and serves on advisory boards for companies developing new aesthetic technologies. His technique selection reflects current evidence rather than habit. His approach to eyelid surgery (blepharoplasty) is grounded in direct, honest communication. He explains when the eyelid is not the right target, when a brow lift or volume restoration is more appropriate, and when doing nothing is the safest recommendation.
That philosophy starts with understanding exactly what is happening anatomically, which is where the next section begins.
The Anatomy Of The Aging Eyelid And What Each Operation Addresses
The eyelid skin is the thinnest on the body and loses elastic recoil sooner than the rest of the face. With age, the orbital septum, the membrane holding orbital fat behind the eye, weakens and allows fat to push forward. This creates the characteristic bags and heaviness that make people look tired. Separately, skin accumulates in the upper lid, the brow descends, and the midface drops away from the lower lid. That shift creates a more visible lid-cheek junction. These are distinct anatomical events. Treating one without diagnosing the others often produces disappointing results.*
Upper Eyelid Surgery
Upper blepharoplasty removes redundant upper lid skin, addresses the medial and central orbital fat compartments, and, when needed, removes a conservative strip of orbicularis muscle. The incision sits in the natural lid crease, where it becomes nearly invisible once healed. Patients who may be candidates often notice skin resting on their lashes, difficulty applying eyeliner to the upper lid, or a sense that the upper visual field is partially blocked, particularly when reading or driving. Upper Blepharoplasty Is The Third Most Common Cosmetic Surgery Performed In The United States, With Over 200,000 Procedures Performed Each Year.
Lower Eyelid Surgery
Lower blepharoplasty addresses the three lower lid fat compartments (medial, central, and lateral), lower lid skin, and lid support structures. The transconjunctival approach, with the incision placed inside the lid, leaves no visible external scar and is preferred for patients with fat herniation and good skin tone. The transcutaneous (subciliary) approach allows direct skin removal and is used when significant skin laxity accompanies fat herniation. Modern Lower Blepharoplasty Practice Has Shifted Toward Fat Repositioning Over Aggressive Fat Removal. Herniated fat is relocated into the tear trough to preserve volume and avoid the hollowed appearance that historical excision-only techniques sometimes produced.
Combined Upper And Lower Blepharoplasty
Combined surgery addresses both lids in a single operative session and concentrates healing into one recovery window. A National Analysis Reported Complication Incidence Of 2.47% For Upper Blepharoplasty, 3.97% For Lower Blepharoplasty, And 4.68% For Combined Upper And Lower Blepharoplasty. Staging may be the safer choice for patients with significant dry eye, lower lid laxity, or other risk factors that call for a more conservative plan.*
Functional Vs. Cosmetic: When Insurance May Cover Surgery
When excess upper lid skin obstructs the superior visual field, blepharoplasty becomes a functional procedure and insurance coverage may apply. Major Insurers Such As Anthem Require Documented Visual Field Obstruction Of 20 Degrees Or Less In The Superior Field, Or A Margin Reflex Distance Of 2.0 Mm Or Less, Along With Photographs And A Taped-Lid Test Demonstrating Restoration Of The Visual Field before coverage is approved. Blue Cross Blue Shield Of North Carolina Similarly Requires Less Than 30 Degrees Of Superior Visual Field From Fixation, With At Least 15 Degrees Of Improvement When The Redundant Tissue Is Raised. Lower lid bag surgery is generally approached as cosmetic care and is not covered by insurance.
Functional cases require visual field testing, taped-lid comparison photography, and documentation of symptom history. Cosmetic cases do not require this testing. At Mirror Plastic Surgery, the consultation evaluates both dimensions. A patient who qualifies for functional coverage deserves to know that before surgery is scheduled.
Candidacy Framework
A thorough blepharoplasty consultation assesses lid laxity, tear film quality, brow position relative to the orbital rim, lower lid vector, and prior ocular surgery history. Patients who describe “droopy inner eyelids” or “skin sitting on my lashes” are often good candidates once brow position and midface volume have been evaluated as contributing factors. Patients with significant pre-existing dry eye, active thyroid eye disease, or prior LASIK surgery require additional assessment before surgery is appropriate.*
Why Mirror Plastic Surgery Is A Strong First Call In Tampa Bay
Mirror Plastic Surgery is a concierge plastic surgery practice in St. Petersburg serving the greater Tampa Bay area. Consultations run up to an hour and function as a top-to-bottom anatomical assessment rather than a rushed overview. The practice limits itself to one to two surgeries per day. This structure keeps the entire team focused on one patient at a time before, during, and after the procedure.
The practice philosophy follows a clear order: safety first, function second, aesthetics third. During an eyelid surgery consultation, the team confirms that the ocular surface is protected, that full eyelid closure will be preserved, and that the eyelid is actually the right target for the concern. Dr. Akash Chandawarkar is board certified by the American Board of Plastic Surgery and holds privileged hospital access for the rare event of a surgical complication. That safety net matters in periorbital surgery, where the most serious complications require immediate intervention.
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Preparation: What Happens Before Eyelid Surgery (Blepharoplasty)
Mirror Plastic Surgery's consultation is an hour-long, top-to-bottom anatomical assessment. In-office diagnostic tools, including ultrasound where relevant, support this evaluation. The conversation is educational first. Patients leave with a clear understanding of their anatomy, why a particular approach is recommended, and what the realistic outcome range looks like.*
Pre-operative preparation focuses on four areas, each aimed at reducing a specific risk.
Medication and supplement review. Blood-Thinning Medications Including Aspirin, Anti-Inflammatory Drugs, Fish Oil, And Certain Herbal Supplements Are Typically Stopped 7 To 10 Days Before Surgery to limit bleeding.
Smoking cessation. Nicotine Narrows Blood Vessels And Reduces Oxygen Delivery To Healing Tissue, Raising Rates Of Wound Separation, Poor Scar Quality, And Infection; Stopping For At Least Four Weeks Before And After Surgery Is Standard Guidance and supports wound healing.
Dry eye optimization. Patients with pre-existing ocular surface disease are managed with lubricating drops and, when necessary, further evaluation before a surgical date is set to protect the eye surface.
Realistic procedure sequencing. Combining too many procedures at once can exponentially increase complication rates. Mirror Plastic Surgery advises against overloading a single operative session to keep risk as low as possible.
Once preparation is complete and surgery is scheduled, most patients want to know how long recovery will take.
How Long After Blepharoplasty Will I Look Normal?
Most Patients Look Socially Presentable 10 To 14 Days After Eyelid Surgery (Blepharoplasty), Once Bruising And Swelling Have Largely Resolved. Subtle swelling can persist up to three months, and final eyelid contour continues to refine over several months as collagen remodels and scars mature. Upper lid recovery is typically faster than lower lid or combined surgery.*
Days 1–3: Swelling And Bruising Peak At 48 To 72 Hours. Cool compresses are applied in 15-minute intervals during waking hours. Sleeping with the head elevated on two pillows reduces fluid pooling in the eyelids. Lying flat increases overnight edema because gravity draws fluid toward the surgical site.
Days 4–7: Bruising shifts from purple to green and yellow as hemoglobin breaks down. Sutures are typically removed at the first follow-up visit. Bending over and straining are avoided because these maneuvers raise intracranial pressure and can trigger delayed bleeding at the surgical site while deeper tissue layers are still healing.
Days 8–14: Most visible swelling resolves. Bruising clears for most patients by the end of week two, though lower eyelid or combined cases may see lingering discoloration into week three. Screen time and reading are limited early in recovery because the tear film is still stabilizing and blink dynamics are altered by post-operative swelling. The eye fatigues more quickly than usual.
Weeks 3–6: Light Exercise Is Generally Appropriate Around Day 10, With Full Clearance For Strenuous Activity At Two To Three Weeks. Subtle swelling that the patient notices but others cannot may persist up to three months. Sun protection over healing incisions remains important because UV exposure on immature scars worsens pigmentation and slows fading.
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Risks, The Honest Downside, And What To Look Out For
The ASPS and Mayo Clinic both identify the following as recognized risks of blepharoplasty:
Dry Eye: Dry Eye Symptoms Occur In Approximately 8 To 21 Percent Of Patients After Upper Eyelid Surgery And Around 11 Percent After Lower Blepharoplasty. Patients with pre-existing dry eye carry a higher baseline risk.
Lagophthalmos: Incomplete eyelid closure from over-resection of upper lid skin. Lagophthalmos Can Produce Exposure Keratopathy, Punctate Epithelial Erosions, And Persistent Epithelial Defects. This functional complication is considerably harder to correct than to prevent.
Ectropion: Outward turning of the lower eyelid, most likely when lower lid laxity is not identified and corrected at the time of surgery. The Rate Of Ectropion Is Meaningfully Reduced When Lower Eyelid Laxity Is Addressed At The Original Procedure.
Asymmetry: Mild asymmetry is common during healing and often resolves as swelling subsides. Persistent asymmetry beyond six to twelve months may warrant revision.
Retrobulbar Hemorrhage: The Most Serious Complication Of Blepharoplasty, With An Estimated Incidence Of Approximately 1 In 20,000 Cases, Requiring Immediate Surgical Decompression.
Why Some Patients Look Older After Blepharoplasty
Some patients feel they look older after eyelid surgery, and the reasons are usually anatomical.
Over-Resection Of Orbital Fat. Up To 30% Of Patients Seeking Revision Eyelid Surgery Cite A Hollow, Skeletal Appearance As Their Primary Complaint, And The Root Cause In The Vast Majority Of Cases Is Over-Resection Of Orbital Fat During The Initial Procedure. The medial fat pad is the most frequently over-resected compartment. Its bulging is visually prominent even in young patients. Aggressive removal creates a dark hollow near the inner eye corner. Orbital Fat Volume Decreases Naturally At Approximately 1% Per Year After Age 35. Removing fat surgically accelerates a deficit that aging was already creating. A patient may look acceptable at two years post-surgery but hollowed and skeletal at ten.
Unmasking Of Brow Ptosis. A low brow pushes skin onto the upper lid. When that skin is removed without addressing the brow, the brow is effectively anchored lower and heaviness returns faster than expected. If Gently Lifting The Brow With One Finger Resolves The Hooding, The Issue Is Brow Descent Rather Than Excess Upper Lid Skin, And Upper Blepharoplasty Alone Will Not Produce The Desired Result.
Changes In Eyelid Position. Upper crease migration occurs as volume disappears and the crease rides higher. Lower lid retraction with scleral show, white visible below the iris, and a visible separation between the lid and cheek (the nasojugal fold or tear trough deformity) are hallmarks of an over-operated lower lid. A Successful Lower Blepharoplasty Result Looks Rested And Natural, Never Hollowed Out Or Obviously Operated On.
When Eyelid Surgery (Blepharoplasty) Is The Wrong Operation
Three situations call for a different path entirely:
Brow Ptosis As The Dominant Cause: When the brow sits below the supraorbital rim and drives upper lid heaviness, a brow lift addresses the actual cause. Removing upper lid skin alone anchors the brow lower and ages poorly. The brow should be set first. Lid skin is then assessed against the new position.
Midface Volume Loss Creating Apparent Lower Lid Bags: Midface Descent Can Create Apparent Lower Eyelid Bags When Cheek Tissue Descends Away From The Lower Lid, Creating Relative Prominence Of The Lid; A Deep Plane Facelift Or Cheek Volume Restoration May Address This More Appropriately Than Lower Blepharoplasty Alone.
Significant Dry Eye: Patients with poorly controlled ocular surface disease, thyroid orbitopathy, or prior LASIK surgery require careful evaluation before any eyelid surgery is planned. Patients With Thyroid Eye Disease Should Generally Delay Blepharoplasty Until The Condition Has Been Medically Stable For At Least Six Months.
At Mirror Plastic Surgery, identifying these situations and recommending against surgery, or recommending a different operation, is considered part of the consultation.
Longevity
Upper Blepharoplasty Results Are Long-Lasting, With Most Patients Enjoying Their Results For 10 Years Or More, Because Removed Skin And Fat Do Not Return. Lower Eyelid Surgery With Fat Transposition Lasts 7 To 15 Years, With Some Patients Seeing Results Last 20 Or More Years. Over time, the brow continues to descend, the midface continues to lose volume, and the remaining eyelid skin continues to age. When hooding recurs years after upper blepharoplasty, brow descent is often the cause rather than new skin excess. In that setting, a brow lift assessment is usually the correct next step.
Alternatives, Honestly
Filler For Under-Eye Bags: Hyaluronic acid filler suits tear-trough hollowing caused by volume loss. It does not correct structural fat pseudoherniation. If The Under-Eye Shadow Is Caused By A Protruding Fat Pad Rather Than A Hollow, Injecting Filler Will Create A Double-Bulge Effect, Making The Under-Eye Area Look Puffier And More Distorted. Filler results last 9 to 18 months and require ongoing maintenance. For true fat herniation, lower blepharoplasty is the definitive treatment.
Laser And Energy-Based Treatments: Fractional CO2 Laser And Radiofrequency Microneedling Can Improve Mild Skin Laxity And Periorbital Texture, But Most Patients Achieve Only 20 To 50% Of The Correction Possible With Surgery. Results require ongoing maintenance. These treatments suit patients with mild dermatochalasis who are not yet surgical candidates or serve as adjuncts after blepharoplasty to address residual skin quality concerns.
Blepharoplasty Vs. Brow Lift: These are different operations. Blepharoplasty removes eyelid tissue. A brow lift repositions the brow and forehead. When brow descent primarily drives upper lid heaviness, a brow lift is the more anatomically correct operation. When both excess lid skin and brow descent are present, the brow is typically addressed first and the lid reassessed. Mirror Plastic Surgery evaluates both in every upper eyelid consultation.
Doing Nothing: For patients whose concern is mild and whose anatomy does not clearly indicate surgery, watchful waiting is a legitimate choice. A consultation at Mirror Plastic Surgery gives patients an honest framework for that decision. Scheduling a procedure is a separate step.
Common Misconceptions
The most consequential misconception about blepharoplasty is that more removal produces better results. Conservative, anatomy-driven surgery usually ages more gracefully than aggressive resection. A board-certified plastic surgeon who takes time for a comprehensive evaluation, explains the reasoning behind every recommendation, and provides dedicated support before, during, and after the procedure is the single most important factor in avoiding the complications described above.*
Frequently Asked Questions
What Is The Downside Of Blepharoplasty?
The most common downsides of blepharoplasty are temporary: bruising and swelling that peak at 48 to 72 hours and largely resolve within 10 to 14 days, dry eye symptoms that affect roughly 8 to 21 percent of upper blepharoplasty patients and typically improve within four to six weeks, and mild asymmetry that often resolves as healing progresses. More significant risks include lagophthalmos, ectropion, and a hollowed or aged appearance from over-removal of orbital fat. As noted in the risks section, revision rates are low in experienced hands but higher for lower lid surgery. The most serious complication, retrobulbar hemorrhage, is rare but requires immediate treatment. Choosing a board-certified plastic surgeon who performs a thorough pre-operative assessment, evaluates dry eye and lid laxity before surgery, and uses conservative tissue management substantially reduces the likelihood of these outcomes.
Why Do I Look Older After Blepharoplasty?
The three causes described earlier, fat over-resection, unmasked brow ptosis, and eyelid position changes, explain most cases. These issues are largely preventable with a thorough pre-operative diagnosis, conservative tissue management, and fat repositioning instead of aggressive excision. They are also among the most difficult problems to reverse after the fact, which is why the first consultation matters more than any later revision.
How Long Will A Blepharoplasty Last?
As covered in the longevity section, upper lid results typically last a decade or more, and lower lid results with fat repositioning often last 7 to 15 years. Some patients maintain lower lid improvements for 20 or more years. The removed or repositioned tissue does not return at the rate skin laxity does. Factors that influence longevity include surgical technique, patient age at surgery, genetics, sun exposure, and smoking history. Daily broad-spectrum sunscreen, UV-blocking sunglasses, and medical-grade skincare help extend results. Neuromodulators for crow's feet and fractional laser for skin texture can complement the surgical result over time without additional surgery.
What Is The Best Age For Blepharoplasty?
There is no single best age. Anatomy, skin quality, brow position, and the nature of the concern matter more than a number. Most blepharoplasty patients are in their 40s to 60s, and the mean age in large published series is approximately 56 years. Patients in their late 30s with significant hereditary fat herniation or early dermatochalasis can also be appropriate candidates. Patients in their 70s can achieve excellent outcomes when their ocular surface health and overall medical status support surgery.
Patients who undergo blepharoplasty in their 40s or early 50s often experience longer-lasting results than those who wait until their 60s or 70s. The reason is simple: there are more years of relatively youthful tissue ahead. Earlier surgery also means the brow and midface have not yet descended as far, which reduces the likelihood of needing combined procedures. The right time is when the concern is anatomically clear, the diagnosis is correct, and the patient's health supports a safe procedure.
What Can I Do Instead Of Blepharoplasty?
The honest answer depends on the underlying anatomy. For mild upper lid heaviness driven primarily by brow descent, a brow lift or botulinum toxin to the depressor muscles can produce meaningful improvement without touching the eyelid. For tear-trough hollowing caused by volume loss, hyaluronic acid filler injected by an experienced provider is an appropriate non-surgical option, though results last 9 to 18 months and require maintenance. For mild skin laxity without significant fat herniation, fractional CO2 laser or radiofrequency microneedling can improve texture and provide modest tightening. For dark circles caused by pigmentation rather than structural shadowing, laser treatments and medical-grade skincare address the actual cause more effectively than either surgery or filler. For true fat pseudoherniation creating structural lower lid bags, or for significant upper lid dermatochalasis resting on the lashes, no non-surgical treatment replicates what blepharoplasty achieves. The most important step is an accurate diagnosis of what is actually causing the concern, which is exactly what a thorough consultation at Mirror Plastic Surgery is designed to provide.
Book A Consultation
Mirror Plastic Surgery is located in St. Petersburg and serves the greater Tampa Bay area. If you are considering eyelid surgery (blepharoplasty), or if you are not sure whether the eyelid is the right target for your concern, the right first step is a consultation with Dr. Akash Chandawarkar. The conversation is honest, anatomically grounded, and often includes a discussion of what to avoid as well as what to consider.
Contact Mirror Plastic Surgery:
Address: 780 4th Ave S, St. Petersburg, FL 33701
Phone: 727-361-6515
Email: [email protected]
Instagram: @mirrorplasticsurgery and @dr.akashplasticsurgery
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*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results.