Upper Blepharoplasty

Upper blepharoplasty is an operation to remove excess skin, muscle, and sometimes fat from the upper eyelids. It reduces heaviness or "hooding" of the upper lids, creating a fresher, more alert appearance, and can also improve upper visual field if the excess skin was obstructing your vision.

Your surgeon will assess you and advise if this procedure is suitable, but the decision to proceed is always yours.

You may benefit from this procedure if you have:

• Excess, drooping skin on the upper eyelids that makes you look tired
• Skin folds that touch your eyelashes or interfere with applying make-up
• In some cases, skin so excessive it obstructs your upper or side vision

Your surgeon will check whether your brow position is also contributing to the hooded appearance — if so, a browlift may be recommended instead of, or alongside, blepharoplasty, as treating the eyelid alone will not correct a low brow.

Most patients experience a noticeably fresher, more youthful, and less tired appearance, and some experience an improvement in visual field. Results cannot be fully guaranteed and depend on individual healing and anatomy.

Fillers or Botox may create a subtle temporary lift to the brow area, but do not remove excess eyelid skin. If your main concern is brow position, a browlift may be more effective. Non-surgical skin tightening treatments have limited effect on true skin excess.

Upper blepharoplasty is usually performed under local anaesthetic with sedation, or occasionally general anaesthetic, and takes around 45 minutes to 1 hour.

• The surgeon marks the amount of excess skin to be removed with you sitting up and looking ahead
• An incision is made within the natural eyelid crease
• A strip of skin (and sometimes a small amount of muscle) is removed
• Bulging fat pads may be trimmed if present
• The incision is closed with fine sutures, usually removed after about a week

All surgery carries risk. The figures below come from published clinical case series and reviews.

General risks of any operation: minor infection, bleeding, allergic reaction, and (rarely) blood clots.

Specific risks of upper blepharoplasty:

• Bruising and swelling: universal and expected, not a complication in itself; usually settles within 1–2 weeks
• Haematoma (bleeding under the skin): uncommon; in a series of 200 patients (upper and lower lid combined), the rate was 0.5%
• Dry eyes / lagophthalmos (difficulty closing the eye fully): this is the most common cause of dry eye after blepharoplasty, usually mild and temporary, resolving with lubricating drops; more likely if too much skin is removed
• Asymmetry: minor differences in eyelid crease height or amount of skin removed are the most commonly noted issue by patients and can sometimes be improved with a small revision procedure
• Eyelid ptosis (drooping): usually caused by swelling and resolves spontaneously within 3 months in most cases; permanent ptosis from muscle injury is uncommon and can be surgically corrected if it persists
• Scarring: eyelid skin heals very well; scars are hidden in the natural crease and usually become nearly invisible
• Orbital haemorrhage with vision loss: this is a rare but serious complication, estimated at between 1 in 2,000 and 1 in 25,000 procedures . It requires immediate treatment (surgical release of pressure), which is why you will be advised to seek urgent attention if you notice worsening pain, swelling, or vision changes after surgery
• Overcorrection: excessive skin or fat removal can cause the eye not to fully close (lagophthalmos) or a hollow, "over-operated" look; careful preoperative planning minimises this risk
• Medial canthal webbing: a rare skin-bridging complication if incisions are placed too close to the inner corner of the eye; usually resolves with massage, rarely needs revision

• Tell your surgical team about all medications, blood thinners, herbal remedies (especially vitamin E, fish oil, ginkgo), and supplements — these are usually stopped up to 2–3 weeks before surgery
• Stop smoking well before surgery to support healing
• A full eye examination (including tear production testing) is usually performed beforehand to check for pre-existing dry eye or eyelid laxity

• Cold compresses and head elevation for the first 2–3 days help reduce swelling and bruising
• Lubricating ointment or drops may be prescribed, especially if your eyes do not fully close during sleep initially
• Sutures are typically removed after about 1 week
• Most bruising resolves within 2 weeks and can be covered with make-up after about 10 days
• Avoid strenuous exercise for about 2 weeks
• Avoid contact lenses for at least a week if advised by your surgeon

Will I be able to see the scar? The incision is hidden within the natural eyelid crease and typically fades to become nearly invisible within a few months.

How long does swelling last? Most visible swelling and bruising settle within 1–2 weeks, though subtle swelling can take a few months to fully resolve.

Is upper blepharoplasty painful? Most patients experience mild discomfort, tightness, or itching rather than significant pain, controlled with simple painkillers.

Can this be combined with a browlift or lower blepharoplasty? Yes, these are commonly combined for comprehensive upper face rejuvenation.

What is the most serious risk? The rare but serious complication of bleeding behind the eye causing vision loss occurs in an estimated 1 in 2,000 to 1 in 25,000 cases . This is why you'll be given clear instructions on warning signs to watch for in the days after surgery.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.