Blepharoplasty (Eyelid Surgery)

What is blepharoplasty?

Blepharoplasty, commonly called eyelid surgery or an eyelid lift, is an operation to remove excess eyelid skin, tighten loose muscle and reduce or reposition fat that has bulged forwards. It can be performed on the upper lids only, the lower lids only, or all four eyelids in one session.

With age, the skin of the eyelids becomes thinner and less elastic, and the membrane that holds the fat around the eye weakens. The result is a fold of skin hanging over the upper lashes and visible bags beneath the eyes. These changes can make you look tired, sleepless or older than you feel.

The aim is not to change the shape of your eyes but to give the eyelids a rested, natural appearance that still looks like you. Removing too much skin or fat can create a hollow, "operated" look and problems with eyelid closure, so a measured, balanced plan is essential.

Who is a good candidate for eyelid surgery?

Blepharoplasty may be suitable if eyelid changes bother you and your general health allows surgery. Typical concerns we see in consultation include:

• Excess upper lid skin that hangs towards the lashes and makes eye make-up difficult
• A fatty bulge in the inner corner of the upper lid
• Under-eye bags, often worse in the morning
• Loose skin and fine wrinkles on the lower lids
• Hereditary under-eye bags appearing at a young age

For some people, excess upper lid skin is more than a cosmetic issue. When the skin rests on the lashes it can narrow the upper and outer field of vision; many patients raise their eyebrows constantly to compensate and feel forehead fatigue or headaches by the end of the day. In these cases we speak of functional blepharoplasty, and a visual field test can be used to document the problem.

Droopy eyelid skin or ptosis?

A "droopy eyelid" is not always caused by excess skin. When the muscle that lifts the eyelid, or its tendon, stretches, the eyelid margin itself sits too low; this is called ptosis. The lid edge covers more of the pupil and the eye looks smaller.

The distinction matters because ptosis cannot be corrected by removing skin alone; it needs a different procedure on the lifting muscle. During the examination we measure the distance from the lid margin to the pupil and the strength of the muscle. If ptosis is present, we discuss whether to address it in the same operation or to plan it together with the relevant specialist. Eyelid drooping that develops suddenly or comes with double vision is not a cosmetic matter and needs medical investigation first.

Eyelid surgery and a low brow

Part of the heaviness in the upper eyelid may actually come from above, from eyebrows that have dropped. When the outer end of the brow descends, it pushes a hood of skin onto the outer upper lid. If only eyelid skin is removed in this situation, the brow can be pulled even lower, narrowing the space between brow and lashes and creating a stern expression.

This is why we always assess brow position when examining the upper lids. If the brow has clearly dropped, a brow lift and upper blepharoplasty can be planned in the same session: the brow is set in the right position first, and the remaining eyelid excess is then measured and removed. Where early ageing affects both the brows and the mid-cheek, an endoscopic facelift may be the more complete option.

How is blepharoplasty performed?

Upper eyelid surgery

The incision is placed in the natural eyelid crease, which sits inside the fold when your eyes are open, and may be extended slightly into a laughter line at the outer corner. The pre-marked excess skin and, if needed, a thin strip of muscle are removed, and a bulging inner fat pad is reduced. The incision is closed with fine stitches.

Lower eyelid surgery

There are two main approaches for the lower lid:

• Transconjunctival approach: The incision is made on the inside of the lower eyelid, leaving no external scar. It suits patients whose main problem is fat bags with little excess skin, often younger patients.
• Subciliary approach: The incision is made just below the lashes. It is used when loose skin and muscle need to be treated in addition to the fat.

If there is a groove between the bag and the cheek (the tear trough), fat can be repositioned into the hollow instead of being removed. If the lower lid has lost tension, additional supporting stitches at the outer corner (canthopexy) may be planned.

Consultation and preparation

At the first consultation we listen to your concerns and expectations, then assess eyelid skin, fat pads, brow position, lid margin height and lower lid tension. Conditions such as dry eye, thyroid disease and previous eye or laser eye surgery can change the plan, so we ask about them carefully and may request an ophthalmology opinion.

Before surgery:

1. All your medicines are reviewed, including blood thinners, painkillers and herbal supplements.
2. Photographs are taken from several angles and the planned change is discussed using these photos.
3. If you smoke, you will be asked to stop before and after surgery, as smoking impairs wound healing.

International patients can share photos and medical history in advance; the treatment plan is finalised after the in-person examination in Izmir. Consultations and aftercare are available in English.

Recovery after blepharoplasty

Upper eyelid surgery alone usually takes around an hour; surgery on all four lids or combined procedures take longer. Most patients go home the same day or after one night in hospital. Recovery varies, but a typical timeline looks like this:

In the first weeks, artificial tears during the day and a protective ointment at night may be recommended for dryness. After the stitch check, further follow-ups can be carried out by video call once you are home.

Risks and possible complications

Like any surgery, blepharoplasty carries risks, including bruising, prolonged swelling, infection, a more visible scar and slight asymmetry between the two sides. Risks specific to eyelid surgery include:

• Dry eye: Usually temporary and managed with drops; it may be more noticeable in people who already have dry eyes.
• Incomplete eyelid closure: Can occur in the first weeks due to swelling; avoiding excessive skin removal reduces this risk.
• Lower lid malposition: The lower lid may pull down or turn outwards; assessing lid tension beforehand helps prevent this.
• Bleeding: Bleeding behind the eye is very rare but requires urgent treatment. Contact us immediately if you notice increasing pain, marked swelling or reduced vision after surgery.

Some patients may need a minor touch-up procedure later on. We discuss the risks that apply to you in detail during the written consent process before surgery.

How long do the results of eyelid surgery last?

Removed skin and treated fat bags generally do not return, and the results of lower lid bag surgery in particular tend to last for many years. However, ageing continues, and upper lid skin may loosen somewhat again over the years.

The eye area does not age in isolation. If you also have volume loss in the mid-face or sagging in the lower face, blepharoplasty alone may not deliver the change you expect, and we will tell you so. In that case we look at options for the whole face as part of a facial aesthetics assessment.