A smiling woman in bed with a sleeping eye mask on, pulling one side of the eye mask up so she can look at camera.

As we age, looking tired around our eyes is not something we can easily hide. But there is a surgical procedure, known as blepharoplasty or eyelid surgery, that is growing in popularity and can help remove and tighten eyelid skin, allowing for a more alert and even youthful appearance.

The physicians of the Washington University Facial Plastic Surgery Center — Dr. Emily Spataro, Dr. Gregory Branham and Dr. John Chi — consult regularly with patients who have found blepharoplasty as a preferred treatment for those “tired” eyes.

What is blepharoplasty?

Blepharoplasty is a procedure that can help improve the signs of aging around our eyes due to increased skin laxity or fat around the eyes. Patients may also seek out this surgery if their lateral eyelids look hooded or there is vision impairment as a result, Dr. Spataro says.

Although most patients consider this treatment because of their own cosmetic concerns, there are some patients who may be referred for blepharoplasty by an ophthalmologist or require an exam prior to considering the procedure.

“If patients have a history of dry eyes, vision changes, glaucoma, eye surgery or other eye conditions, they should be seen by an ophthalmologist to ensure these issues will not be impacted by surgery,” Dr. Spataro explains. “Also, if patients have a decreased field of vision due to their eyebrow or eyelid position, they may be referred by a physician.”

In addition to the eyelid surgery, patients should consult with a fellowship-trained facial cosmetic surgeon about additional procedures, if needed.

“The brow position can also be assessed, and if this is found to be low, then patients may benefit from a brow lift at the same time of upper or lower blepharoplasty,” Dr. Spataro says. “Often, lower blepharoplasty will be accompanied by fat transposition, as well, to essentially re-drape the orbital fat over the cheek bone to enhance the contour of this area. By not removing too much fat, you avoid the ‘hollowed out’ look that some blepharoplasty patients may have had in the past.”

These combined procedures can give patients a complete upper facial rejuvenation that lasts for years for many people.

What to expect?

If a patient is a good candidate for blepharoplasty, their procedure will either be done under local anesthesia in the office or, for a more extensive procedure, general anesthesia in the operating room. They are also advised to stop taking any medications that can cause bleeding.

During eyelid surgery, or with the addition of other treatments, different combinations of procedures can be performed.

“If it is determined a brow lift would be beneficial as well, this is usually done first and usually with endoscopic technique through incisions in the scalp,” Dr. Spataro says. “The upper blepharoplasty is performed with an incision in the upper eyelid crease, while lower blepharoplasty can be undertaken through either an incision through the inner part of the lower eyelid (transconjunctival) or with an incision in the lower eyelid skin just under the eyelashes.”


Patients can expect bruising and swelling around the eyes for up to a few weeks after surgery, so most people take at least a week off from work. There are some risks, as with all surgeries, that should be discussed with your surgeon during consultation.

Icing the area will help with recovery, as will and staying somewhat elevated during sleep immediately after the operation. Patients can have headaches, more commonly if a brow lift was also performed, Dr. Spataro adds.

For many patients, blepharoplasty is a cosmetic procedure and typically not covered by insurance.

“Insurance can cover procedures for the upper eyelids and brows if there is a visual field impairment from the lateral hooding of the eyes,” Dr. Spataro says. “An ophthalmologist will assess this through visual field tests, and if found to be abnormal, insurance may cover this.”

For more information about blepharoplasty or to schedule a consultation with the physicians at the Facial Plastic Surgery Center, call 314-996-3880 or click here.