What blepharoplasty is and when it is indicated

What does blepharoplasty correct?

Blepharoplasty treats a set of problems in the area around the eye which together can make the face look aged, tired or even sad. The main aims of the surgery are to:

• Remove the excess skin on the upper lids that forms folds or hangs over the lashes.
• Correct the fat pads in the lower lids that create volume or puffiness under the eyes.
• Reposition or remove the fat that has collected in the lower orbital area.
• Improve the symmetry and the contour around the eye.
• In some cases, improve peripheral vision if the upper lid is blocking the field of view.

It is worth stressing that this surgery does not remove dark circles or the lines around the eye, although it can be combined with other procedures such as CO2 laser, botulinum toxin or a facelift for a more complete result.

Medical and aesthetic indications

Most patients have a blepharoplasty for aesthetic reasons, but there are medical indications too. The commonest are:

• Excess skin on the upper lids that interferes with vision.
• Eyelid ptosis (drooping of the upper lid), whether age-related or congenital.
• Prominent herniated fat pads that make the eyes feel heavy.
• Chronic irritation of the eyelid from the skin fold rubbing.
• Asymmetry of the eyes with an anatomical cause.

Aesthetically, patients who come about blepharoplasty are usually between 40 and 70, although there are younger cases too, particularly where the bags are hereditary. The key is a proper medical assessment that takes account both of eye health and of what the patient expects.

Pre-operative assessment

The medical consultation is essential for deciding whether surgery is indicated and for tailoring the approach. The assessment looks at key factors such as:

• The quality and elasticity of the eyelid skin.
• The condition of the orbicularis muscle.
• Whether there are fat pads, and where.
• The position of the eyeball and of the brows.
• The function of the levator muscle of the eyelid.
• General health and any history of eye problems.

The surgeon will also explain the different techniques available, the anaesthetic recommended and the care needed before and after the procedure.

Current surgical techniques

There are several blepharoplasty techniques, and the choice depends on the patient’s anatomy. The most widely used are:

• Upper blepharoplasty: an incision is made in the natural crease of the upper lid to remove the excess skin and fat. The scar is perfectly hidden.
• External lower blepharoplasty: an incision is made just below the lower lashes to reach the fat and the spare skin. It is useful in cases with lax skin.
• Transconjunctival blepharoplasty: access is through the conjunctiva of the lower lid, with no visible incision. This technique is ideal for removing fat pads in patients whose skin is in good condition.
• CO2 laser blepharoplasty: it can be used to treat mild excess skin, by applying fractional CO2 laser.

At the Instituto de Cirugía Plástica del Mediterráneo all of these techniques are applied precisely and conservatively, to achieve balanced rejuvenation with no obvious signs of surgery.

Anaesthetic and the procedure

Upper blepharoplasty and the CO2 laser technique are generally done under local anaesthetic, and lower or complete blepharoplasty under general anaesthetic, which still allows the patient to go home the same day.

The operation usually takes between 45 minutes and 2 hours, depending on whether one or both lids are operated on and on the technique used. At the end of surgery very fine sutures are placed, and cold should be applied locally for the first 48 hours to control swelling.

Aftercare and recovery

Recovery from a blepharoplasty is quick and, in most cases, causes little discomfort. Aftercare includes:

• Applying cold locally for the first 48 hours.
• Keeping the head raised when sleeping, to reduce swelling.
• Using eye drops and ointments if they are prescribed.
• Avoiding make-up and exercise for at least a week.
• Strict sun protection for the first few months.

The sutures come out between the fifth and seventh day, depending on the case. Most patients can go back to their usual activities from the first week.

Bruising and swelling in the first few days are normal. They disappear gradually and the final result can be seen from the first month, although complete healing can take several months.

Results and how long they last

Blepharoplasty gives lasting results which in many cases hold for between 10 and 20 years, depending on individual factors such as skin ageing, lifestyle and genetic predisposition. It does not stop ageing, but it does remove the most visible signs around the eye and significantly improves the expression of the face.

The expected results include:

• Fewer bags and less spare skin.
• A more open, brighter, more youthful look.
• Greater symmetry and a more natural appearance.
• An improved field of vision where it was obstructed.

At the Instituto de Cirugía Plástica del Mediterráneo every case is documented photographically before and after the procedure, to make the result transparent and to assess the patient’s progress objectively.

Risks and complications

Like any surgical procedure, blepharoplasty is not without risks. Uncommon though they are, these can occur:

• Haematoma.
• Infection.
• Residual asymmetry.
• Difficulty closing the eyes fully (temporary).
• Visible scars (very uncommon).
• Temporary dry eye.

The key to keeping these complications to a minimum is the right indication, the right technique and proper post-operative follow-up.

Why choose a specialist clinic

A blepharoplasty should be carried out by a board-certified plastic surgeon with specific experience in facial surgery. Choosing a specialist clinic such as the Instituto de Cirugía Plástica del Mediterráneo in Valencia guarantees not only a high technical standard but personal care, an accurate diagnosis and a medical approach built on safety, natural results and aesthetic excellence.

Detailed guides to each technique

This page describes blepharoplasty as a whole. Each surgical variant and each stage of the process also has its own guide:

By technique

• Types of blepharoplasty — an overview of the techniques and when each is chosen.
• Upper blepharoplasty — excess skin and heaviness in the upper lid.
• Lower blepharoplasty — bags, laxity and lines under the eyes.
• Upper versus lower — what changes between operating on the upper lid and the lower one.
• Transconjunctival blepharoplasty — the internal route, with no visible scar on the skin.
• CO₂ laser blepharoplasty — what the laser adds over the scalpel.
• Combined blepharoplasty — upper and lower lid in a single operation.
• Asian blepharoplasty — creating or defining the eyelid crease.

By reason for the consultation

• Aesthetic blepharoplasty — the purely rejuvenating approach.
• Functional blepharoplasty — when the eyelid starts to limit the field of vision.
• The aesthetic benefits of blepharoplasty — what changes in the eyes and in the expression.
• Blepharoplasty in men and in women — differences in planning according to the face.

Before surgery

• Ideal candidates for blepharoplasty — which signs and which expectations make someone a good candidate.
• The pre-operative process — the tests and the assessment before surgery.

Frequently asked questions about blepharoplasty

How much does a blepharoplasty cost in Valencia?

The price is, as a guide, between 2,300 and 5,500 € (2026). The difference depends above all on whether only the upper lids, only the lower lids or all four are operated on, and on the anaesthetic your case requires.

It is a guide figure and subject to individual assessment, and the quote given after the first consultation is fixed and all-inclusive: operating theatre, anaesthetist, follow-up appointments, compression garment and VAT. Nothing appears on the bill afterwards.

What it does not include are the optional post-operative treatments — radiofrequency, massage or lymphatic drainage — which are recommended according to what each patient needs and are quoted separately.

And if there is a complication or I need a revision? Who covers it?

Every case is looked at individually, but the general principle is clear. If a medical complication arises, treating it normally involves only the cost of materials and theatre, so the cost is very small compared with a standard operation: the surgery is not charged for again.

As for minor refinement procedures, they are usually included, at minimal cost.

This is not a guarantee of outcome — medicine is an obligation of means, not of results — but an undertaking that, if something requires a second operation, we will make that as straightforward as we possibly can so that any problem can be dealt with.

Does blepharoplasty cause dry eye?

It can, and it is the complication least talked about. In the published series, dry eye symptoms after lower lid surgery appear in around 23-29% of cases, depending on the technique: they are commoner when the orbicularis muscle is lifted through a skin approach (~29%) and less common with the transconjunctival route (~23-26%).

That said — and this is the most important thing to know — in the great majority of cases it is temporary and resolves on its own. In the published series, 95% of patients had fully recovered by 8 weeks, and only about 2% still had symptoms beyond two months. In the meantime it is well controlled with artificial tears.

The risk is higher if the upper and lower lids are operated on at the same time and if the eye does not close fully after surgery. The exception is people who already had dry eye before surgery: there the changes can be more marked and last more than six months. That is why it should be assessed before operating, not afterwards.

Upper lid surgery on its own behaves differently: in the reviews it does not worsen dryness, and some papers even describe symptoms improving.

Does blepharoplasty get rid of dark circles?

Not necessarily, and this is the commonest confusion in the consulting room. Blepharoplasty deals with volume and excess skin: the fat pads and the laxity. The dark colour of the circle is a different problem.

There are shadow circles — caused by the relief of the bag itself, and those do improve with surgery — pigmented circles from excess melanin, and vascular circles, where the vessels show through thin skin. The last two are not corrected by surgery and need a different kind of treatment. Working out which you have is exactly what is assessed at the first consultation.

Can eye bags be removed without a visible scar?

Yes, through the transconjunctival route: the incision is made inside the eyelid, in the conjunctiva, and leaves no mark on the skin at all. It is the technique of choice when the problem is the fat pad and there is neither excess nor sagging skin.

That said, it is worth being honest about this: if there is excess skin, it has to be removed. Insisting on avoiding any scar when there is excess skin gives a worse result — the lid ends up wrinkled or sagging even though the bag has gone — and that is precisely the complaint that is not easy to put right afterwards.

In those cases the transconjunctival route is combined with a minimal removal of skin, whose scar sits hidden just below the lash line and is barely visible. The priority is the result, not the absence of a scar.

Why do eye bags appear? Do they go away on their own?

They do not go away on their own: over time they get worse. Bags appear because the septum holding the fat around the eye weakens and that fat herniates forwards. It is an ageing process with a strongly hereditary component — which is why some people have them in their early twenties — and it has nothing to do with sleeping well or badly.

They should be distinguished from morning puffiness caused by fluid retention, which comes and goes through the day and is not the same thing. A fat pad is always there.

Can eye bags be a symptom of an illness?

In most cases no, but there are situations worth ruling out before considering surgery. Swelling that is recent, on one eye only, or accompanied by other symptoms deserves a medical assessment.

Some thyroid disorders can change the eyelids and the position of the eye; fluid retention of kidney or cardiac origin causes swelling that varies through the day; and allergy produces swelling with itching and redness. That is why the first consultation starts by ruling out a medical cause: operating on swelling that is not a fat pad resolves nothing.

Who should not have eyelid surgery?

It is best to wait, or to rule surgery out, where there is active eye disease — including thyroid eye disease, which must be stable — significant uncontrolled dry eye, uncontrolled blood pressure, or anticoagulant treatment that has not been adjusted.

Also when expectations do not match what the technique can deliver: blepharoplasty rejuvenates the eyes, but it does not lift the brow, erase crow’s feet or change the shape of the eye.

Can I have surgery if I already use artificial tears?

Using artificial tears does not on its own rule surgery out, but it changes the planning. Pre-existing dry eye is the main risk factor for symptoms worsening afterwards, so it has to be assessed and treated first, the technique least aggressive to the orbicularis muscle chosen, and any excess removal of skin avoided.

If the dry eye is severe, the prudent course is not to operate.

When can I wear contact lenses again?

You have to wait until the swelling in the lid has gone and the surface of the eye has settled. As a guide it is usually two or three weeks, but it is an individual judgement: putting them in too early, with the lid still swollen, is uncomfortable and can further irritate an eye already dry from surgery. In the meantime, glasses.

How long does the result of a blepharoplasty last?

It is one of the longest-lasting facial operations. The herniated fat that is removed does not come back, so the result on the bags usually holds for many years, often permanently.

What does carry on is the ageing of the rest of the face: the skin goes on losing elasticity and the brow can drop over the years. That does not mean the operation has “come undone”.

What is the difference between upper and lower blepharoplasty?

They correct different problems. The upper removes the excess skin of the upper lid, which is the one that falls over the lashes, feels heavy and in advanced cases reduces the field of vision. It is the one that most often has a functional component.

The lower deals with the fat pads and, where appropriate, the laxity beneath the eye. They can be done together, but doing so increases the risk of post-operative dry eye, so the decision to combine them is not automatic.

Sources and clinical review

The clinical statements on this page are based on the following sources, accessed on 1 August 2026:

• Incidence and mechanisms of dry eye after cosmetic blepharoplasty: Cosmetic blepharoplasty and dry eye disease.
• Course and resolution of dry eye after periorbital surgery: Preventing and managing dry eyes after periorbital surgery.
• Safety and complications of lower eyelid blepharoplasty, systematic review: Safety and Complications in Lower Eyelid Blepharoplasty.