Blepharoplasty: upper vs lower eyelid surgery, recovery and results

Blepharoplasty, or eyelid surgery, is one of the most common facial procedures for a simple reason: the eyes often show tiredness before the rest of the face does. Heavy upper lids that touch the lashes, puffy bags that no amount of sleep fixes, a shadow under the eyes that concealer can’t quite hide. The good news is that eyelid surgery is a relatively small operation with a fairly predictable recovery. Still, it has its own rules, limits and trade-offs, and it helps to understand them before you book anything.

This guide explains how upper and lower blepharoplasty differ, how long blepharoplasty takes to heal, how long the results last, what aftercare looks like and when another option, such as a brow lift or Botox, might suit you better.

What blepharoplasty is and who it helps

Blepharoplasty is surgery to reshape the eyelids. The surgeon removes excess skin, and where needed removes or repositions small fat pockets and tightens the supporting tissue. It is performed by plastic surgeons and by oculoplastic surgeons (ophthalmologists who specialise in eyelid surgery).

People usually come in with one or more of these concerns:

• upper lid skin folding onto the lashes, making eye makeup hard and the face look tired or stern;
• persistent bags under the eyes;
• a deep groove between the lower lid and cheek (the tear trough);
• in some cases, hooded skin narrowing the upper or side field of vision.

It is just as useful to know what eyelid surgery does not do. It doesn’t remove fine crow’s feet, change dark pigmentation, or lift a drooping brow. Those need other treatments, covered below.

Upper eyelid surgery: how it is done

The incision sits in the natural crease of the upper lid, so once it heals the scar is usually hidden when your eyes are open. Before surgery, the surgeon carefully marks how much skin can be removed while still letting the eye close fully. A strip of skin is removed, sometimes with a thin strip of muscle and a little fat near the inner corner.

Upper blepharoplasty usually takes about 45 to 90 minutes. It is often done under local anaesthesia, frequently with light sedation. Stitches typically come out around day 5 to 7.

Lower eyelid surgery: inside or outside incision

The lower lid is more delicate, because it holds the lid in the right position against the eye. There are two main approaches:

• Transconjunctival. The incision is made on the inside of the lid, so there’s no visible scar. It suits people whose main issue is fat bags rather than loose skin.
• Subciliary (external). The incision runs just below the lashes. It allows the surgeon to remove extra skin, reposition fat into the hollow and, if needed, tighten the outer corner of the lid (canthopexy).

Lower blepharoplasty usually takes 1 to 2 hours and is more often done under general anaesthesia or deeper sedation. Doing all four lids together typically takes 2 to 3 hours.

Blepharoplasty, brow lift or Botox: which do you need?

Heavy upper lids are not always caused by eyelid skin. Sometimes the brow has dropped and pushes skin down onto the lid. If a surgeon simply removes skin in that situation, the brow can sit even lower and the look becomes heavier, not fresher.

• Botox can give a small lift to the tail of the brow and soften lines around the eyes. It lasts roughly 3 to 4 months and doesn’t remove skin or fat.
• A brow lift addresses a low brow. It can be done alone or together with upper blepharoplasty.
• Blepharoplasty deals with excess skin and fat on the lids themselves.

A quick mirror test: gently lift your brows with your fingertips to where they naturally “should” sit. If the lid looks almost normal, it’s worth discussing your brow position at the consultation. Your surgeon makes the final call after examining you.

Who should not have eyelid surgery (yet)

Surgery may be postponed or not recommended if you have:

• significant dry eye syndrome;
• active or uncontrolled thyroid eye disease;
• uncontrolled high blood pressure or diabetes;
• a bleeding disorder, or blood thinners that can’t be safely paused;
• an active eye or eyelid infection, including cold sores near the area;
• pregnancy or breastfeeding;
• recent laser eye surgery (timing is agreed with your ophthalmologist);
• glaucoma or other eye conditions that need clearance from an eye specialist.

Typical pre-op checks include routine blood tests and sometimes an ECG, plus an eye exam if you have dryness or vision issues. If you smoke, stopping for several weeks before and after surgery makes a real difference to healing.

How long does blepharoplasty take to heal?

Everyone heals at their own pace, but this is a typical picture:

1. Days 1–2. Lids feel swollen and tight. Watery eyes and slightly blurry vision from ointment are common. Discomfort is usually moderate and controlled with standard pain relief. Cold compresses and sleeping with your head raised help a lot.
2. Days 3–4. Bruising often peaks and may drift down onto the cheeks. That’s normal. Most people can read or watch TV, though eyes tire quickly.
3. Days 5–7. Stitches are removed. Swelling starts to settle noticeably.
4. Week 2. Most bruising has faded. Many people go back to desk work, using glasses to hide what’s left.
5. Weeks 3–6. Residual swelling keeps going down. Upper lid scars are still pinkish.
6. 3–6 months. The final result settles and scars fade.

Blepharoplasty aftercare: the practical list

• Use cold compresses as instructed for the first 48 hours.
• Sleep on your back with your head elevated for about a week.
• Don’t rub your eyes; use only the drops and ointments your surgeon prescribed.
• Skip contact lenses for about two weeks and eye makeup for about 10–14 days.
• Avoid gym workouts, saunas and heavy bending for 2–3 weeks.
• Wear sunglasses outdoors and protect scars from the sun for several months.
• Contact your surgeon immediately if you notice sudden severe pain, increasing swelling on one side or any change in vision.

How long does blepharoplasty last?

Upper eyelid results usually last many years, often 10 years or more. Skin keeps ageing, so some heaviness may return over time, but typically not to where you started. Lower lid fat that has been removed or repositioned usually doesn’t come back, although the surrounding tissues still change with age. Sun protection, not smoking and a stable weight all help results last.

Risks to discuss honestly

Eyelid surgery is considered a relatively safe procedure, but no surgery is risk free. The most common issues are temporary: dryness, watering, light sensitivity and swelling. Less common risks include asymmetry, difficulty closing the eyes fully, visible scarring, bleeding or infection. After lower lid surgery the lid margin can occasionally pull down, which may need correction. Bleeding behind the eye that threatens vision is very rare but serious, which is why aftercare instructions in the first day matter.

Is blepharoplasty covered by insurance?

Cosmetic eyelid surgery is generally not covered by health insurance. In some countries, upper blepharoplasty may be covered when drooping skin genuinely blocks your vision, usually documented with a visual field test and photos. This depends entirely on your insurer and policy. If you travel abroad for elective cosmetic surgery, assume you will pay privately, and consider travel insurance that covers complications from planned procedures, which is a separate product from standard travel cover.

Eyelid surgery in Yerevan: how long to stay and when to fly

• Upper lids only: usually 5–7 days in Yerevan, to have stitches removed and a check-up.
• Lower lids or all four: usually 7–10 days.

Many surgeons are comfortable with a short flight a few days after surgery, but most prefer you to wait until the stitches are out. Your surgeon decides. Pack lubricating drops (if prescribed), sunglasses and water for the flight.

Back home, it’s sensible to see a local eye doctor or surgeon if you have dryness or any concerns. We also arrange remote check-ins with your Yerevan surgeon, so you can send photos and questions throughout recovery.

What drives the cost of blepharoplasty

We don’t quote one figure because the scope varies a lot. The price depends on:

• upper lids, lower lids or all four;
• technique (fat repositioning, canthopexy);
• anaesthesia type and whether an overnight stay is needed;
• combining with a brow lift or other procedures;
• the surgeon’s experience and the clinic;
• your package: transfer, accommodation, interpreter.

You get an exact figure in your personal estimate after an online consultation. You can read more on our blepharoplasty page.

Frequently asked questions

Is blepharoplasty painful?

You shouldn’t feel pain during surgery thanks to anaesthesia. Afterwards most people describe tightness and mild to moderate soreness for a few days, managed with standard pain relief.

How long does blepharoplasty take to heal?

Most bruising and swelling fade within about 2 weeks, and many people return to desk work then. Final results and scar maturity take around 3–6 months.

Will I have visible scars?

Upper lid scars sit in the natural crease and usually become hard to see within a few months. The inside approach for lower lids leaves no external scar.

Can I combine eyelid surgery with a facelift or brow lift?

Yes, combinations are common. Whether it’s safe and sensible for you is decided by the surgeon after consultation and pre-op tests.

When can I wear contact lenses again?

Usually after about two weeks, once your surgeon confirms the lids have healed well enough.

If you’re considering eyelid surgery, send us front and side photos of your eyes along with your questions. We’ll arrange a free online consultation with a surgeon in Yerevan and prepare a personal estimate. Get in touch through our contact page.

This article is for general information and does not replace a consultation with a qualified doctor.