Eyelid Surgery



Patient: Female Age 50-55

Concerns: She was bothered by the puffiness of her lower lids and heavy upper lids.

Treatment: Bilateral Upper and Lower Lid Blepharoplasty

Surgery by Dr. Baljeet K. Purewal in New Jersey.


Eyelid Surgery (Blepharoplasty)

About Eyelid Surgery (Blepharoplasty)

Blepharoplasty eyelid surgery (sometimes referred to as an eyelid lift) is a plastic surgery procedure for correcting sagging eyelids, drooping eyelids, or baggy or puffy eyes.

The skin on and around our eyes is much thinner and delicate than other areas of the face. As a result, our eyes are often one of the first facial areas to exhibit signs of aging. While sagging eyelids, droopy eyelids, bags under our eyes or puffy eyes are a common effect of aging, there’s no reason to suffer through an appearance that troubles you or impacts your way of life. An eyelid lift (blepharoplasty) is often the most effective procedure to quickly restore your eyes to their youthful state.

Curious to see how other patients look after blepharoplasty? Take a peek at our before and after photos for real-world examples of what a big impact a subtle change through blepharoplasty can make.

What causes saggy, droopy, baggy, or puffy eyes?

There are many factors that contribute to saggy, droopy, baggy, or puffy eyes. External factors like sun damage, smoking, obesity (or subsequent weight loss), etc. can cause the muscles and tissue that support the eyelids to weaken. Genetics can play a significant factor as some of us are just naturally more prone to saggy, baggy, droopy, puffy eyes. Whether from external factors or genetics, eventually aging will affect every one of us, and our eyes are often one of the areas of our face that bear the most dramatic impact.

What is the treatment for saggy, droopy, baggy, or puffy eyes?

Blepharoplasty (eyelid lift) is one of the most common treatments to quickly and effectively treat droopy eyes, saggy eyes, baggy eyes, and puffy eyes. Blepharoplasty is a surgical procedure that is typically performed as an outpatient procedure requiring local anesthesia and sedation (although general anesthesia may be used for patients who request it). Patients can choose upper blepharoplas
ty to treat saggy eyes, and droopy eyes, or lower blepharoplasty to treat baggy eyes, and puffy eyes. Many patients opt for both procedures to address full upper and lower eyelid aging at the same time. Blepharoplasty (eyelid lift) procedures take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on.

What is involved in blepharoplasty (eyelid lift)?

Upper blepharoplasty is a procedure used to treat sagging and/or drooping eyelids. In an upper blepharoplasty procedure, an incision is typically made along the eyelid’s natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed.

Lower blepharoplasty is a lower eyelid procedure used to treat bags under the eyes and/or puffy eyes. Lower blepharoplasty employs an incision, usually made just below the lash line, so that excess skin can be removed. For a lower eyelid that needs fat rather than skin removed, a trans-conjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision but results in a more refreshed, youthful appearance.

After the procedure, the incisions are closed with sutures and a thin layer of ointment is applied to encourage healing.

How long is the recovery period for blepharoplasty (eyelid lift)?

The recovery from blepharoplasty is typically uncomplicated and requires minimal downtime. Some simple steps like applying lubricating drops/ointment and utilizing cold compresses will aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 1 week. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind.

Any minor scars that result from blepharoplasty are well-concealed and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

Have more questions? Check out our informative blog, Your Blepharoplasty Questions Answered, where we cover all things Blepharoplasty.

FAQ: Upper and Lower Eyelid Blepharoplasty

Am I candidate for Upper and Lower Lid Blepharoplasty?

If heaviness or puffiness of your eyelids is consistently bothering you about your appearance, then you are a candidate for upper and lower lid blepharoplasty.

How long does the surgery take?

The surgery takes approximately 1.5-2.5 hours to perform.

Where is the surgery performed?

IV sedation or general anesthesia makes the procedure for lower lid blepharoplasty surgery more comfortable. Therefore, the procedure for both upper and lower lid blepharoplasty is performed in an operating room at a surgical center.

What is the recovery time?

Most patients will look like they had surgery for about 1-2 weeks because of mild bruising and swelling. Intraoperative techniques and medications in combination with supplements given ahead of surgery help to minimize bruising and swelling.

How long do results last?

10-15 years

Are there alternatives, less invasive options to Upper and Lower Lid Blepharoplasty?

Some patients may be candidates for less invasive options to correct heaviness of their upper lids and puffiness of their lower lids if they are not ready for surgical intervention. A chemical browlift can be performed with strategically injected botox in the eyebrow area to give a 1-2mm lift of the brow. This can open the eyes slightly and can be combined with Ultherapy of the brows for a stronger effect. Injectable fillers can be used to camouflage the puffiness of the lower lids and treatments such as lasers, microneedling or chemical peels can improve lower lid skin texture and tone. While these treatments will not achieve surgical results, in certain patients they can be considered as an alternative to rejuvenation in this area. These treatments can also be combined with surgery for an even better result.

Eyelid Surgery (Blepharoplasty)

Each face is unique, which is why it is an individual’s distinct facial features that help to define who he or she is to the rest of the world. This is one of the reasons people seek a solution for facial changes that occur as part of the natural aging process. Unwelcome facial features, such as puffy bags under the eyes and drooping upper or lower eyelids cause people to seek a solution for these unwanted signs of aging. These characteristics can be addressed with a blepharoplasty (aka eyelid surgery or eyelid lift).

What Factors Cause the Natural Signs of Aging that Eyelid Surgery can Address?

The skin surrounding the eyes is thinner and more delicate than the skin on other areas of the face: These characteristics frequently lead to the eye area being one of the first places to show the signs of aging. Numerous factors contribute to the droopy, saggy, puffy or baggy eyes that are commonly associated with the signs of aging.

Factors contributing to the signs of aging include:

  • Smoking.
  • Sun damage.
  • Obesity.
  • Losing a substantial amount of weight.

Each of the issues listed above can lead to a weakening of the tissue and muscles that support the eyelids. Genetics can also affect whether an individual is more prone to developing the signs of aging around the eyes.

These signs of aging include:

  • Under eye areas that sink in.
  • Puffiness around the eyes.
  • Under eye areas that bulge.
  • Droopy eyelids.
  • Under eye areas that sag.

How these signs of aging affect the eyes:

  • The under-eye bags can become so heavy that the lower eyelid is pulled downward, exposing the white area beneath the iris.
  • When the natural contours of the upper eyelids become lax, the lids begin to droop. These droopy upper eyelids can become so severe that the patient’s field of vision is hindered.
  • When fatty tissue builds up above the eyes, the upper eyelids can appear puffy.

Eventually, everyone falls victim to the signs of aging and although these changes are normal, with the innovative plastic surgery procedures available today, the areas around the eyes and the eyelids can be rejuvenated with a blepharoplasty. Using plastic surgery procedures and non-surgical rejuvenation techniques, board-certified Oculoplastics and Reconstructive Surgeon Dr. Baljeet K. Purewal can effectively turn back the hands of time. To view examples of some of Dr. Purewal’s patients who chose to have eyelid surgery to address their signs of aging, click here.

What Issues Can Dr. Baljeet Purewal Address with Eye Surgery?

Dr. Purewal addresses saggy, droopy, baggy and puffy eyes with eyelid lifts. She can also reposition fat beneath the eye to address eyes that look as if they are sunken in.

Since Dr. Baljeet K. Purewal performs eyelid surgery as an outpatient procedure, patients return home after their eyelid lift.

During blepharoplasty procedures, patients receive local anesthesia with sedation, which is frequently referred to as twilight anesthesia, however, Dr. Purewal does provide general anesthesia to her patients who request it. Since patients receive twilight or general anesthesia during their procedure, they are unable to drive themselves home; therefore, patients are required to bring a licensed driver with them on the day of their eyelid lift procedure. Patients who arrive without a driver on the day of their eyelid surgery will need to reschedule their procedure: For the safety of her patients, Dr. Baljeet Purewal does not permit the use of transportation services after a patient has any procedure that requires sedation or general anesthesia.

A blepharoplasty procedure can last up to two hours. The length of the procedure is dictated by whether Dr. Purewal is addressing both the upper and lower eyelids during the eyelid lift, or if she is just addressing the upper or lower eyelids.

Who Should Consider Having Eyelid Surgery?

A healthy individual whose eyes have developed the unwanted characteristics associated with the natural aging process may be a good candidate for an eyelid lift. An individual who would like to have a blepharoplasty procedure with Dr. Purewal must have realistic expectations as to what an eyelid surgery can accomplish.

Unfortunately, except in special circumstances, patients who have dry eye or eye diseases, including glaucoma, are not considered good candidates for blepharoplasty procedures.

What Determines If a Patient Needs the Upper, Lower or Both Eyelids Addressed?

Upper eyelid surgery is used to address droopy, saggy eyes and lower eyelid surgery is used to treat baggy, puffy-looking eyes. Patients who have noticed changes in their upper and lower eyelids may choose to have an eyelid lift on their upper and lower lids during a single surgical session.

Addressing Functional and/or Aesthetic Issues with an Upper Blepharoplasty

Upper eye surgery may be performed for cosmetic reasons, functional reasons or to address both of these issues.

The goal of a functional upper blepharoplasty procedure is to eliminate excess skin, tissue and muscle that is causing the lid to fall too far down over the patient’s eye. Sometimes, an upper eyelid lift will need to include ptosis repair. Ptosis is a term that refers to the margin of the upper eyelid sitting too low and covering a portion of the patient’s pupil; thus, interrupting his or her range of vision.

The goal of an aesthetic blepharoplasty is to address overhanging skin to provide the patient with more youthful-looking eyes.

Upper Eyelid Surgery

An upper blepharoplasty procedure is performed to remove excess fat and skin. This excess skin and fat can make the upper eyelids appear heavy and puffy, both of which can lead to the eyelid blocking a patient’s upper field of vision.

Addressing Changes in the Eyelids and the Brow

Upper eyelid surgery involves the removal of the excess skin, tissue and muscles that are causing unflattering changes in the upper eye area. Sometimes, patients choose to have a combination procedure which includes an upper blepharoplasty, lower blepharoplasty and a brow lift.

Procedure Steps for Upper Eyelid Surgery

The patient receives local anesthesia with sedation or general anesthesia to ensure that he or she remains comfortable throughout the upper blepharoplasty procedure.

1. The first step in performing an upper blepharoplasty involves locating the natural crease on the upper eyelid.
2. After locating the natural crease, Dr. Baljeet K. Purewal creates an incision that corresponds with this crease, which ensures that the resulting scar remains well hidden within the upper eyelid.
3. Once Dr. Purewal creates the incision, she gently repositions or removes fat deposits, tightens the tissue and the muscles, and then removes the excess skin. Dr. Baljeet Purewal has the skill necessary to alleviate the problem a patient is experiencing while preserving enough upper eyelid skin to ensure normal eyelid closure.
4. After completing the upper eyelid surgery, Dr. Purewal carefully brings the upper eyelid skin together with a thin stitch.

Once healing is complete, the crease of the upper eyelid successfully camouflages the resulting scar.

Lower Eyelid Surgery

With a lower blepharoplasty, Dr. Baljeet K. Purewal addresses the bags that develop under the eyes as well as the sunken-in look that is sometimes seen beneath the eye.

During a lower blepharoplasty, she removes excess skin and improves the lower eyelid’s contour by either adding or removing fat. In addition, some patients will need to have their lower eyelids tightened to address sagging.

Procedure Steps for a Lower Blepharoplasty

1. While performing a lower blepharoplasty, Dr. Purewal creates an incision just below the lash line. This allows her to access the excess skin that needs to be removed.
2. Once Dr. Purewal removes the excess skin, she closes the incisions using sutures. She also applies a thin layer of ointment. This ointment helps encourage healing.

A transconjunctival blepharoplasty procedure:

When a patient needs to have fat removed or added, Dr. Baljeet Purewal performs what is referred to as a transconjunctival blepharoplasty. During this procedure, she creates the incision inside the lower eyelid, thus, ensuring there are no visible scars. This procedure is used to provide the patient with a more youthful appearance.

What Patients Can Expect as They Recover from Their Eyelid Surgery

Recovery following an eyelid lift is usually uncomplicated, requiring only minimal downtime. While it is common for patients to experience inflammation, bruising and a tight feeling in their eyelids, some patients also experience intermittent symptoms like dry eyes and/or watery eyes after their surgery. Although the majority of these post-surgical effects typically subside within a couple weeks, following the recommendations provided by Dr. Baljeet K. Purewal can help the patient remain more comfortable as he or she recovers.

Dr. Purewal’s recovery recommendations include:

  • Applying lubricating ointment to the eyes and using artificial tears. These treatments will minimize the side effects associated with eyelid surgery and aid in the healing process.
  • Continuing to avoid the use of products that contain nicotine.
  • Avoiding exposure to smoke emitted by cigarettes, e-cigarettes, cigars, pipes and any other product that is used in this way. In addition, stay away from campfires, grills and fireplaces that are in use. Smoke from any of these sources will irritate the eyes.
  • Reducing the inflammation and bruising around their eyes, and face by using cool compresses. After surgery it is common for the eyelids to feel tight, however, wearing some cool gauze and/or an eye-shaped cooling pack over the eyes intermittently for the first 48 hours usually reduces swelling. Reducing the inflammation helps relieve the uncomfortable tight feeling in the eyelids.
  • Avoiding excessive use of computers, smartphones and iPads as well as limiting the amount of time spent watching television is vital because viewing the screens during each of these activities can contribute to dry eye.
  • Drinking plenty of fluids and avoiding alcoholic beverages can hasten the healing process.
  • Wearing dark sunglasses while spending time outside or in bright light. Wearing these glasses protects the patient’s eyes from wind, the sun and other bright lights. These glasses should be worn for at least two weeks after surgery.
  • Refraining from wearing eye makeup and contact lenses for at least two weeks.
  • Avoiding hot tub use and swimming, even with goggles: Besides being painful, these activities increase the likelihood of developing an infection.
  • Performing light activities (e.g., walking), as these kinds of activities slowly increase the speed at which blood moves throughout the body, thus, continuously providing the areas that are healing with the nutritious, oxygenated blood required for healing.
  • Cleaning the areas around the eyelids very gently.
  • Keeping their heads elevated.
  • Using several pillows during sleep.

Driving restrictions, follow-up appointments and returning to work:

  • Following anesthesia use, patients need to refrain from driving for at least 24 hours. Furthermore, individuals who have eyelid surgery may not feel comfortable driving for some time. This uncomfortable feeling typically resolves within five to 10 days.
  • Dr. Purewal may place thin bandages over the incision sites. These bandages can be removed several days after eyelid surgery.
  • A week after surgery, patients typically return to Dr. Purewal’s office to have their stitches removed.
  • Most of Dr. Baljeet Purewal’s patients can return to work within a week. However, patients who work in positions requiring strenuous activity must remain off work for at least two weeks.
  • After a few months have passed, patients will have a follow-up appointment at Fresh Face & Eye. During this appointment, Dr. Purewal will evaluate the patient’s blepharoplasty results.

Addressing Wrinkles During a Blepharoplasty Procedure

While performing an eyelid lift, Dr. Purewal can also use a HALO laser treatment to revitalize the skin and decrease the visibility of the wrinkles that form next to the eyes (i.e., crow’s feet).

It is during the initial consultation that Dr. Baljeet Purewal determines whether the patient can benefit from an upper, a lower or full eyelid surgery. If the patient is interested, Dr. Purewal can also determine if he or she is a good candidate for a HALO laser treatment.

An Appointment with Dr. Baljeet K. Purewal at Fresh Face & Eye

During the initial consultation, patients should be prepared to discuss the issues that they would like Dr. Purewal to address with an eyelid lift. Once she knows what the patient would like addressed, Dr. Baljeet Purewal will examine his or her eyes. After this examination, Dr. Purewal will be able to determine which eyelid surgery will provide the patient with optimal results.

Patients who take medications on a regular basis need to provide Dr. Baljeet K. Purewal with a list of these medications. Please include the name of the medication, the dose, the number of times the medication is taken within a 24-hour period and the reason the medication is prescribed.

If the patient has any ongoing medical conditions, it is vital that these conditions are discussed with Dr. Purewal at this appointment. In addition, since anesthesia is used during eyelid surgery, for the safety of her patients, Dr. Baljeet Purewal frequently requests that her patients have their general practitioners perform a physical to clear them for surgery.

The benefits and potential risks associated with blepharoplasty procedures, as well as any other procedure the patient would like to know more about, will be discussed during this consultation.

At Fresh Face & Eye, patients are always encouraged to ask questions.

Dr. Baljeet Purewal and her staff take the time to understand each patient’s hopes, dreams and concerns. For this reason, during an initial consultation for eyelid surgery, Dr. Purewal provides her patients with detailed information about the procedures that she believes will help them achieve their goals. The procedures discussed may be non-surgical, surgical or a combination of both. At Fresh Face & Eye, despite the procedure the patient receives, our goal is to provide each patient with a soft, natural-looking result.

Preparing for a Blepharoplasty Procedure

Once the patient is cleared for eyelid surgery, he or she needs to begin preparing for the recovery phase. By reviewing the preoperative and postoperative instructions before their procedure, patients will know exactly what they need.

Preparing for recovery ahead of time ensures that the patient has the medication, gel packs, gauze and artificial tears necessary to help him or her remain comfortable throughout recovery.

Patients who smoke cigarettes, e-cigarettes, cigars, pipes and/or any other nicotine-containing product must discontinue using these prior to surgery.

Patients taking blood thinners must stop taking this type of medication before their blepharoplasty procedure and for some time afterwards. To ensure the patient’s safety, he or she needs to discuss this necessary lapse in medication use with the prescribing physician.

Are There Visible Scars Following an Upper and/or Lower Blepharoplasty?

Any scars that result from upper eyelid surgery are camouflaged within the upper-eyelid crease and as time passes these scars will become virtually undetectable. The incision created during lower eyelid surgery is either beneath the eyelashes or inside the lower eyelid. Just like the upper eyelid incision, the incisions used for the lower eyelids are well-hidden, making them nearly invisible.

How Long Do the Results Achieved During Eyelid Surgery Last?

While the eyes will always be vulnerable to the signs of aging, an eyelid lift at Fresh Face & Eye does turn back the clock, offering patients long-lasting results.

Potential Complications and Risks of Eyelid Surgery

Although complications associated with an eyelid lift are rare, by choosing an experienced, board-certified Oculoplastics and Reconstructive Surgeon like Dr. Purewal to perform your blepharoplasty, you reduce the likelihood of experiencing a complication even more.

Risks associated with eyelid surgery include:

  • Bleeding.
  • Infection.
  • Visible scarring.
  • Dry eye.
  • Difficulty or inability to close the eye.
  • Double vision.
  • Abnormal eyelid positioning.
  • Vision loss (which is extremely rare).

How Much Does It Cost to Have Eyelid Surgery?

The cost of a blepharoplasty procedure depends on the complexity of the procedure being performed and whether the patient is having an upper eyelid lift, lower eyelid lift or both of these procedures.

Will Health Insurance Cover a Blepharoplasty Procedure?

Health insurance will cover some of the costs associated with eyelid surgery if it is medically necessary. For example, if a patient’s visual field is obstructed due to a drooping upper eyelid, health insurance may cover his or her upper eyelid lift. Patients need to check with their insurance carrier to determine what information they must submit to request coverage.

Using an eyelid lift, an experienced, board-certified Oculoplastics and Reconstructive Surgeon like Dr. Baljeet Purewal can skillfully alter the eye region to restore the youthful characteristics that have been lost due to the natural aging process. She can also address lax upper eyelids that are affecting an individual’s range of vision.

The Fresh Face & Eye Difference: What Makes Us Unique

At Fresh Face & Eye, we realize that the preventive care, anti-aging and skin maintenance options available can be somewhat overwhelming, for this reason, we encourage patients to ask questions and are always happy to provide them with the information they need to make the best choices. Furthermore, at Fresh Face & Eye, we believe that every patient should have access to treatment and product information without concerns related to being pressured into making an appointment or purchasing a product.

Dr. Baljeet K. Purewal is an experienced, board-certified Oculoplastics and Reconstructive Surgeon who specializes in non-surgical rejuvenation treatments for the face and surgical procedures for addressing the signs of aging that affect the eye. She has been serving Northern New Jersey for 10 years.

To schedule an appointment with Dr. Purewal at her Fresh Face & Eye practice, located in Chatham, New Jersey, please call 973-635-4000 or click here. Fresh Face & Eye is located at 82 Main Street.