What Happens During Blepharoplasty?

The decision to undergo eyelid surgery should not begin with the operation itself. It begins with understanding what is causing your concerns and whether surgery is the right solution for you.

Our Sapphire treatment journey is designed to support patients throughout the process.

At your consultation, your eyes and eyelids are assessed before your consultant discusses the treatment options that may be appropriate. If surgery is recommended and you decide to proceed, our team will then help organise your treatment and provide the information you need to prepare.

Support continues after surgery, with follow-up care designed to monitor your recovery.

If you are thinking about blepharoplasty but are not yet ready to book a surgical consultation, you can start by speaking with our team.

You can book a Free Online Consultation, contact Sapphire Eye Care directly or request a callback to discuss your concerns and the possible next steps.

An initial online consultation can be a useful way to find out more about blepharoplasty and whether further assessment may be appropriate. However, it does not replace the detailed clinical assessment required before surgery.

If you decide to explore treatment further, you will have the opportunity to meet with a specialist consultant who can assess your eyes and eyelids thoroughly and determine whether blepharoplasty is the right procedure for you.

Considering blepharoplasty? Start with a Free Online Consultation

Once your assessment has been completed, your consultant can recommend a personalised treatment plan.

There is no single blepharoplasty operation that is appropriate for everybody.

Depending on your individual findings, treatment may involve:

• Upper blepharoplasty
• Lower blepharoplasty
• Combined upper and lower eyelid surgery
• Removal of excess eyelid skin
• Treatment or repositioning of fat where appropriate
• Treatment of a small amount of underlying muscle where appropriate
• Another eyelid procedure if blepharoplasty alone would not address the underlying problem

For example, somebody with excess upper eyelid skin may require a different surgical approach from somebody whose main concern is prominent lower eyelid fat or another eyelid condition.

Your consultant can explain the expected benefits of treatment, the result that may realistically be achieved, alternatives to surgery, potential risks, anaesthetic options and likely recovery before you make a decision.

If you and your consultant decide that blepharoplasty is appropriate and you would like to proceed, the Sapphire team will help arrange the next stages of your treatment.

Our secretarial team can work with you to organise a suitable treatment date and appropriate private hospital or surgical location.

Before your operation, you will receive information about your admission and any specific preparation required. Depending on your circumstances, this may include:

• Pre-operative information
• A health questionnaire
• Guidance about medications
• Guidance about contact lens wear (if worn)
• Anaesthetic or fasting instructions
• Your admission arrangements
• Personalised instructions from your clinical team

You will also have the opportunity to contact us if you have questions before the day of your procedure.

You can read more about preparing for eye surgery at Sapphire Eye Care.

Your preparation will depend on your health, medication, type of surgery and the anaesthetic being used. You should therefore always follow the individual instructions provided by your consultant and surgical team.

Tell Sapphire About Your Medication

Make sure the clinical team knows about all medication you take, including prescribed medications.

Some medicines, particularly anticoagulants and other medications that affect bleeding, may require particular consideration before eyelid surgery.

Do not stop prescribed medication yourself before surgery.

If medication needs to be changed or temporarily stopped, this should only happen following appropriate medical advice.

Smoking Before Blepharoplasty

Smoking can interfere with the body’s healing process.

Sapphire’s current oculoplastic guidance recommends that patients who smoke avoid smoking for at least two weeks before eyelid surgery and for the first few weeks afterwards.

Your consultant can give you personalised advice based on your circumstances.

Eating and Drinking

Whether you can eat or drink before blepharoplasty depends partly on the anaesthetic being used.

Requirements can differ between surgery performed under local anaesthetic, with sedation or under general anaesthetic. Do not assume you need to fast — or that you do not need to fast.

Follow the specific instructions supplied by the hospital or surgical team for your personalised procedure.

Plan for Your Recovery

It is also worth thinking beyond the operation itself.

You should plan how you will get home after treatment and allow yourself sufficient time to recover before returning to work, exercise and social activities.

Recovery differs between individuals, but Sapphire generally recommends allowing approximately one to two weeks away from work following blepharoplasty.

It is also sensible not to arrange eyelid surgery immediately before an important event, as bruising or residual swelling can take longer to disappear completely.

Blepharoplasty is normally performed as a day-case procedure, meaning most patients can return home later the same day.

When you arrive at the hospital or surgical facility, you will be welcomed by the clinical team and the necessary pre-operative checks will be completed.

You will also have another opportunity to speak to your consultant before the procedure. This gives you the chance to ask any final questions and allows your surgeon to review the planned treatment with you.

If general anaesthesia is being used, you will also meet the anaesthetist.

Once you are ready for treatment, the procedure itself follows a carefully planned sequence.

There are different types of blepharoplasty depending on which part of the eyelids needs treatment. Upper blepharoplasty focuses on the upper eyelids, while lower blepharoplasty addresses concerns such as excess skin or prominent fat beneath the eyes; some patients may benefit from treatment to both. The exact approach is always determined by your individual anatomy and goals. In the following section, we focus specifically on a typical upper blepharoplasty procedure, as this is the treatment demonstrated in our Sapphire Eye Care procedure video.

During an upper blepharoplasty, the surgeon carefully assesses and marks the eyelid before anaesthetic is administered. An incision is then made within the natural upper eyelid crease, the tissue identified in your individual surgical plan is treated, and the incision is carefully closed with fine sutures.

The exact procedure varies from person to person.

Step 1 – Examining and Marking the Eyelids

Before beginning the operation, your surgeon carefully reassesses your eyelids position and determines the appropriate amount of eyelid tissue that is to be treated.

Marks are drawn on the eyelid using a surgical marking pen.

These markings act as an important guide during the surgery and help the surgeon plan your individual treatment according to your eyelid anatomy.

Step 2 – Local Anaesthetic

Many upper blepharoplasty procedures can be carried out under local anaesthetic, although sedation or general anaesthesia may be recommended or preferred in some circumstances.

When local anaesthetic is used, it is injected around the eyelid.

You may experience a brief stinging sensation when the anaesthetic is administered. Once the area is numb, you may still be aware of sensations such as touch, pressure or movement, but you should not experience sharp surgical pain.

Step 3 – Preparing the Surgical Area

The area around the eyes is carefully cleaned and prepared for surgery.

Sterile drapes are used to help maintain the surgical field, and the clinical team will make sure you are appropriately positioned and comfortable before treatment continues.

Step 4 – Making the Incision in the Natural Eyelid Crease

For upper eyelid surgery, the incision is carefully positioned within the natural crease of the upper eyelid.

This gives the surgeon access to the tissue that needs to be treated while helping the eventual scar sit within the normal eyelid fold, where it should become increasingly discreet as healing progresses.

Step 5 – Removing or Repositioning Excess Tissue

What happens next depends on what your consultant identified during your assessment.

For some patients, the main issue is excess upper eyelid skin. For others, underlying muscle or areas of prominent fat may also need to be addressed.

Depending on your needs, the surgeon may therefore:

• Remove excess eyelid skin
• Preserve or partially treat a small amount of underlying muscle
• Remove or reposition prominent fat where appropriate

Not every blepharoplasty involves treatment of all these structures. This is why detailed assessment and individual surgical planning are so important.

Step 6 – Closing the Eyelid with Fine Sutures

Once the planned correction has been completed, the edges of the incision are carefully brought together.

Fine sutures are positioned along the eyelid crease to close the skin and help reform its natural fold.

The type of suture used can vary. Your surgical team will explain whether your stitches need to be removed at a follow-up appointment or whether dissolvable sutures have been used.

Many upper blepharoplasty procedures can be performed under local anaesthetic, meaning you may remain awake while the eyelid area is numb.

Some patients or procedures may instead be more suited to sedation or general anaesthesia.

Your consultant will discuss the available options with you and recommend an approach based on the procedure being performed, your medical circumstances and individual preferences.

The injection used to administer local anaesthetic can cause a brief stinging sensation.

Once the anaesthetic has taken effect, the eyelid should be numb. You may remain aware of touch, movement or pressure during the procedure, but sharp surgical pain should not normally be experienced.

The clinical team remains with you throughout the procedure and your comfort is monitored during surgery.

Afterwards, some soreness, tightness or discomfort can occur as the anaesthetic wears off. Your team will provide appropriate aftercare advice and guidance on managing discomfort.

The exact operating time depends on whether the upper eyelids, lower eyelids or both are being treated and on the complexity of the individual procedure.

Many blepharoplasty operations take around an hour, although some procedures take longer. Combined upper and lower eyelid surgery, for example, may take more time than upper eyelid surgery alone.

Your consultant will be able to give you a more personalised indication of the likely procedure time once your treatment has been planned.

Following surgery, you will usually return to a recovery area or private room where the nursing team can make sure you are comfortable.

Cold packs may be used to help reduce early swelling and bruising, and pain relief can be provided where necessary.

If you have received sedation or a general anaesthetic, you will remain at the facility until the team is satisfied that you have recovered sufficiently.

Blepharoplasty is normally a day-case procedure, so once the clinical team is happy with your recovery, you can usually return home later that day.

You should follow the specific discharge and transport instructions you have been given and arrange for somebody to take you home where advised.

Bruising and swelling around the eyelids are expected during the early stages of recovery.

They are generally most noticeable initially and then gradually settle. Many patients allow approximately one to two weeks before returning to work or social activities, although individual recovery varies and subtle swelling can take longer to resolve.

Depending on the sutures used, they may either dissolve naturally or be removed at a follow-up appointment.

Your final result also develops gradually as swelling settles and the eyelids continue to heal.

Importantly, Sapphire’s care does not end when you leave the hospital. One of our specialist ophthalmic nurses will contact you within 48 hours of your procedure to check how you are getting on and make sure your recovery is progressing as expected.

For a more detailed week-by-week explanation, read our upper blepharoplasty recovery guide.

If you are considering treatment to the lower eyelids, we also have a dedicated lower blepharoplasty recovery guide.

For patients who would like to understand the procedure in more detail, the video below follows a real Sapphire Eye Care patient through an upper blepharoplasty procedure – from consultation and eyelid assessment through to the operation itself and the final before-and-after result.

The video shows several of the stages described in this guide, including assessment of the eyelids, surgical marking, preparation, local anaesthetic, treatment of the upper eyelids and closure of the incision.

Blepharoplasty can be extremely effective for suitable patients, but the same operation should not simply be applied to everyone with hooded, heavy or ageing eyelids.

The appropriate treatment depends on factors including:

• Your eyelid anatomy
• Your overall eye health
• Eyelid position and function
• The amount and distribution of excess skin or fat
• Whether another eyelid condition is contributing to the problem
• Whether your concerns are cosmetic, functional or both
• What you would realistically like treatment to achieve
• How much eyelid surgery has already been undertaken

Choosing a provider with specialist oculoplastic expertise means your assessment can consider the appearance of your eyelids alongside their function and the health of your eyes.

At Sapphire Eye Care, our aim is to establish the treatment that is right for you, rather than assuming that blepharoplasty is always the answer.

If you are considering upper or lower eyelid surgery, the specialist team at Sapphire Eye Care can help you understand whether blepharoplasty may be suitable for you and what treatment could realistically achieve.

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