Eyelid Surgery (Blepharoplasty)

Blepharoplasty at Brandeis Clinic removes excess skin and fat deposits from the upper and/or lower eyelids that accumulate with age, causing hooded lids, a tired appearance, and in advanced cases a narrowing of the visual field. The procedure is performed under local anaesthesia on an outpatient basis — patients arrive, undergo surgery lasting 40–90 minutes depending on the combination, and leave the same day. Upper-lid work uses incisions in the natural eyelid crease; lower-lid work removes or repositions the fat pads responsible for under-eye bags. Fine cosmetic sutures are removed after one week. Most patients return to normal activities within 10–14 days once bruising and swelling resolve.

Blepharoplasty at Brandeis Clinic is one of the more commonly requested facial procedures, partly because it can produce a substantial improvement in apparent age and alertness without the recovery and cost of full facial surgery. **Upper eyelid blepharoplasty:** The upper eyelid incision is placed precisely in the existing skin crease — the natural fold that forms when the eye opens. This placement ensures the scar is invisible when the eye is open and a very fine line when closed. The excess skin is excised as a carefully measured ellipse; if fatty prolapse is present in the medial (nasal) fat compartment, this is addressed simultaneously. The crease incision is closed with fine sutures (removed at 7 days) or a continuous subcuticular suture. Functional indication: In cases where excess upper-eyelid skin encroaches onto the visual field — a condition documented on visual field testing — blepharoplasty may qualify as a partially or fully reimbursed functional procedure. The clinic can advise on this at consultation. **Lower eyelid blepharoplasty:** The lower eyelid is more anatomically complex. The primary targets are the three fat compartments (medial, central, lateral) that herniate through the weakened orbital septum, producing the "bags" that characterise advanced lower-eyelid ageing. The approach is either transcutaneous (external incision just below the lash line) or transconjunctival (internal incision through the conjunctiva, leaving no external scar) depending on whether skin excision is also required. Where the dominant issue is hollowing rather than fat prolapse — a common finding in thinner patients — fat repositioning rather than removal preserves volume and avoids a skeletonised appearance. **Combined upper and lower:** The most complete correction addresses all four eyelid quadrants in a single session lasting approximately 1.5 hours. This is the most commonly selected option at Brandeis Clinic, as the visual improvement from both upper and lower correction creates a more harmonious, rejuvenated result than treating one area in isolation. **Anaesthesia and setting:** All blepharoplasty is performed under local anaesthesia as an outpatient procedure. General anaesthesia is not required or offered for blepharoplasty at this clinic. Light sensitivity is common immediately after, and patients are asked to bring dark sunglasses to wear on departure. **Preparation:** Arrive without eye makeup. Avoid blood-thinning medications (aspirin, ibuprofen, vitamin E, certain supplements) for the period instructed by the surgeon. Arrange a companion to accompany you home. **Recovery:** Avoid screen use for 2 days (which strains the eyes and increases swelling). Apply cold compresses as instructed. Sutures are removed after 7 days at the clinic. Bruising and swelling typically resolve within 10–14 days. Contact sports and swimming are paused for approximately 1 month. Eye makeup can resume after suture removal. **Results:** The improvement in eyelid position and periorbital appearance is permanent in the sense that the removed tissue does not regenerate; however, the underlying ageing process continues and some recurrence of skin excess is expected over 10–15 years.