Blepharoplasty (Eyelid Surgery): The Complete Patient Guide

Upper vs lower eyelid blepharoplasty — they are different operations

Upper eyelid blepharoplasty removes excess skin and sometimes a small strip of orbicularis muscle from the upper eyelid. When drooping upper eyelid skin is hooding the visual axis, the operation is functional — it genuinely improves the visual field. When the skin is loose but not obstructing vision, it is aesthetic.

Lower eyelid blepharoplasty addresses the 'bags under the eyes' — fat pads that protrude beneath the lower lids, creating shadowing and a tired appearance. The approach can be external (skin incision just below the lash line) or transconjunctival (internal, no skin scar), depending on whether excess skin needs to be removed as well.

Am I a candidate?

• Upper lid: if your upper eyelid skin rests on your lashes, obscures your peripheral vision, or you find yourself lifting your brow to see clearly, you are likely a functional candidate.
• Upper lid aesthetic: if you simply dislike the heaviness or hooding of your upper eyelids and wish to look more refreshed.
• Lower lid: persistent 'bags' — fat prolapse beneath the lower lids — that are unchanged by sleep or diet.
• Not a candidate: significant dry eye disease (surgery can temporarily worsen dryness), certain thyroid eye disease states, unrealistic expectations about result.

Can I get upper blepharoplasty on the NHS?

Upper blepharoplasty is available on the NHS when there is documented functional impairment — specifically, when the excess upper eyelid skin significantly restricts the superior visual field. This is assessed by a formal visual field test. The criteria are strict, and many patients who feel their vision is affected do not meet the threshold.

Aesthetic blepharoplasty (lower eyelid or upper eyelid without functional impairment) is not funded by the NHS.

The procedure

Upper blepharoplasty: performed under local anaesthetic as a day case. A carefully planned ellipse of skin is marked, excised, and the wound closed with fine sutures. The operation takes 30–60 minutes. You are awake throughout and can go home the same day.

Lower blepharoplasty: typically performed under local anaesthetic with sedation, or occasionally general anaesthetic. The transconjunctival approach leaves no external scar; the external approach allows removal of excess lower lid skin.

Recovery

• Expect bruising and swelling for 1–2 weeks. Cold packs for the first 48 hours.
• Sutures removed at 5–7 days.
• Most patients return to office work within 10–14 days.
• Final cosmetic result is typically visible at 3–6 months once swelling has fully resolved.
• Avoid strenuous exercise for 2 weeks.
• Avoid eye makeup for 2 weeks post-operatively.

Scarring

The upper eyelid scar is hidden in the natural lid crease and is typically imperceptible once healed. Lower eyelid scars (when an external approach is used) are placed just below the lash line and heal to a fine, barely visible line in the vast majority of patients.

Cost

Private upper blepharoplasty in the UK typically ranges from £2,000–£3,500 per procedure (both upper lids). Lower blepharoplasty is generally £2,500–£4,000. Combined upper and lower lid surgery is possible and the total cost is usually less than the sum of each separately. Costs include consultation, surgery and follow-up.