Blepharoplasty FAQ

An office examination with a facial plastic surgeon can provide further information specific for you regarding eyelid surgery. Continue doing your research before speaking with a specialist and bring your questions to the office. Schedule a consultation today!

Generally, a minimum of 2 weeks are allowed from the consultation to prepare for surgery. Select procedures may be performed earlier. Nonsurgical procedures may be performed at the same time as the initial consultation.

Yes, it’s generally preferred to combine procedures such as eyelid surgery with a facelift or another complementary treatment. First, by combining surgeries, you may save money on some fees. Secondly, tissue modified from one area may be used for another surgical area. Lastly, by combining the recovery processes, you minimize downtime from work, school, and physical activities. Commonly combined procedures with eyelid surgery include the following:

• Brow Lift
• Facelift
• Fat Transfer
• BOTOX® Cosmetic

Strenuous activities or exercise after plastic surgery will increase the risk of bleeding, swelling, and bruising. Activity restriction during the recovery period varies based on the operation performed and patient’s medical condition. Light activities, such as slow walking, may be performed soon after anesthesia. Heavy activity, such as aerobics, yoga, cycling, running, heavy lifting, or similar vigorous activities are allowed 2 weeks after the procedure. Contact sports are generally allowed after 6 weeks.

Patients can go to work or school the next day or work from home, if desired. Most patients, however, plan at least 1 week off from work or school after plastic surgery. A longer period of recovery may be necessary for combined procedures.

Eyelid surgery is a relatively quick surgical procedure. However, the length of surgery depends on the complexity and number of procedures performed. Dr. Chaboki will discuss the length of your individual procedure with you prior to the date of the eyelid surgery.

Patients should remain in the area at least the first day after plastic surgery. Regional travel by car is allowed the following day after surgery. Patients should wait at least one week before air travel after plastic surgery, but waiting two weeks is preferred. The risks associated with travel reduce with time.

Makeup should not be used around the operated area for the first week after surgery. Contact lenses are usually allowed after the first week from eyelid surgery. As healing is monitored, Dr. Chaboki will help determine an appropriate time to resume makeup on operated areas.

Dissolving sutures are generally used for eyelid surgery. Skin sutures usually dissolve or are removed within the first couple weeks after surgery.

Dr. Chaboki performs a history and physical on all patients prior to undergoing cosmetic treatments. Eyelid surgery may be safely performed on many chronic, stable medical conditions. However, eyelid surgery may be delayed or cancelled as needed for patient safety. Dr. Chaboki will work with his cosmetic patients to help find a safe, appropriate aesthetic option if eyelid surgery cannot be performed.

Smoking adversely affects health and recovery after plastic surgery. Treated areas are at a greater risk of poor healing, scarring and infection. Blood vessels that supply oxygen and nutrients to the tissues shrink up and subsequently prevent optimal healing.

Patients must stop smoking for a minimum of 2 weeks prior to surgery to decrease the risk of these complications, and continue smoking cessation after the procedure. Cosmetic surgery is an opportunity to quit smoking all together.

Any plastic surgery procedure (surgical or nonsurgical) may result in bruising and swelling, which may peak in the first day before improving. In addition, the bruising generally fades away faster than swelling. Lastly, surgical procedures tend to swell or bruise more, as compared to nonsurgical treatments performed in the office.

To ensure the best outcomes after eyelid surgery, make sure to read and follow our plastic surgery care instructions and the following guidelines below:

Avoid Blood Thinners
Some normal medications or herbs may worsen bruising. Stop all ibuprofen, aspirin and aspirin-like products for at least 2 weeks prior to your procedure. Avoid any herbal teas, supplements, or medications which thin the blood such as St. John’s wort, ginkgo, ginger, garlic, ginseng, kava, vitamin C, and vitamin E.

Elevate Your Head
Let gravity play a role in the recovery process. Positioning your head on top of a few pillows, or elevated mattress top, will help reduce bruising and swelling in the treated area. Avoid bending over as much as possible, too.

Apply Ice
In addition to reducing swelling, a cool compress helps constrict blood vessels, which may decrease the extent of bruising. Ice, however, should not be placed directly on the skin. A soft cloth helps spread the cooling effects. Ice is the most important during the first 2 days after cosmetic treatments.

Avoid Heavy Activity
Heavy or strenuous activity that increases the heart rate or blood pressure can increase bruising and delay recovery. Heavy activities to avoid include, but are not limited to, all types of exercise and sex. Even lighter activity, such as yoga, should be avoided. This restriction on activity is for the first 2 weeks after plastic surgery.

Try Arnica Montana and Bromelain
Herbal supplements that help some patients reduce bruising and swelling include Arnica montana and bromelain. Both of these are available over the counter without a prescription. You should look for these supplements in a tablet form. Bromelain is also found in pineapples.

Bruising improves faster than swelling after plastic surgery. On average, most bruising resolves within the first 1 to 2 weeks in the early phase of healing.

The immediate swelling after eyelid surgery may last approximately a week or 2, depending on several factors. After this initial healing period, swelling is still present, but usually only noticeable by the patient. The very last tiny bit of swelling takes several months to gradually abate.

It’s possible to have swelling in areas of the face and eyes adjacent to the surgery site, even though plastic surgery was not necessarily performed in those areas. This extension of facial swelling is due to gravity and the natural movement of fluid in the tissues. In addition, keep in mind that the eyelids, face, and nose are very sensitive to swelling from other factors, such as allergies, diet, hormones, gravity, sleep, etc.

Patients are comfortable during surgery, whether the procedure is performed in the office via local anesthesia or in a surgical facility with IV sedation. Patients may experience a very brief, mild sting from the initial numbing medication.

A certain level of discomfort is normal and expected after plastic surgery. Patients often describe sensations as tightness, soreness, or discomfort that is easily managed by oral pain medication (e.g., acetaminophen, codeine). Many patients have reported not requiring prescription pain medication after the first day or so.

Severe pain, which is unusual, should always be reported immediately to your plastic surgeon.

Every patient will recover at his or her own rate. There are 3 general phases of healing after any plastic surgery: early (days/weeks), intermediate (weeks/months), and late (months/years). The phases of recovery don’t have distinct transitions between them.

The early phase of healing occurs within the first days and weeks after plastic surgery. Most bruising and swelling resolve during this early phase, including stitches dissolving or being removed. Generally, patients report not requiring pain medication after the first day or so after eyelid surgery.

On average, patients are “back to normal” approximately 2 weeks after plastic surgery. Exercise may be resumed after 2 weeks, around the time when the intermediate phase of healing begins. During the first couple months after plastic surgery, skin continues to tighten and swelling continues to resolve. Patients have already returned to work or school by this intermediate healing timeframe. Any residual swelling is usually noticeable by the patient only.

The last phase of healing really takes several months to years, as gradual changes continue to occur in the skin and tissue. Any external scars and residual mild swelling continue to fade. Patients should continue healthy habits to maintain their aesthetic results, such as eating a healthy diet, routinely exercising, avoiding excess salt or processed foods, using consistent sun protection, avoiding smoking, and getting adequate sleep.

Downtime after cosmetic procedures varies from a few hours to several days, depending on the specific procedure and areas treated. Office procedures are performed under local anesthesia, if any anesthesia is required. Surgical procedures are performed with either IV (twilight) sedation or general anesthesia and require a longer recovery period. Anesthesia normally wears off within the first 24 hours after surgery.

General instructions for before and after plastic surgery can be found on our Care Instructions page. Dr. Chaboki may provide specific instructions for individual patients personalized to their procedure. This will be discussed extensively both before and after the procedure.

Safety is our primary concern, and perioperative instructions can help reduce the risks associated with plastic surgery and anesthesia. In addition, preparation before eyelid surgery helps expedite recovery afterwards. Each patient and procedure is unique, so variations will occur that are specific for each patient. Patients must read the care instructions before any procedure.

Common preparation tips prior to or after any plastic surgery procedure:

• Avoid blood-thinning medications or supplements, such as ibuprofen, aspirin, or herbal supplements.
• Stay hydrated and drink plenty of water.
• Avoid excess salts in your diet, including processed and fast food.
• Strictly avoid smoking.

All plastic surgery procedures require some form of anesthesia, even if minimal. The minimal amount of anesthesia is referred to as local anesthesia, where ice, vibration, numbing cream, and/or local injection is used to numb the treated area. Only the treated area is numbed, and the patient remains awake, alert, and comfortable. Nonsurgical office treatments (e.g., BOTOX® or Restylane®) and upper eyelid surgery are often performed via local anesthesia.

Nonsurgical eyelid procedures (e.g., BOTOX® or Restylane®) are performed in the office with local anesthesia. Minor surgery (e.g., upper blepharoplasty) is also normally performed with local anesthesia. Eyelid surgery may be performed with either IV (twilight) sedation or general anesthesia at accredited facilities with a licensed anesthetist.

Patients are safe and comfortable during their procedures. The decision on the type of anesthesia used during plastic surgery depends on the extent of surgery, additional cosmetic surgery procedures along with the eyelid surgery, patient factors and preference, and surgeon factors and preference. After an evaluation, the plastic surgeon and patient decide together the appropriate anesthesia type for plastic surgery.

Dr. Chaboki practices facial plastic surgery at several DC area surgical facilities to accommodate his patients:

• Georgetown University Medical Center
• MedStar Surgery Center

Minor procedures with local anesthesia are performed in the DC office. Surgical procedures with IV (twilight) sedation or general anesthesia are performed at accredited facilities with a board-certified anesthetist.

After eyelid surgery, you should look better than nature intended for the remainder of your life. The aging process continues, however, so wrinkles and sagging skin will reappear years after facial surgery. You can expect to always look better than if you had not had the procedure in the first place. Patients may consider nonsurgical treatments to help maintain a rejuvenated appearance after cosmetic surgery.

The best eyelid surgeons tailor each surgery to the specific needs of each patient without any specific branded name. One eyelid surgery is not necessarily better than another. Be cautious when speaking to a branded or trademarked cosmetic surgeon. Keep in mind that safe and reliable eyelid surgery techniques are used by the entire community of plastic surgeons and are not associated with trademarked or branded names.

Eyelid surgery candidates generally have the following qualities, which may vary for each person:

• Good general health
• Over 18 years old
• Excess skin and/or fat of the eyes
• Droopy or sagging tissue

As a facial plastic surgeon, Dr. Chaboki will tailor the eyelid surgery as appropriate for you. Eyelid surgery is customized to your degree of facial aging, underlying anatomy, and most importantly, your personal goals. Some patients require a limited lift, while other patients would benefit from extensive procedures. A nonsurgical lift may be appropriate for some patients too, especially those with very limited time for recovery. Only after a comprehensive evaluation can Dr. Chaboki help determine appropriate options customized for you.

Patients with some medical conditions or medications may not be good plastic surgery candidates. In addition, those with unrealistic expectations should not have treatments.

Patients may start considering cosmetic eyelid surgery at a young age, such as creating a double fold in Asian blepharoplasty or for those who were born with excess skin or fat. Many patients start considering cosmetic eyelid surgery after age 40.

There isn’t an ideal age for eyelid surgery. Dr. Chaboki evaluates an individual’s anatomy (skin, muscle, fat, bone, etc.) and discusses the patient’s personal preferences (upper eyelid and/or lower eyelid, degree of change, recovery time, etc.). He will then suggest appropriate surgical or nonsurgical procedures based primarily on these 2 factors.

Nonsurgical alternatives to eyelid surgery include BOTOX® Cosmetic or Dysport® injections around the eyes and forehead to reduce wrinkles and improve brow position. Facial fillers (such as Restylane® or BELOTERO®) may reduce fine wrinkles, dark circles, or lower eye bags. Nonsurgical treatments last several months.

For optimal outcomes in patients with significant excess or loose skin, eyelid surgery is required.

Education is the best method to reduce risks. Learning about the procedure and risks, including a discussion with your plastic surgeon helps promote safety.

Follow the preoperative and postoperative care instructions of your plastic surgeon. These care instructions are meant as a guide and do not replace specific instructions for you. Preparation reduces risks both before surgery and during your recovery after cosmetic surgery.

A patient’s safety is always our primary concern. Any plastic surgery has inherent risks, but eyelid surgery is considered a safe surgery in healthy patients.

Dr. Chaboki will review your medical history and medications, in addition to an appropriate examination to evaluate not only the aesthetic plan, but also to perform plastic surgery safely. Some patients may also need testing and/or preoperative medical evaluation by their primary care physician before surgery.

The skin and tissue near incisions may appear puffy and pink initially. This puffiness will improve with time. Topical petroleum jelly (e.g., Vaseline® or Aquaphor®) applied to external incisions helps the skin appear its best and reduces scars. Keep incisions moist with petrolatum ointment at all times for 1 month. Do not use any other creams or lotions until advised otherwise.

Other methods to maximize skin health include not smoking, staying adequately hydrated, maintaining a healthy diet, sleeping well, and using sun protection.

The upper eyelid incision is placed in a natural contour in the skin, hidden from view. The lower eyelid incisions may be placed externally under the eyelashes (subciliary approach) or internally in the pink area of the eyelid (transconjunctival approach).

The incision location and length vary largely based on the age of the patient and how much lift he or she needs. Dr. Chaboki will minimize the incision but maximize the lift, without creating an unnatural appearance. The eyelid surgery incision, regardless of exact location, fades from view over time.

The shape of the eyes may appear to change in some patients after removal of sagging skin, muscle, or fat. Dr. Chaboki’s general goal in cosmetic surgery is not necessarily to change people, but rather to improve and freshen their existing appearance.

Eyelid surgery of the upper eyelid primarily removes excess skin from the top eyelid and generally does not directly change the eyebrow. A brow lift both lifts the eyebrow and pulls up some extra skin from the upper eyelid area. For some, a brow lift alone may be sufficient to improve the appearance of the upper eyelid. For others, an upper blepharoplasty combined with brow lift surgery at the same time is preferred for upper facial rejuvenation.

For more information, read our blog post on brow lift vs. blepharoplasty.

Dark circles often require different treatments for improvement. Skin treatments including eye creams, tretinoin, laser therapy, or chemical peels can improve some dark circles. Hollow eyes and volume loss contributing to dark circles are treated with facial fillers (such as Restylane®) or fat transfer. Excess eyelid skin and sagging muscle are usually treated with blepharoplasty.

Some asymmetry might be improved with eyelid surgery. Eyelid surgery can be considered as 2 operations: 1 procedure on the left eye and another procedure on the right eye. As a result, Dr. Chaboki may make modifications on eyelid surgery to improve symmetry.

Keep in mind that a certain degree of asymmetry will still persist and cannot be corrected. For example, patients with asymmetric eyes commonly also have asymmetry of the eyebrows, ears, and face.

There are several types of upper and lower eyelid surgery. The combination of upper and lower eyelid surgery may be referred to as a “quad blepharoplasty.” Dr. Chaboki performs a variety of methods of eyelid surgery to rejuvenate the appearance of the eyes. Eyelid plastic surgery is tailored for each patient.

Upper eyelid surgery has 2 main types:

• Surgery for the aging eyelid (excess skin or hooding)
• Surgery for the Asian eyelid to create a crease (double eyelid)

Lower blepharoplasty has a few types:

• Skin pinch: a small amount of skin from the lower eyelid is removed by “pinching” excess skin. May be performed via local anesthesia in the office. Fat and muscle are not modified.
• Subciliary: an external incision is placed under the eyelashes, which allows modifications of the skin, muscle, and/or fat.
• Transconjunctival: an internal incision is placed behind the lower eyelid, then only fat is removed.
• Fat transposition: does not remove lower eyelid fat from bags, but rather repositions eye fat via a transconjunctival incision.

Eyelid surgery, otherwise known as blepharoplasty, is plastic surgery of the upper eyelid or lower eyelid. Eyelid surgery is one of the most common aesthetic procedures for both men and women to rejuvenate the face. Patients appear more rested and refreshed by reducing wrinkles, tightening and lifting eyelid tissue, and reducing dark circles.

Plastic surgery covers a broad area of medicine, which includes both reconstructive procedures and cosmetic procedures. If your procedure is medically indicated, some portion of the cost may be covered by your insurance plan. Insurance coverage varies greatly for patients, and patients are ultimately responsible for fees.

Each eyelid surgery procedure is different, so there’s no singular cost. Instead, like other plastic surgery procedures, the cost of blepharoplasty falls within a range — typically $3,500 on the low end and $10,000 * on the high end.