Having the signs (folds, bags, laxity) does not automatically make you a candidate: the indication comes from a medical assessment combining anatomical, functional and psychological criteria.
Most cases fall between the ages of 40 and 70, but surgery can be carried out earlier where there are inherited bags, and after 70 if general health is good and the skin keeps its elasticity.
Good eye health and well-controlled chronic conditions favour surgery; severe dry eye, uncontrolled glaucoma, poorly controlled thyroid disease or diabetes, and healing disorders limit or rule it out.
The ideal candidate has realistic expectations: they want to improve, not to be transformed; the surgery restores harmony to the eyes, it does not change identity or solve emotional problems.
With marked laxity of the lower eyelid or a tendency to ectropion, additional procedures such as a canthopexy may be needed to avoid complications.
Blepharoplasty is an operation that rejuvenates the eyes by correcting excess skin, fat or laxity in the upper and lower eyelids. The surgery has an aesthetic effect but can also improve the field of vision in certain cases. Not everyone with signs of ageing around the eyes, however, is a suitable candidate for it.
At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, candidates are selected after a rigorous medical assessment based on anatomical, functional and psychological parameters. That approach ensures each patient receives treatment suited to their needs, their expectations and their general state of health.
What follows describes in detail the ideal patient profile for blepharoplasty, taking into account age, medical conditions, anatomical background and personal motivation.
Before assessing whether you are a candidate it helps to know exactly what the surgery corrects: we explain that in the general guide to blepharoplasty.
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There are a number of physical signs that usually prompt a consultation about blepharoplasty. They can appear gradually with ageing or be present in younger patients for inherited reasons.
The most frequent signs that can make this surgery advisable are:
Excess skin on the upper eyelid forming visible folds.
Drooping of the upper eyelid that hides the natural crease.
Pads of fat appearing under the eyes.
Laxity or lines in the lower eyelid.
A constant look of tiredness, sadness or facial ageing.
A reduced field of vision from mechanical obstruction.
Asymmetry between the eyes caused by changes in the eyelids.
Having one or more of these signs does not automatically make a patient a candidate. A detailed analysis is needed to assess whether surgery is indicated.
The recommended age for blepharoplasty
There is no single age for this surgery. The most frequent cases, however, are concentrated in people between 40 and 70. In that band, ageing has already produced visible changes in the eyelids, but the skin still has an adequate capacity to recover.
The surgery can also be carried out in younger people where there are pads of fat of inherited origin or an early drooping of the eyelids. In those cases it is essential to check that the change is not due to other medical causes, such as neuromuscular or endocrine problems.
In patients over 70, blepharoplasty may be indicated if general health is good, the skin has enough elasticity and the aim of treatment is compatible with a reasonable aesthetic result.
To be considered a suitable candidate, the patient has to be in good general health. Blepharoplasty is not a complex operation, but it is still surgery, so there are certain medical requirements to be met.
Favourable medical conditions are:
The absence of poorly controlled chronic conditions.
Blood pressure properly controlled.
No clotting disorders.
Good eye health.
Not being on active immunosuppressant treatment.
The ability to follow the instructions before and after surgery.
There are also some absolute or relative contraindications to be taken into account:
Severe dry eye syndrome.
Uncontrolled glaucoma.
Poorly controlled thyroid disease.
Uncontrolled diabetes.
Healing disorders.
Psychiatric conditions that alter the perception of body image.
Before surgery is scheduled, the patient must undergo a complete medical assessment including an eye examination, a review of their medical history and a functional assessment of the eyelids.
Ideal anatomical characteristics
Anatomically, certain characteristics favour better recovery and more predictable results in blepharoplasty. Among them:
Skin with sufficient elasticity.
No abnormality of the levator muscle of the eyelid.
A proper position of the eye in relation to the eyelid margin.
Good tone in the orbicularis muscle.
Harmonious facial structural support.
In patients with excessive laxity of the lower eyelid or a tendency to ectropion, additional procedures such as a canthopexy may be needed to avoid complications afterwards.
Surgery has to be adapted to each patient’s anatomy. The assessment beforehand therefore includes a detailed analysis of the tissues around the eye, the movement of the eyelid and the contour of the face.
Dry eye: what weighs most in selecting candidates
Of everything assessed at the consultation, there is one matter that decides more than any other who is a good candidate and on what plan: the tear film. And it is worth discussing with figures, because it is common.
In a review of 892 blepharoplasties carried out by a single surgeon over ten years, 26.5% of patients reported symptoms of dry eye and 26.3% had chemosis. It is not a rarity: it happens to one in four. What matters is that the factors that predict it can be identified before surgery:
Pre-existing scleral show — white showing below the iris — and laxity of the lower eyelid.
Symptoms of dryness already present beforehand.
Hormone treatment.
And two that depend on the surgical planning: operating on the upper and lower eyelid in the same sitting, and the use of a skin-muscle flap.
That penultimate point is the one that changes a consultation most. Combining upper and lower is convenient and tempting, but it multiplies the risk of dryness and chemosis; in an eye already short of tears, separating the two operations is a reasonable decision even though it means going through theatre twice.
And here comes the other half of the message, the half that tends to be missing: both dry eye and chemosis settle on their own in the great majority of cases. They are not lasting damage, they are phases of recovery. Chemosis — that jelly-like puffiness of the white of the eye that is so alarming in the mirror — resolves by itself as the inflammation goes down, and the dryness does the same as blinking returns to normal; meanwhile it is managed with artificial tears and lubrication at night, which is supportive treatment, not a remedy for something that will not settle.
The figures bear this out. In a series of 202 patients, symptoms lasted more than two weeks in 10.9%, persisted beyond two months in only 2% and just one patient (0.5%) needed a surgical correction. Put another way: it is frequent at first and exceptional for it to stay. The way to keep it that way is to identify beforehand who it is going to happen to and adjust their plan.
Realistic expectations and personal motivation
An essential aspect in selecting the ideal candidate is the patient’s motivation and their understanding of the procedure. Blepharoplasty does not transform the face or change the patient’s identity. Its aim is to restore harmony to the eyes, removing the signs of ageing without producing an artificial result.
Ideal candidates show the following attitudes:
They want to improve their appearance, not to be transformed.
They understand the limits of the surgery.
They are aware of the recovery time needed.
They are willing to follow the aftercare instructions.
They are not looking to surgery for a solution to emotional or personal problems.
Where expectations are disproportionate, or the patient is not willing to accept the possible risks and limitations of the procedure, it is better to postpone or rule out the operation.
Frequent profiles of ideal candidates
Some common profiles of candidates for blepharoplasty include:
People between 45 and 60 with marked bags and drooping upper eyelids.
Women who have lost definition in the eyelid crease and cannot apply make-up normally.
Men with a constantly tired expression from laxity in the lower eyelid.
Younger patients with inherited bags and no excess skin.
Patients with restricted vision from obstruction of the upper field.
In every case the procedure is adapted to the specific needs, using upper, lower, transconjunctival or combined techniques, with or without laser.
Once it has been confirmed that the patient is a suitable candidate, the operation is prepared in a planned way. The measures beforehand include:
Stopping anticoagulant or anti-inflammatory medication where indicated.
Avoiding tobacco, to help healing.
Blood tests and an anaesthetic assessment.
Explaining the procedure, the recovery time and the aftercare advice.
Good surgical preparation is essential in keeping complications to a minimum and ensuring a quick, safe recovery.
Blepharoplasty is surgery with high rates of satisfaction, provided it is carried out on the right patient and under the right clinical conditions. Identifying the ideal candidate rests not only on the visible signs but on an integrated assessment covering eye health, the quality of the tissues, emotional stability and realistic expectations.
If you are considering this operation, we recommend booking a medical consultation at the Instituto de Cirugía Plástica del Mediterráneo. Our team of specialists will analyse your case individually to determine whether you are a good candidate and which technique is the most suitable for you. Safety, a natural appearance and respect for each individual anatomy are the pillars of our surgical approach.
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Having the signs does not automatically make you a candidate. The indication comes from a medical assessment combining anatomical, functional and psychological criteria: the periorbital tissues, the dynamics of the eyelid and the facial contour all have to be analysed before deciding.
Is there a right age for surgery?
There is no single age. Most cases fall between 40 and 70, when the changes are already visible but the skin still recovers well. It can be done earlier where there are inherited fatty bags — having checked that they are not due to neuromuscular or endocrine causes — and after 70 if general health is good and the skin keeps its elasticity.
Which medical conditions favour surgery?
No decompensated chronic illness, well-controlled high blood pressure, no clotting disorders, good eye health, not being on active immunosuppressant treatment, and being able to follow the pre- and post-operative instructions.
And which ones rule it out?
Severe dry eye syndrome, uncontrolled glaucoma, poorly controlled thyroid disease, uncontrolled diabetes, healing disorders and psychiatric conditions that alter the perception of body image.
Why do they ask so much about dry eye?
Because it is what weighs most in selecting candidates. In a review of 892 blepharoplasties, 26.5% of patients reported dry eye symptoms and 26.3% chemosis: it happens to one in four. And the factors that predict it can be identified before surgery: existing scleral show, lower lid laxity, dryness already present, hormone treatment, operating on the upper and lower eyelids in the same session, and the use of a skin-muscle flap.
If it happens to me, will it stay that way?
Almost never. Both dry eye and chemosis settle on their own in the great majority of cases: they are phases of the recovery, not sequelae. In a series of 202 patients, symptoms lasted more than two weeks in 10.9%, persisted beyond two months in only 2% and just one patient (0.5%) needed surgical correction. Meanwhile they are managed with artificial tears and night-time lubrication.
Which anatomical features help?
Skin with enough elasticity, no abnormality of the levator muscle, an adequate position of the eyeball relative to the lid margin, good orbicularis tone and a harmonious facial structural support. With marked lower lid laxity or a tendency to ectropion, additional steps such as a canthopexy may be needed.
What expectations should the patient have?
Realistic ones. The ideal candidate wants to improve their appearance, not to be transformed: they understand the limits of surgery, are aware of the recovery time, are prepared to follow the post-operative instructions and are not looking to solve emotional problems through surgery. Where expectations are disproportionate, it is better to postpone or set the operation aside.
Which profiles are the most common?
People aged 45 to 60 with marked bags and drooping upper eyelids; women who have lost definition of the crease and cannot apply make-up normally; men with a permanently tired expression from slackness of the lower eyelid; young patients with inherited bags and no excess skin; and patients with restricted vision from obstruction of the superior field.
Sources
Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW.Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg. 2013;15(1):39-46. PMID 23329270 — 26.5% with dry eye symptoms and 26.3% with chemosis; among the risk factors, pre-existing scleral show, eyelid laxity and operating on the upper and lower lid together.
Hamawy AH, Farkas JP, Fagien S, Rohrich RJ.Preventing and managing dry eyes after periorbital surgery: a retrospective review. Plast Reconstr Surg. 2009;123(1):353-359. PMID 19116572 — 202 patients: symptoms beyond two weeks in 10.9%, beyond two months in 2% and surgical correction in 0.5%.
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