By Dr. Richard Levine, MD, FAAD | DermaBlue
If you’ve noticed your eyelids starting to droop, feel heavier than they used to, or make you look more tired than you actually are, you’re not imagining it. Skin loses elasticity as we age, and the eyelids often show it first, being some of the thinnest, most delicate skin on your body.
I’m Dr. Richard Levine, and I’m excited to now offer blepharoplasty here at DermaBlue. I wanted to write directly to you about what this procedure involves, because it’s one I get a lot of questions about, and I think a little clarity goes a long way.
Whether you’re just starting to explore your options or you’ve already decided surgery is the right path, here’s what you need to know.
What Exactly Is Blepharoplasty?
Blepharoplasty is eyelid surgery that removes or repositions excess skin, fat, and sometimes muscle around the upper and/or lower eyelids. For the upper lid, that usually means correcting hooded or heavy-looking eyes and, in some cases, improving vision that’s actually being obstructed by drooping skin. For the lower lid, it typically addresses under-eye bags and that puffy, tired look that concealer just can’t fix.
I often describe it to patients as one of the most effective ways to restore a refreshed, alert appearance. Unlike many non-surgical options, it physically removes the excess tissue rather than just tightening or filling it.
Who’s a Good Candidate?
In my experience, good candidates for blepharoplasty are generally healthy adults who are bothered by sagging or puffy eyelids, have realistic expectations about the results, and don’t have underlying eye conditions that would complicate healing (things like severe dry eye or certain thyroid-related eye issues give me pause). Age isn’t really the deciding factor, as I often see patients notice these changes anywhere from their 30s to their 60s and beyond.
The best way to know if you’re a candidate is a consultation, where I can evaluate your skin, muscle tone, and eyelid function in person.
Blepharoplasty vs. Other Cosmetic Treatments
One of the most common questions I get is: “Do I need surgery, or would something less invasive work?” It’s a great question, and the honest answer depends on what’s actually going on with your eyelids.
Dermal fillers are my go-to for hollowing or volume loss under the eyes, especially in younger patients whose main issue is shadowing rather than excess skin. But if the skin itself is loose or crepey, I’ll often steer away from filler there, since it can sometimes make that texture more noticeable rather than less.
I also use laser resurfacing frequently. It’s excellent for improving skin quality, fine wrinkles, and pigmentation around the eyes. I often pair it with blepharoplasty for an even more polished result, but on its own it doesn’t address significant excess skin or fat pockets.
In short: if your concern is mostly about skin quality, texture, or subtle volume loss, non-surgical treatments may be all you need. If you’re dealing with true excess skin, hooding that affects your vision, or persistent under-eye bags that don’t respond to anything else, blepharoplasty tends to be the more lasting solution.Â
I’m happy to help you figure out exactly where you fall on that spectrum, and it’s not uncommon for me to combine approaches for the best overall outcome.
What Happens During Your Consultation
Your first visit with me is all about listening and evaluating. We’ll talk through what’s bothering you, I’ll examine your eyelids and surrounding skin, and we’ll review your medical history, including any eye conditions, medications, or previous procedures.Â
From there, I’ll walk you through whether blepharoplasty is the right fit, what results you can realistically expect, and how I’d tailor the procedure to your anatomy (upper lids, lower lids, or both). This is also the time to ask me every question on your mind, from downtime to cost to what the scars will look like (spoiler: I place incisions in natural creases, and they heal remarkably well).
What to Expect During the Procedure
I typically perform blepharoplasty under local anesthesia with sedation, or sometimes general anesthesia, depending on the extent of the surgery and your comfort preferences. I make precise incisions along the natural folds of the eyelid, remove the excess skin and fat, and close everything with fine sutures designed to minimize scarring.Â
Recovery and Post-Op Care
Recovery from blepharoplasty is generally smoother than people expect, but it does require some patience. In the first few days, you’ll likely have some swelling and bruising around the eyes. I recommend cold compresses and keeping your head elevated (even while sleeping) for the first 48 hours, which goes a long way. Most of my patients feel comfortable returning to light activities within a few days and are back to work within one to two weeks, often with the help of sunglasses to cover any lingering bruising.
I’ll give you specific instructions on eye drops or ointments to keep the area moist, how to care for your incisions, and when it’s safe to resume exercise, contact lens use, or makeup. I usually remove sutures within the first week, and final results continue to improve over the following weeks as swelling fully resolves.
A Note From Me
I’m thrilled to be part of the DermaBlue team. As a board-certified dermatologist and surgeon, I bring a focus on both the medical and cosmetic sides of skin health to procedures like blepharoplasty. My goal with every patient is the same: results that look natural, feel like you, and hold up over time.
Ready to Talk About Your Options?
If tired, heavy, or puffy eyelids have been bothering you, I’d love to sit down with you for a consultation. I’ll help you understand whether blepharoplasty, a non-surgical treatment, or some combination is the right fit for your goals.
It’s a no-pressure encounter where we make absolutely sure that blepharoplasty is the right call for you. Surgery is permanent, after all, and we don’t recommend it lightly. If, at the end of the consultation, we decide that you’re not a good fit for blepharoplasty, we’ll often recommend one of our many other cosmetic treatments that can help treat your concerns in a much less permanent and invasive manner.
Schedule your blepharoplasty consultation with me at DermaBlue today.
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Dr. Richard Levine, MD, FAAD
Board-Certified Dermatologist & Mohs Surgeon • Fellow, American Academy of Cosmetic Surgery
With over two decades of experience, Dr. Levine combines surgical precision with an eye for natural-looking results. Board-certified in dermatology and fellowship-trained in cosmetic and facial surgery, he specializes in eyelid, brow, and facial rejuvenation procedures. Outside the clinic, he’s usually cycling Western North Carolina’s mountain roads or on the tennis court, bringing the same precision and care to every patient he treats.
Frequently Asked Questions About Blepharoplasty
How long will a blepharoplasty last?
For most patients, the results last a long time, often 10 to 15 years or more, especially for the upper eyelids. Your skin will keep aging naturally after surgery, but the excess tissue we removed doesn’t come back, so you’re essentially getting a head start that holds up for years.
How painful is blepharoplasty surgery?
Most patients are surprised by how manageable it is. During the procedure you won’t feel pain thanks to anesthesia, and afterward it’s more tightness, swelling, and mild discomfort than actual pain, usually well controlled with over-the-counter medication. I’d describe it as uncomfortable for a few days, not painful.
What is the best age for blepharoplasty?
There isn’t one “right” age as it’s really about when your eyelids start bothering you, not a number on a calendar. I’ve done this for patients in their 30s with early hooding and patients in their 70s finally addressing years of change. The best time is when it starts affecting how you feel or see.
What can I do instead of blepharoplasty?
If your main concern is skin texture or fine lines, RF microneedling or laser resurfacing can help. If it’s mostly volume loss or shadowing under the eyes, filler is often a good option. None of these remove excess skin the way surgery does, but for milder concerns they can make a real difference without downtime.
Do they do both eyes at the same time for blepharoplasty?
Yes, in most cases I do both eyes in the same session because it keeps things symmetrical and means you only go through recovery once. Whether we treat upper lids, lower lids, or both on each eye just depends on what you need.
