The Blepharoplasty Procedure: What Happens on the Day, Step by Step

Blepharoplasty takes roughly 45 minutes to 1 hour for the upper lids alone, or about 1 to 2 hours for all four lids, and follows the same broad shape: the lid is numbed under local anaesthetic (with or without sedation, or occasionally a general), an incision is hidden in the upper crease or reached from below or inside the lower lid, excess skin and fat are removed or repositioned, the incision is closed with fine stitches, and you go home the same day.¹

The day was the part I braced hardest for and, in the end, the part I remember least. I wanted someone to walk me through it in plain words beforehand, so I stopped imagining something dramatic and understood it as a small, methodical piece of work done very close to the eye. This is that walk-through. For the bigger picture of what the operation is and does, start with the pillar guide to blepharoplasty.

How long does the procedure take?

Upper blepharoplasty takes roughly 45 minutes to 1 hour; all four lids or a combined procedure takes about 1 to 2 hours. The time depends on which lids are treated, the technique, and whether the lower-lid fat is being repositioned rather than simply removed¹.

That range surprised me, because I had pictured something that would be over in fifteen minutes. It is quick as operations go, but it is not instant. The surgeon is working in a few millimetres of tissue, measuring skin against a lid that has to close and open thousands of times a day, and the lower lid in particular is unhurried because the whole aim there is a lid that will still sit correctly afterwards. The upper and lower operations differ in exactly this: one trims a strip of hooded skin, the other settles the fat pads beneath the eye.

What anaesthetic is used?

Upper blepharoplasty is usually done under local anaesthetic, with or without sedation, so the lid is numbed while you stay awake; lower, combined or double-eyelid procedures may instead use sedation or a general anaesthetic.² Which one is chosen depends on the extent of the surgery, your health, and the judgement of the surgeon and anaesthetist.

Mine was under local with light sedation, and the strangest part was being awake and asked, at one point, to look up and then gently close my eyes so the surgeon could check how the lid sat. There was no pain, just a tug and the odd flash of cold from the antiseptic. The reasons one option is recommended over another, and what awake surgery near the eye is actually like, are laid out in blepharoplasty anaesthesia.

Where are the incisions?

The upper incision sits in the natural crease of the lid, so the healed line hides when your eye is open; the lower lid is reached either through an external incision just below the lashes or, scarlessly, from inside the lid.³ The inside-the-lid (transconjunctival) route treats the fat pads with no visible scar and carries a lower risk of the lid pulling down.

This was the detail that reassured me most. I had imagined a scar I would have to explain; the reality on the upper lid is a fine line tucked into a fold that already exists. On the lower lid the choice of route matters, because the external approach can address loose skin but carries the higher risk of the lid being tugged out of position, while the inside route avoids a visible mark. That trade-off is explained in the transconjunctival approach.

What does the surgeon do once the incisions are made?

Through the upper crease the surgeon removes a measured strip of loose skin, a little of the muscle beneath, and a small amount of herniated fat, then reforms the crease with fine sutures; on the lower lid the fat pads are trimmed or draped over the bony rim rather than simply removed.² Increasingly the fat is repositioned to soften the hollow rather than taken away, because over-removal can leave a sunken look.

The honest headline is that the “best” technique is the one matched to the eyelid in front of the surgeon, and lower-lid work is judged on avoiding a lid that will not sit right, not on how much is taken away³. It is careful, conservative work: skin removed cannot be put back, so a good surgeon takes less rather than more. How the fine crease line then heals and fades is covered in blepharoplasty scars.

Do you go home the same day?

Blepharoplasty is almost always a day-case, so you go home the same day, usually within a couple of hours of finishing.¹ You cannot drive yourself, and you should have a responsible adult take you home and stay with you, because ointment and early swelling blur your vision and the local anaesthetic is wearing off.

I went home the same afternoon with cool packs and a tube of ointment, my vision smeared and my lids feeling tight and full. Having someone there mattered more than I had admitted it would, partly for the lifts and cups of tea and partly because the first hours are exactly when the one rare emergency, a bleed behind the eye, would show itself as escalating pain and pressure. Knowing what counts as normal swelling and what does not is something a good surgeon briefs you on before you leave.

What happens straight after?

Straight after surgery your lids are swollen, greasy with ointment, and the eyes in the mirror are not the eyes you will keep. Bruising and swelling peak at 2 to 3 days and settle over 1 to 2 weeks, upper-lid stitches usually come out at 5 to 7 days, and most people are presentable at 7 to 14 days, with the fine scars fading over weeks to a few months²⁴.

No one quite prepared me for how puffy and unfamiliar I looked at first, and it helps enormously to know in advance that the swollen early version is normal and temporary. The practical timeline from that first day onward is in blepharoplasty recovery week by week.