Blepharoplasty: Types, Indications, Contraindications, Surgery Stages, and Complications

Polina S. Dermatologist, aesthetician, MD

9 min read · April 16, 2026

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Blepharoplasty is a surgical procedure designed to correct age-related, anatomical, and functional changes of the periorbital region. During the procedure, excess eyelid skin is removed, fat herniations are corrected, orbital fat compartments are either repositioned or preserved, and, when necessary, the muscular and ligamentous support structures are reinforced. The periorbital region is characterized by thin skin, a rich vascular network, and complex anatomy, all of which require a high degree of surgical precision. Blepharoplasty is one of the most commonly performed aesthetic facial procedures.

3D Animation: Blepharoplasty

Anatomical and Physiological Features of Periorbital Region

The periorbital region is characterized by:

thin skin (3–5 times thinner than in other facial areas);
minimal fatty layer of subcutaneous tissue;
a prominent vascular network;
a complex muscular and ligamentous support system.

These anatomical and physiological features predispose the region to changes such as:

early wrinkling and skin folds;
dermatochalasis (overhanging excess skin of the upper eyelid);
rapid development of edema and hematomas;
prolapse of orbital fat (“eyelid bags”);
dark circles around the eyes;
deepening of the tear trough deformity;
decreased eyelid tone and alteration of eyelid contour;
functional disorders (visual field obstruction, lagophthalmos, ectropion).

These changes may have both aesthetic and functional significance, such as visual field obstruction caused by pronounced dermatochalasis.

Types of Blepharoplasty

1. Upper Blepharoplasty

Upper blepharoplasty is performed to address excess upper eyelid skin and prolapse of the upper eyelid fat compartments. The incision is made within the natural upper eyelid crease, making the eventual scar nearly imperceptible.

2. Lower Blepharoplasty

This technique is intended to correct eyelid bags under the eyes and tear trough deformities. Two approaches are commonly used:

Transcutaneous (external) lower blepharoplasty: the incision is subciliary, just below the lash line. This approach allows removal of excess skin and correction of fat herniations;
Transconjunctival lower blepharoplasty: access is obtained through the conjunctiva without an external skin incision. This technique is used when there is no significant excess skin and is most commonly performed in younger patients.

3. Combined Blepharoplasty

Simultaneous correction of the upper and lower eyelids during single surgery.

4. Ethnic Blepharoplasty

This procedure is aimed at creating a supratarsal crease and correcting the epicanthal fold in patients of Asian ethnicity.

Indications for Blepharoplasty

Aesthetic Indications:

excess skin of the upper eyelids;
fat herniations of the upper and lower eyelids;
deep tear trough deformity;
age-related changes of the periorbital region (soft tissue ptosis, decreased skin turgor, wrinkles);
eyelid asymmetry;
post-traumatic and postoperative eyelid deformities.

Functional Indications:

visual field obstruction secondary to dermatochalasis;
steatoblepharon;
heavy eyelid syndrome;
entropion;
ectropion;
lagophthalmos;
cicatricial eyelid deformities;
impaired eyelid closure.

Contraindications to Surgery

Absolute Contraindications:

decompensated medical conditions;
significant coagulation disorders;
active inflammation of the eyes and eyelids;
malignant neoplasms.

Relative Contraindications:

dry eye syndrome;
glaucoma;
diabetes mellitus in the subcompensated stage;
autoimmune diseases;
psychiatric disorders.

Main Stages of Combined Blepharoplasty

Combined blepharoplasty involves simultaneous correction of the upper and lower eyelids. The procedure may be performed under local anesthesia combined with intravenous sedation or under general anesthesia. The choice depends on the extent of the procedure and the patient’s individual characteristics.

Preoperative Preparation. Preoperative evaluation includes the patient’s medical history, ophthalmologic examination with mandatory evaluation of tear function, and physical examination. A comprehensive assessment of the patient’s systemic health, anatomical features, and eyelid function helps reduce the risk of complications and determine the optimal extent of surgical correction.
Preoperative Marking. Preoperative markings are performed with the patient in a sitting or standing position, taking into account anatomical landmarks, the degree of dermatochalasis, brow position, the prominence of fat herniation, and lower eyelid tone. The planned incision lines and the amount of tissue to be excised are determined at this stage.
Infiltration Anesthesia (For Local Anesthesia). The anesthetic solution containing a vasoconstrictor is administered in a layered fashion to provide analgesia and reduce intraoperative blood loss.
Incisions:

Upper eyelid: the incision is placed within the natural eyelid crease.
Lower eyelid: either a subciliary (just below the lash line) or transconjunctival approach is used.

Tissue Dissection. The tissues are carefully dissected while preserving anatomical structures and assessing the condition of the orbital septum and orbicularis oculi muscle.
Correction of Fat Compartments. Orbital fat may be excised, redistributed, or repositioned (particularly in the tear trough region) to create a smooth transition between the lower eyelid and the cheek.
Removal of Excess Skin. The amount of skin removed is carefully controlled to prevent lagophthalmos and lower eyelid retraction.
Additional Procedures (When Indicated):

Canthopexy or canthoplasty in patients with reduced lower eyelid tone.
Lateral canthal resuspension.
Combination with periorbital fat grafting (lipofilling).

Meticulous Hemostasis. Bleeding control is maintained throughout the procedure to minimize the risk of postoperative hematoma.
Closure. Fine atraumatic sutures are used. The sutures are placed to minimize scarring and preserve the natural eyelid crease.

The average duration of the procedure ranges from 30 to 120 minutes.

Postoperative Period

During the early postoperative period, patients may experience:

swelling;
hematomas;
mild pain or discomfort;
transient dry eye symptoms.

Sutures are typically removed between postoperative days 4 and 6. Complete recovery generally takes approximately one month. The final aesthetic outcome is usually assessed 3 to 6 months after surgery, once scar maturation is complete.

Complications

Early Complications:

hematomas;
swelling;
infectious complications.

Late Complications:

hematomas;
lagophthalmos;
ectropion (outward turning of the lower eyelid);
asymmetry;
dry eye syndrome;
scar-related changes.

The incidence of complications is low when patients are appropriately selected and a proper surgical technique is followed.

FAQ

1. What is blepharoplasty, and what results can it achieve?

Blepharoplasty is a surgical procedure designed to correct age-related and anatomical changes of the eyelids. Surgery can eliminate a “heavy” appearance of the eyes, remove redundant eyelid skin (dermatochalasis), and correct fat herniations (“eyelid bags”). As a result, the face typically appears more youthful and refreshed.

2. Who is a good candidate for transconjunctival blepharoplasty?

This technique is most appropriate for patients, often younger individuals, who have prominent lower eyelid fat herniations but little or no excess skin. Its principal advantage is that the incision is placed on the inner conjunctival surface of the eyelid, leaving no visible external scar.

3. Which eyelid aging changes are indications for surgery?

The most common indications include upper eyelid skin redundancy, eyelid bags, deepening of the tear trough deformity, and decreased eyelid tone. In some cases, surgery is performed for functional reasons when upper eyelid skin redundancy begins to obstruct the visual field.

4. How long does recovery take, and when are the sutures removed?

Most swelling and bruising resolve within 7 to 14 days. Sutures are typically removed early, on postoperative days 4 to 6. Complete tissue healing and scar maturation occur over approximately 3 to 6 months. During this period, patients should protect their eyes from sun exposure and avoid strenuous physical activity.

5. What type of anesthesia is typically used for eyelid surgery?

The choice depends on the extent of the procedure. Isolated upper or lower blepharoplasty is often performed under local anesthesia with sedation, allowing the patient to remain relaxed and comfortable without experiencing pain. When combined blepharoplasty involving all four eyelids is performed, general anesthesia is more commonly used.

6. Can surgery correct dark circles under the eyes?

Yes, if the dark circles are caused by shadowing from lower eyelid fat herniations or a deep tear trough deformity. In such cases, the surgeon may redistribute the orbital fat compartments to smooth the contour and create a more gradual transition between the lower eyelid and the cheek.

7. Are there absolute contraindications to blepharoplasty?

Yes, the procedure should not be performed in cases of active ocular inflammation, significant coagulation disorders, malignant disease, or decompensated cardiovascular conditions. Dry eye syndrome and glaucoma are considered relative contraindications and require ophthalmologic evaluation prior to surgery.

8. What risks and complications may occur after surgery?

Common temporary postoperative effects include swelling and dry eye symptoms. Less common procedure-specific complications include incomplete eyelid closure (lagophthalmos) and outward turning of the lower eyelid (ectropion). These risks can be minimized through appropriate patient selection, careful surgical planning, and accurate amount of skin to be excised.

References

VOKA 3D Anatomy & Pathology – Complete Anatomy and Pathology 3D Atlas. VOKA 3D Anatomy & Pathology.

Available from: https://catalog.voka.io/

Nahai F, Niazi F, Nahai F, Niazi S, Foster JA, Doroodgar F, et al. An Overview of Surgical Approaches for Lower Eyelid Blepharoplasty. Aesthet Surg J. 2023 Nov 16;43(12):1429-1440. doi: 10.1093/asj/sjad245. PMID: 37531619.

Alghoul M. Blepharoplasty: Anatomy, Planning, Techniques, and Safety. Aesthet Surg J. 2019 Jan 1;39(1):10-28. doi: 10.1093/asj/sjy034. PMID: 29474509.

Rodrigues C, Carvalho F, Marques M. Upper Eyelid Blepharoplasty: Surgical Techniques and Results-Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2023 Oct;47(5):1870-1883. doi: 10.1007/s00266-023-03436-6. Epub 2023 Jul 10. PMID: 37430010; PMCID: PMC10581926.

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