It corrects the aged appearance of the eyes: excess skin above, bags and grooves below, fine lines and asymmetry between the eyelids.
It does not change the shape of the eye or the identity of the face: the effect sought is natural rejuvenation, not a transformation.
According to the diagnosis, the upper, lower, transconjunctival or combined technique is chosen, and it can be combined with canthopexy, a brow lift, fat transfer or laser.
It takes between 45 and 90 minutes; stitches come out between the fifth and seventh day and most patients resume working and social life at 7-10 days, with the result settling between the third and the sixth week.
Uncommon complications: bruising or persistent swelling, irregular scars, asymmetry of the eyelids, temporary dry eye and retraction of the lower eyelid if too much skin is removed.
Cosmetic blepharoplasty is an operation whose purpose is to rejuvenate the eye region by correcting excess skin, fat or laxity in the eyelids. Through a precise, minimally invasive technique, the eyes are left looking more harmonious, fresh and rested, without altering the patient’s facial identity. It is one of the most requested operations in facial plastic surgery, thanks to its high effectiveness, low risk and lasting results.
At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, cosmetic blepharoplasty is carried out individually, taking into account the anatomy, the age, the sex and the patient’s realistic expectations. Tailoring the treatment in this way guarantees natural results, avoiding an artificial expression or an excessive change to the features.
What follows sets out the most relevant aspects of this surgery: from its indications to how it is carried out and the aftercare, with the aim of offering the reader a clear, professional and useful guide.
Cosmetic blepharoplasty is indicated in patients who want to improve the aged appearance of their eyes, caused by structural changes in the upper eyelids, the lower eyelids or both. The most frequent situations in which it is recommended are:
Excess skin on the upper eyelid giving a tired look.
Pads of fat in the lower eyelid creating a visible bulge.
Lax skin with folds or fine lines forming.
Deep grooves between the lower eyelid and the cheek.
Asymmetry of the eyelids affecting facial harmony.
Difficulty applying make-up because of the fold of the upper eyelid.
The procedure can be carried out on its own or as part of an overall facial rejuvenation. In some cases it is combined with complementary techniques such as canthopexy, a brow lift, fat transfer or laser treatments.
Tired-looking eyes are not one single thing: skin above, bag and groove below. Each piece has its own solution.
A proper medical assessment is essential in ensuring cosmetic blepharoplasty is properly indicated. At the first consultation we carry out:
A detailed study of the anatomy of the eyelids.
Assessment of the state of the skin, the orbicularis muscle and the fat pads.
Analysis of the symmetry of the eyes and of the relationship between eyelid and brow.
Review of the medical history, previous surgery and any eye conditions.
Photographic records for clinical documentation and planning.
The surgeon determines the most suitable type of operation according to the diagnosis: upper, lower, transconjunctival or combined blepharoplasty. The patient’s expectations are also discussed, with a clear explanation of the benefits and the limitations of the procedure.
Types of cosmetic blepharoplasty
The technique used depends on the site and the type of change to be treated. The main options are:
Upper blepharoplasty
Indicated where there is excess skin or fat in the upper eyelid. An incision is made along the natural crease of the eyelid, the excess tissue is removed and the internal structures repositioned. It restores the expressiveness of the eyes and lightens the visual weight.
Lower blepharoplasty
Indicated to correct bags, lines or laxity in the lower eyelid. It can be carried out by the subciliary route (an external incision below the lashes) or the transconjunctival route (an internal incision), depending on whether skin has to be removed or only fat. It improves the contour of the dark circle and removes the tired look.
Transconjunctival blepharoplasty
Recommended for younger patients with fat pads but no excess skin. It leaves no visible scars and recovery is quicker. The pads are reached from inside the eyelid.
Uses the CO₂ laser applied in fractional mode to the surface, to improve slight excesses of skin, treat fine lines and improve the texture of the skin.
How the operation is carried out
Cosmetic blepharoplasty is carried out in theatre, generally under local anaesthetic for the upper lid, and under general anaesthetic or sedation for the lower. The operation lasts between 45 minutes and 90 minutes, according to the type of surgery. The procedure includes:
Detailed marking before surgery with the patient sitting up.
Local anaesthetic to the eyelid area.
An incision in the natural crease of the eyelid (upper), below the lashes (lower), or through the transconjunctival route.
Removal of the excess skin, fat or muscle.
Repositioning of the tissues where necessary.
Closure with a very fine suture.
After the operation the patient stays under observation and is given the necessary instructions for aftercare at home.
Recovery after a blepharoplasty
Recovery after a blepharoplasty is relatively straightforward. Initial swelling and bruising are normal in the first few days and fade gradually. The usual aftercare includes:
Applying cold locally during the first 48 hours.
Sleeping with the head raised to reduce the swelling.
Avoiding strenuous physical exercise during the first week.
Not applying make-up or creams until the surgeon says so.
Keeping the area clean and dry as instructed.
Stitches come out between the fifth and seventh day. Most patients resume working and social life at 7-10 days, although the final outcome is apparent between the third and sixth week.
The results to expect
The results of cosmetic blepharoplasty are visible from the first few days, although they settle completely once the swelling has gone. The benefits include:
More open, rejuvenated eyes.
Fewer folds, bags and lines.
A more rested and harmonious facial expression.
Restored symmetry and a natural contour around the eye.
Improved self-esteem and confidence.
The result is lasting and holds for many years, although it is subject to the natural changes of ageing. In some cases a slight touch-up may be needed later on if new laxity or a build-up of fat appears.
The serious complication: how likely it is and how it is recognised
There is one complication worth explaining properly, precisely because it is rare: a retrobulbar haematoma, bleeding behind the eye that compresses the optic nerve and can cause loss of vision. It is the main cause of blindness after a blepharoplasty, and it deserves figures rather than silence.
Two large surveys of surgeons have estimated how often it occurs:
Across 269,433 operations, orbital haematoma appeared in around 1 in 2,000 cases (0.055%), and haematoma with permanent loss of vision in approximately 1 in 22,000 (0.0045%).
Across 752,816 blepharoplasties, loss of vision of any kind was estimated at 1 in 20,000 and permanent loss at 1 in 30,000.
Put in context, these are figures of the same order as other risks we accept daily without a second thought. But what is genuinely useful about these studies is not the probability: it is when it happens and how it shows.
When. Most cases occur within the first three hours after surgery, with two peaks described — from theatre to the first hour, and between six and twelve hours — and the risk falls markedly after 24 hours. That is why the first few hours are watched as closely as they are.
How it shows. The most frequent symptoms are pain and a sensation of pressure in the eye, very different from the normal discomforts of recovery. Pain that grows instead of easing, with the eyelid tense, is not something to leave until tomorrow: it is something to telephone about there and then. Treated in time, this has a solution.
And what does depend on the patient: the associated factors that recur in both studies are high blood pressure — the most frequent — the use of aspirin around the time of surgery, vomiting afterwards and early physical exertion. Controlling blood pressure, stopping in good time what needs stopping and not pushing yourself in the first few days are not routine advice: they are exactly the four points that can be acted on.
Uncommon complications
Cosmetic blepharoplasty is safe surgery when carried out in expert hands. As with any operation, however, complications can arise. The least common are:
Bruising or persistent swelling.
Visible or irregular scars.
Asymmetry of the eyelids.
A sensation of dry eye or temporary irritation.
Retraction of the lower eyelid if too much skin is removed.
The key to avoiding these complications lies in proper planning, a precise surgical technique and responsible follow-up. At the Instituto de Cirugía Plástica del Mediterráneo, strict safety protocols are applied and every patient is followed closely.
Cosmetic blepharoplasty is an effective, safe and lasting solution for anyone wanting to rejuvenate their eyes without changing their identity. The operation restores the harmony of the face, removing signs of tiredness or ageing naturally and with respect for the patient’s anatomy.
At the Instituto de Cirugía Plástica del Mediterráneo, every case is approached with professionalism, medical honesty and individual planning. If you are considering eyelid surgery, we invite you to book a specialist consultation. Our medical team will assess your case individually and advise you on the best option for rejuvenated, harmonious eyes that are still true to who you are.
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The aged appearance of the eyes: excess skin on the upper eyelid, fatty bags on the lower one, slack skin with folds or fine lines, deep grooves between the lower eyelid and the cheek, eyelid asymmetry and the difficulty of applying make-up because of the fold of the upper eyelid.
Will it change my face?
That is not the aim. It does not change the shape of the eye or alter the character of the face: the effect is perceived as natural rejuvenation, not a radical change. Care is taken to avoid overcorrection or artificial results.
Which type do I need?
It depends on the diagnosis. The upper procedure when there is excess skin or fat above; the lower one for bags, lines or slackness below, by the subciliary or transconjunctival route according to whether skin or only fat needs removing; the transconjunctival one in young patients with bags but no excess skin; and the laser for mild excess skin, fine lines and texture.
How long does the operation take?
Between 45 and 90 minutes, according to the type of surgery. It is carried out in theatre, generally under local anaesthetic for the upper eyelid, and with sedation or general anaesthetic for the lower one.
When can I go back to work?
The stitches come out between the fifth and the seventh day and most patients return to social and working life at 7 to 10 days. The final outcome is seen between the third and the sixth week, once the swelling has gone.
What aftercare is needed?
Cold locally for the first 48 hours, sleeping with the head raised to reduce swelling, avoiding intense exercise during the first week, no make-up or creams until the surgeon allows it, and keeping the area clean and dry.
How long do the results last?
They are lasting and hold for many years, although they are subject to the natural changes of ageing. In some cases a slight touch-up may be needed over time if new slackness or a build-up of fat appears.
Can this surgery cause loss of vision?
It is the serious complication, and precisely because it is rare it deserves figures rather than silence. Retrobulbar haematoma — bleeding behind the eye — appeared, across 269,433 operations, in around 1 in 2,000 cases, and with permanent visual loss in approximately 1 in 22,000. Another survey of 752,816 blepharoplasties estimated visual loss of any kind at 1 in 20,000 and permanent loss at 1 in 30,000.
How is it recognised and when does it happen?
Most cases occur in the first three hours after surgery, with two described peaks — from theatre to the first hour and between six and twelve hours — and the risk falls markedly after 24 hours. The commonest symptoms are pain and a feeling of pressure in the eye, quite unlike the normal discomfort. Pain that grows instead of easing, with a tense eyelid, is a reason to call there and then; treated in time it can be resolved.
What can I do to reduce that risk?
The associated factors are four, and all four can be acted on: high blood pressure — the most frequent — perioperative use of aspirin, post-operative vomiting and early physical effort. Controlling blood pressure, stopping in good time whatever needs stopping and not overdoing it in the first few days are not routine recommendations.
What other complications can there be?
Uncommon ones: haematoma or persistent swelling, visible or irregular scars, eyelid asymmetry, a sensation of dry eye or temporary irritation, and retraction of the lower eyelid if too much skin is removed.
Sources
Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC.Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthalmic Plast Reconstr Surg. 2004;20(6):426-432. PMID 15599241 — 269,433 cases: orbital haematoma in 1 in 2,000 and permanent visual loss in 1 in 22,000; most within the first three hours.
Mejia JD, Egro FM, Nahai F.Visual loss after blepharoplasty: incidence, management, and preventive measures. Aesthet Surg J. 2011;31(1):21-29. PMID 21239669 — 752,816 blepharoplasties: visual loss in 1 in 20,000 and permanent loss in 1 in 30,000; high blood pressure was the most frequent risk factor and pain with pressure the guiding symptom.
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