Face & Eyes

Blepharoplasty

at Cadogan Clinic, London’s Leading Cosmetic Surgery Specialists. 

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Medically Reviewed 14 February 2024, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is a Blepharoplasty (Eyelid Reduction)?

Blepharoplasty, also known as eyelid reduction, is a surgical procedure to reshape the eyelids by removing excess fat and skin. Blepharoplasty is a highly effective treatment for the signs of ageing around the eye area and improves the common concerns of eye bags and hooded or droopy eyelids. In instances where these concerns are more severe, blepharoplasty can also help to improve vision.

As we age, our skin and muscles lose elasticity, causing loss of tone, resulting in wrinkles and sagging. This causes the upper and lower eyelids to sag. As the skin around the eye area is especially delicate, the signs of ageing often occur here sooner than in other areas of the face. Loose skin accumulates as folds in the upper eyelids which can droop over the natural eyelid, obscuring the patient’s vision. The relaxation of the muscle in the lower eyelid causes the fat which cushions the eyes in their sockets to push forward, causing eyebags to appear.

Blepharoplasty is often combined with other procedures such as a facelift or eyebrow lift to enhance the overall result. At Cadogan Clinic, we are one of the leading blepharoplasty London providers, and our team of consultant surgeons' reptuation spans the UK.

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Stress, a lack of sleep, excessive sun exposure, smoking and genetics can make eye folds, creases and bags look worse.

The ageing process can also cause eyelids to droop and folds of skin to accumulate in the upper lids. Sometimes this gathered skin can hang over the eyelashes and interfere with vision. An upper blepharoplasty can improve vision and make you look younger. A lower blepharoplasty reduces wrinkles and puffiness, rejuvenating the eye area. The procedure is suitable for men and women looking for a quick and effective way to eliminate the tell-tale signs of aging around the eyes.

Blepharoplasty surgery is increasing in popularity and was the third most popular surgical procedure carried out on men and women in the UK in 2020, beaten only by breast augmentation and breast reduction.


Blepharoplasty (Eyelid Reduction)
At a glance

Surgery Time

1 - 2 hours

Time off work

1 week

Hospital Stay

Day Case

Shower

After 1 week

Reasonable Mobility

After 1 day

Exercise

After 6 weeks

Sexual Activity

After 4 weeks

Sleeping on back

2 - 4 weeks

Full Recovery

2 weeks

Driving

1 week


Before and after Blepharoplasty (Eyelid Reduction)

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Why do people have it?

Why do people have it & Who is suittable

As we age, the building blocks of our skin, collagen and elastin begin to weaken and break down. This results in wrinkles and sagging occurring. This can be especially prominent in the eye area, as the skin is especially thin and delicate, meaning it is more prone to these natural signs of ageing. 

In the upper eyelids, this results in folds forming which make the eyes look smaller and some patients describe as making them look sad leading to a loss in confidence. In severe cases, these folds can push down over the eyelashes, causing loss of vision. 

In the lower eyelids, the natural weakening of the muscle causes the fat pads under the eyes to push forward leading to eye bags forming. This can have a dramatic appearance on the face and can lead to feelings of self-consciousness because of ‘tired eyes’. This is why some patients opt for lower eyelid surgery, or a lower blepharoplasty.

Surgeons recommend blepharoplasty as a highly effective procedure that improves these concerns with minimal downtime. The procedure can improve the patient’s physical concerns, as well as leading to an improved quality of life. This is evident in our eyelid reduction before and after cases.

Who is suitable?

At Cadogan Clinic, our consultant surgeons will assess whether you are suitable for blepharoplasty in a bespoke one to one consultation. 

Your surgeon will examine your eye area and discuss your concerns so they can recommend the best surgical plan for you. They will discuss your expectations of surgery and ensure you understand the individual results that are possible from blepharoplasty. They will also assess your general physical and mental health to make sure you are suitable for a general anaesthetic or sedation procedure, this may include your weight, and any medical and mental conditions you have. You must be over 18 to have this procedure.

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The cost of Blepharoplasty (Eyelid Reduction)

Cadogan Clinic has collaborated with Chrysalis Finance to offer a variety of payment choices for our patients including:
12 months 0% Interest-free - APR
24 - 60 months at 12.9% APR
Flexible Finance

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Included in this treatment

Up to two 60 minute consultations with a leading specialist plastic surgeon at our award-winning premises in Chelsea

Your procedure carried out at London’s leading specialist cosmetic surgery centre of excellence

24/7 on call nurse assistance

Dedicated Patient Co-ordinator, as a personal point of contact through your journey with Cadogan

A pre-operative medical assessment to ensure you are fit for surgery

Comprehensive post-operative aftercare courtesy of our specialist cosmetic nurses

What are the different types of eyelid reduction surgery?

Blepharoplasty is a surgical procedure carried out under either general anaesthetic, meaning you are completely asleep and unaware of your surgery, or sedation - you are awake but unaware of the procedure and feel no pain or discomfort. Your surgeon will explain which is the best option for you during your consultation.

Depending on the techniques used, and whether other surgical procedures are required, a blepharoplasty takes 30-90 minutes. There are three different techniques that we carry out at Cadogan Clinic:

Your surgeon will make a small oval shaped incision along the eyelid crease before removing excess skin, fat or sagging muscle. They will then stitch the two sides together to lift the eyelid and remove any skin folds. This is the most common form of Blepharoplasty surgery and targets age-related concerns around the eyes, such as drooping skin and loss of tone. It can also restore vision in cases where this is a concern due to folds of skin sitting on the eyelashes. Any scarring will be concealed within the eyelid crease.

Lower eyelid blepharoplasty targets wrinkles and puffiness below the eye, usually caused by the fat pads pushing forwards as the muscle around the eye has weakened with age. Your surgeon will either make an incision from under the lower eyelashes to the outside corner of the eye, or inside the lower eyelid before taking out or repositioning fat pads from the under-eye bags. Sometimes the surgeon will also manipulate and tighten the skin, supporting the muscles and tendon of the eyelid if required. The skin is repositioned to smooth out the wrinkles and the incision is then closed.

Some people have visible eyelid creases, known as double eyelids, while others were born without eyelid creases - this is especially common in people from an East Asian background. Although there is nothing medically concerning about this feature, some patients feel it makes their eyes look smaller. Several small incisions are made on the natural double eyelid line and skin is removed. The muscle which closes the eyelids - called the orbicularis oculi, and fat tissue will be removed between the incisions. The incisions are then closed so the eyes heal with a natural double crease. 

Blepharoplasty (Eyelid Reduction) Surgeons

We have invited a selection of the country's very best consultants to join us at the Cadogan Clinic so that you can be sure that whatever the nature of your treatment, you will be seeing one of the top practitioners in the country.


What to expect

Below you will find some key information to help you prepare for surgery and make necessary arrangements to ensure you have the support you need and that everything runs smoothly on the day.

Your package includes up to two consultations with your consultant at our award-winning Chelsea based clinic. You will get to discuss your concerns and the results you are looking for from your eyelid reduction procedure. Surgical consultations are usually up to an hour long, and your surgeon will explain what they are planning on including in your surgical plan and any specific steps you need to take to prepare.

We recommend preparing for your consultation, by writing down any questions you have for your surgeon. This will allow you to get the most from your consultation and feel fully prepared. Your surgeon will also assess your general health and wellness, take your measurements, and take photos of your eyes and face.

Your surgeon will write up your plan and send it to your patient advisor. If your surgeon has recommended blepharoplasty for you, your advisor will contact you with your surgical plan, your quote and let you know when your surgeon’s next available dates are. You will then have a two-week cooling off period to allow you to reflect on your surgical plan and decide whether you would like to proceed with your blepharoplasty.

If you do proceed with your blepharoplasty, your next visit to Cadogan Clinic will be on your surgery day. You will be asked to follow these steps to prepare for your procedure:

  • You will need to complete your pre-operative medical and psychological assessment forms to allow your surgeon, anaesthetist, and nurses to review all your information and ensure you are safe for surgery.
  • Your surgeon will ask you to stop smoking and vaping for six weeks before surgery can take place. This results in a smoother and more efficient recovery.
  • Excessive alcohol consumption can also have a negative impact on your recovery. You will be asked to reduce your alcohol consumption and consume no alcohol in the 48 hours before your procedure.
  • You will be asked to not take any anti-inflammatory medications such as ibuprofen and aspirin, and any herbal supplements, a week before your surgery as these can increase the risk of bleeding.
  • You will need to make sure you have a chaperone confirmed to come and collect you after your procedure. This should be a family member or friend who can either drive you or accompany you in a taxi and stay with you for the first night.
  • In the 6 hours before you arrive at the clinic, you mustn’t eat any solid food or consume any juice or milk (including tea or coffee). You can have sips of clear liquids (water, or black tea and coffee) up to 2 hours before you arrive at the clinic.

You will be asked to arrive at the clinic an hour before your surgery time for admission. You will speak to your surgeon, anaesthetist, and our nurses. You will be asked to put on a surgical gown and compression socks and your surgeon will make any marks they need around your eyes.

When you enter the theatre, your anaesthetist will administer your general anaesthetic or sedation. All general anaesthetic procedures at Cadogan Clinic are carried out using TIVA (Total Intravenous Anaesthesia) which has many benefits including less risk of feeling sick during your recovery and waking up faster.

Your surgeon will then complete your Blepharoplasty. After they have finished, you will first go to our recovery ward and then our ambulatory ward, once you are fully awake and comfortable. You will have pre-ordered some food, and the nurses will check your vital health signs. They will also explain any aftercare you need to be aware of such as your medication and looking after your incisions. Once they are happy that you are well and ready, you will be discharged, and your chaperone will be asked to come and collect you.

During the first few days following surgery you may experience some slight discomfort. Blepharoplasty patients are often prescribed an antibiotic eye ointment which can make your vision slightly blurry. Blepharoplasty recovery is usually relatively fast, and you can expect the swelling and bruising to reduce within 1-2 weeks.

One week after your surgery you will have an in-person appointment to have your sutures removed and have your incisions cleaned. The team will explain how you need to continue to look after your dressings and answer any questions.

Six weeks after your procedure you will be asked to come and see your surgeon so they can examine your eyes again and make sure you are happy with your results. They will explain what you can expect going forwards. If you have any questions from this point onwards, you will still be able to contact our specialist cosmetic surgery nurses at any time.

The Patient Journey. A breakdown of what you can expect on your journey with us

We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journey

The Patient Journey

Frequently Asked Questions

Eyelid reduction is another term for blepharoplasty, but is specifically used to refer to techniques designed to tighten the eyelids and reduce, reshape or lift the eyelid skin around the eye to achieve a refreshed, rejuvenated appearance.

It is possible to tighten the eyelids and reduce, reshape and lift the eyelid skin in just 45 minutes, and this treatment is appropriate for both men and women.

It is very common after surgery to have puffy eyelids for a while, but significant complications are rare. You might have more trouble in the evening when trying to shut your eyes to sleep the first few nights. Your eyes may be irritated or watery for several weeks following the surgery, but this will return rapidly to normal. You may also have bruising resembling a black eye, and some light pink scarring that will fade over time.

Blurred vision immediately after surgery due to persisting local anaesthetic and ointment applied to the eye at the end of the procedure.

Our surgeons will explain all the risks, the likeliness of them occurring and any possibilities of complications upon consultation. 

Blepharoplasty is a straightforward surgery which is carried out as a day case. It is usually done under Total Intravenous Anaesthesia (TIVA), a light anaesthetic, but smaller procedures may only require local anaesthetic. The surgery takes between 30 minutes and one hour, depending on the particular type of blepharoplasty which is being carried out.

There are three different types of procedure that our blepharoplasty surgeons carry out at the Cadogan Clinic:

  • Upper eyelid blepharoplasty: This surgery eliminates vision problems caused by age-related drooping eyelids. Upper eyelid blepharoplasty also restores a youthful appearance. Your surgeon will make an incision along the eyelid crease before removing excess skin, fat or sagging muscle from the area. The skin is stretched in order to smooth out any wrinkles and the incisions are closed. The beauty of this procedure is that the scar is well hidden in the natural fold of the eyelid.
  • Lower eyelid blepharoplasty: This particular type of blepharoplasty is concerned with the elimination of wrinkles and puffiness below the eye. In lower eyelid blepharoplasty, the surgeon will make an incision just below the eyelashes, the cut extending into the crow’s feet, or inside the lower eyelid before taking out or repoisionting fat from under eye bags. Sometimes the surgeon will also do this to the skin supporting the muscles and tendon of the eyelid if required. The skin is stretched to smooth out the wrinkles and the incision is then closed. 
  • Double eyelid blepharoplasty: Some people have visible eyelid creases, known as double eyelids, while others were born without eyelid creases. Although there is nothing medically wrong with this, some people opt for double eyelid blepharoplasty for a more ‘wide eyed’ appearance. In this particular surgery, several small incisions are made on the double eyelid line and skin is removed. The orbicularis oculi muscle (the muscle which closes the eyelids) and fat tissue will be removed between the incisions. The incisions are then closed. 

Double eyelid blepharoplasty is particularly popular in East Asia.

Blepharoplasty is a safe surgical procedure, and you will be in the hands of a world-class, highly experienced, blepharoplasty surgeon here at the Cadogan Clinic.

However, like any other surgery, blepharoplasty is not entirely without risk.

Common side effects include:

  • Puffy, numb eyelids that are difficult to close at night
  • A black eye (bruising)
  • Irritated or watery eyes

If you already suffer from irritated or dry eyes which require regular eye drops, it is quite likely that you will need to use even more eye drops, post-surgery. Watery eyes are temporary and should clear up in a couple of weeks.

An eye lift can very occasionally result in:

  • Temporary blurred or double vision
  • Blood pooling under the skin (haematoma)
  • Asymmetrical eyes

Very rarely, a blepharoplasty may result in more serious problems, such as:

  • Infection
  • Eye muscle injury
  • Drooping of the eyelid
  • Lower eyelid pulling downwards, showing the white of the eye below the iris (eyelid retraction)
  • Lower eyelid drooping away from the eye and turning outwards (ectropion)

Ectropion is caused by post-operative swelling and usually settles as the swelling subsides.

Visual impairment is an extremely rare side effect of blepharoplasty and many people find that their vision improves in the long term.

Your surgeon will give you all your pre-operative advice at your consultation. This may include having an eye test, if you have eye health issues, as well as a physical examination and eyelid photography from all angles. 

You will need to stop taking blood thinning medication such as aspirin, ibuprofen, naproxen, and any other medication or herbal supplement associated with increased bleeding. Your surgeon will advise how long before surgery you need to stop taking these medicines.

You are advised to stop smoking for at least two weeks before your surgery. Smoking reduces healing and increases the risk of complications. Arrange for someone to drive you to and from surgery on the day.

Blepharoplasty is basically skin deep and there is little pain in the post-operative recovery phase. Any discomfort is minor and can be controlled with simple pain relief and eye ointments provided by your surgeon.

Most patients need no analgesia at all after this surgery. Any feeling of grittiness after surgery can be treated with the eye ointment given to you at the time of surgery. Although patients may look bruised and have visible dressings, they can often work from home the next day, and be back to their daily activities after a few days. The pain is minimal. 

Recovery from Blepharoplasty is quick but because surgery is in the middle of the face, the dressings and any bruising will be visible. There are a few patients who disregard this and continue normal life, however, we would suggest that exercise is a bad thing as it will delay recovery from bruising and swelling. Working from home is a good option, but it will take 10 days for bruising of the lower eyelids to settle, the upper eyelids generally settle rather quicker. Bruising can be disguised with make-up and we can advise you about cosmetic camouflage. If you are at all sensitive, you should take two weeks before appearing at work. Stitches are removed in the first week. You should also remember that vision can be a little blurred the first day. This is partly due to the surgery and local anaesthesia used, even when you have a general anaesthetic, but also the ointment applied inside the eyelid morning and night does to some extent obscure vision.

On occasion surgery to the lower rather than the upper eyelid can cause swelling which is a nuisance for longer. There is always swelling of tissues after surgery and if this extends under the conjunctiva and on to the eyeball, this is called chemosis. It makes the eye look watery and this can take several weeks to completely settle. In addition, any bruising under the conjunctiva gives bright red ‘haemorrhages’. Chemosis and haemorrhages are of no significance other than the appearance, it does eventually settle.

Swelling can also push the lower eyelid away from the eyeball causing an ectropion, which is annoying but in most cases settles spontaneously within a few days or weeks.

This really depends on your tolerance to of your appearance. All the surgery is in the middle of the face and therefore rather obvious. There will be some small dressings for about a week and a little bruising of the cheeks below the eyelids. There may be some minor pain and swelling around the incision areas, and your eyes will tend to water.

Alternatively, there may be some dryness that occurs, which is easily relieved with some ointment that your surgeon will provide. Occasionally the ointment will cause the patient to have slightly blurred vision, so you may want to rest and take some extra time off work to just relax at home where you’ll be comfortable. Some patients may have added sensitivity to light temporarily following eyelid surgery, so bare that in mind if your work involves bright lights.

Longer term you may develop chemosis, which is oedema (swelling) of the conjunctiva covering the white of the eye. It settles, but it may take a week or two. Those people who have malar pads or festoons of the upper cheek will find that these swell and persists for a month or two.

We would advise you to rest, avoid putting your head down and ad an extra pillow at night, so that any swelling or bruising settles quicker. We do have patients, who completely disregard this advice, without long-term issues and go back to full work or off on holiday the following day. We do however, like to see the patients to remove stitches a few days later. We will advise on make-up or in the form of cosmetic camouflage which does allow you to get out and about with confidence.

Blepharoplasty surgery can give life-changing results and an experienced expert surgeon will not change the shape of the eyes, unless this is the aim. Surgery has evolved in recent years and less muscle fat and skin are being removed.

Fat may be repositioned rather than removed. There will be no tell-tale signs that it has been removed, you will have a natural, face new look to your face. In addition, we aim for an extra youthful vitality which is achieved by fat grafting of the brow, temple, cheekbones, lower eyelids that surround the eye. Fat grafts include stem cells, which improve skin quality as well as contours This is a very specialised technique which makes all the difference in achieving incredible results you’ll be happy with. 

Blepharoplasty leaves minimal scarring. Any upper blepharoplasty scars will be well hidden in the fold of the eyelid, while lower blepharoplasty scars heal very well, disguised by the eyelashes and in the crow’s feet.

However blepharoplasty scars may potentially be visible when there is a hood of skin extending into the eyelashes to be removed. However this scar fades to be virtually invisible on most people.

It is vital that you follow all the aftercare instructions issued by your surgeon to help aid the scarring process.

We advise total rest for several days after treatment, including taking at least one week off work.

You should avoid UV light for between two and four weeks and quit smoking, as this irritates the eyes, delays healing and can cause scars to be more noticeable.

Typical genetic causes for eyelid surgery include an array of cosmetic issues such as lumps on the eyelid, sunken eyes, droopy eyelids (ptosis).

Some individuals are also genetically predisposed toward dark circles under the eyes, and the early formation of bags under the eyes.

All of these genetic conditions can be addressed by eyelid surgery and blepharoplasty.

Blepharoplasty, eyelid surgery, is a highly specialised area. So it is important that you choose an expert in this field to carry out any surgery on this most delicate of areas.

An oculoplastic surgeon is an ophthalmologist, otherwise known as an eye doctor, who has undergone many years of specialised training in eyelid and facial plastic surgery. Although plastic surgeons are highly trained and are able to carry out aesthetic eyelid surgery, they do not possess the depth of knowledge or expertise of the eye as an oculoplastic surgeon does.

As a trained ophthalmologist, an oculoplastic surgeon is able to examine the eye, identify any pre-existing eye disease and deal with any functional eyelid disease such as eyelid cancer, lid malpositions and entropion, a condition which turns the eyelid inward. These specialists are also able to examine the eye after blepharoplasty to ensure there are no eye complications and expertly manage any complications should they arise after surgery. A plastic surgeon will not be able to carry out these examinations as they have not undergone the same level of training in the eyes and have no training in the basic equipment used to carry out eye examinations. As a result, a plastic surgeon cannot provide the same level of expert care as a trained ophthalmologist.

These specially trained oculoplastic surgeons are responsible for eyelid surgery in hospitals across the UK.

As well as blepharoplasty, oculoplastic surgeons can carry out other eyelid surgery including repairing an eyelid which is turning in or out, correcting drooping eyelids (ptosis) and removing eyelid cysts (also known as chalazion or meibomian cyst).

Here at the Cadogan Clinic, we would highly recommend that an oculoplastic surgeon carries out any eye-related surgery, be it for functional or purely aesthetic reasons.

Eyelid reduction surgery, also known as blepharoplasty, is a highly specialised area, so it is important that you choose a surgeon who is an expert in their field to carry out this type of surgery.

The best surgeon to carry out eyelid reduction is an oculoplastic surgeon, an ophthalmologist who has undergone many years of specialised training in eyelid and facial plastic surgery.  Although highly qualified, a plastic surgeon does not possess the same  expert knowledge about the eye and has not undergone the same level of training as an oculoplastic surgeon.

A good surgeon should be able to explain the procedure in great depth, as well as the recovery period and any potential risks or complications. They will also be honest about potential outcomes and help you to manage your expectations.

When you have your initial consultation, make sure the surgeon has an extensive portfolio of before and after photographs that they can share with you so you can get a good idea of how the results of your surgery will look. Be sure to check out testimonials from previous patients.

If you are not physically and psychologically fit and healthy, an ethical surgeon will not attempt to perform the procedure.

You can check if a surgeon is a registered doctor or surgeon on the General Medical Council (GMC) online register.

Some surgeons may be members of professional associations, such as the British Oculoplastic Surgery Society (BOPSS). However there are some qualified surgeons who are experts in their field but choose not to sign up to a trade body for their own reasons.


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The Risks of a Blepharoplasty

Every surgical procedure comes with certain risks that you must understand and be aware of. Your surgeon will explain these in your consultation and will also assess your personal risk for certain factors. They may ask you to take certain precautions during your surgical preparation to reduce these risks.

 

Specific risks associated with eyelid reducion surgery include:

  • Dry eyes - if you have previously suffered from dry eyes, or already use eye drops, this may worsen after surgery.
  • Irritated or watery eyes - this usually resolves within two weeks.
  • Temporary swelling around the eyes making them difficult to close.
  • Blurred or double vision - this is rare and usually temporary.
  • Dropping of the upper eyelid - this may require a secondary surgery.
  • The lower eyelid pulling downwards, known as eyelid retraction.
  • The lower eyelid drooping away from the eye and turning outwards, this is known as an ectropion. It is usually caused by normal post-operative swelling and usually settles on its own.
  • Haematoma - blood pooling under the skin. This will need to be treated by your surgeon.
  • Seroma - fluid collecting under the skin. This will require treatment from your surgeon.
  • Asymmetrical eyes - On occasion your surgical results will appear differently on each eye.

Occasionally, complications or less than favourable results, will result in the need for a revision or secondary surgery. Complications can arise for reasons out of your surgeon’s control. The consultant surgeons at Cadogan Clinic are fully qualified and have performed Blepharoplasty frequently, for many years, and are some of the leading eyelid surgery London providers.


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