An upper blepharoplasty is a surgical procedure that removes excess skin, muscle, and sometimes fat from the upper eyelids. It’s one of the most common facial surgeries, performed both for cosmetic reasons (to create a more alert, youthful appearance) and for functional ones (when drooping skin starts blocking your vision). The procedure typically takes one to two hours and is done on an outpatient basis, meaning you go home the same day.
What Happens During the Procedure
The surgeon makes an incision along the natural crease of your upper eyelid. This placement is intentional: once the scar matures, it hides within the fold where your eyelid naturally creases when your eyes are open. Through that incision, the surgeon trims away sagging skin and muscle, removes excess fat if needed, then closes the incision with fine sutures.
Most upper blepharoplasties are performed under local anesthesia alone, often right in the surgeon’s office rather than a hospital operating room. In one study of nearly 100 patients, about two-thirds had the procedure done with local anesthesia only, while the remaining third received either sedation or general anesthesia in a surgical suite. Your surgeon will recommend an approach based on the complexity of your case and your comfort level.
Cosmetic vs. Functional Blepharoplasty
The distinction between cosmetic and functional matters most when it comes to insurance coverage. A cosmetic blepharoplasty addresses appearance. A functional blepharoplasty corrects a measurable problem: the excess upper eyelid skin (called dermatochalasis) droops far enough to obstruct your peripheral or upper visual field.
To qualify for insurance coverage, you’ll typically need a documented functional complaint (not a cosmetic one), clinical photographs showing the eyelid abnormality, and visual field testing. The standard test measures your field of vision twice: once with your eyelid resting naturally, and again with the lid taped up. The difference between those two measurements demonstrates how much improvement surgery could provide. Your surgeon will also measure the distance between your pupil center and upper eyelid margin, a metric called the margin reflex distance. Requirements vary by insurer, so your surgeon’s office will know exactly what documentation your specific plan needs.
Recovery Week by Week
The first few days are the most uncomfortable. Expect swelling, bruising, and tightness around your eyes. Stanford Medicine recommends icing 30 minutes per hour while awake for the first 48 to 72 hours after surgery, which makes a significant difference in controlling swelling.
Between days five and seven, external stitches come out if non-dissolvable sutures were used. This is also around the time many people get clearance to start wearing contact lenses again, though you should begin with short wear times and work up gradually.
During week two, you can start gentle, low-intensity activity like casual walks or easy time on a stationary bike. Heavy lifting, running, contact sports, and hot yoga are still off limits. By weeks three and four, visible bruising is typically gone, and most people feel comfortable in public without concealer. You can gradually increase exercise intensity during this window. Full clearance for unrestricted physical activity usually comes around weeks six to eight.
How Scars Heal Over Time
Because the incision sits in your eyelid crease, the scar is well-concealed from the start. During the first one to three months, the scar flattens and fades, becoming paler. Most people feel comfortable going without makeup to cover it by this point. Between three and six months, scars are typically barely perceptible, especially when you’re looking straight ahead with your eyes open. Final maturation happens between six and twelve months, at which point the scar is usually soft, thin, and blends with surrounding skin.
Risks and Complications
Dry eye is the most talked-about complication. Studies have reported dry eyes in up to 26.5% of people who undergo blepharoplasty. The surgery can change your tear composition, reduce your blink rate, and leave your blink reflex slightly incomplete, all because a small amount of the muscle responsible for closing your eyes is removed or disrupted during the procedure. If you already have dry eyes before surgery, this is worth discussing with your surgeon in detail.
Having both upper and lower blepharoplasty at the same time increases the odds of developing dryness compared to operating on just one set of eyelids. Another potential complication is lagophthalmos, where you temporarily can’t fully close your eyes. This happens when too much skin is removed and usually improves as healing progresses, though it can worsen dry eye symptoms in the meantime.
Other risks include infection, bleeding, asymmetry, and in rare cases, changes in eyelid position that require revision surgery.
Preparing for Surgery
Your surgeon will ask you to stop taking blood thinners, aspirin, ibuprofen, and anti-inflammatory medications at least five days before the procedure (with your primary care doctor’s guidance if you take these for a medical condition). Supplements and vitamins also matter here. Fish oil, vitamin E, and certain herbal supplements can increase bleeding and bruising, so make sure your surgical team knows about everything you take, not just prescription medications.
Smoking constricts blood vessels and slows healing. Most surgeons will ask you to stop smoking well in advance of surgery and throughout recovery.
Cost of Upper Blepharoplasty
The average surgeon’s fee for a cosmetic upper blepharoplasty is $3,359, according to the American Society of Plastic Surgeons. That number covers only the surgeon’s time. It does not include anesthesia fees, facility costs, or related expenses, which can add substantially to the total. If your procedure qualifies as functional and your insurance covers it, your out-of-pocket cost will depend on your plan’s deductible and copay structure.
How Long Results Last
The tissue removed during an upper blepharoplasty doesn’t grow back. In that sense, the results are permanent. However, your skin and remaining tissue continue to age. Upper eyelid results typically last around seven years before subtle changes might prompt consideration of a touch-up procedure. Factors like genetics, sun exposure, and skin quality influence how quickly aging becomes noticeable again.