Upper Eyelid Surgery: What to Expect Before, During & After

You've been told you look tired. You're not tired — you slept eight hours, you feel fine — and yet there it is, that same comment from your coworker, your mom, the barista who's known you for years. The skin above your eyes has started to fold, to droop, to do something you keep noticing in photos and quickly swiping past.

Upper eyelid surgery — clinically called upper blepharoplasty — is one of the most consistently satisfying procedures I perform. Not because it's dramatic. Actually, quite the opposite. When it's done right, you don't look like you had surgery. You just look like yourself again — rested, alert, like the version of you that other people apparently aren't seeing anymore.

This post is for the person who's been quietly researching this for a while. The one who has questions they feel a little embarrassed to Google. I want to walk you through exactly what upper eyelid surgery involves: what I'm looking at in a consultation, what the procedure actually looks like, and how recovery plays out week by week. No glossing over the real parts.

What Upper Eyelid Surgery Actually Does

The upper eyelid has a natural crease — a fold in the skin where the eyelid naturally opens and closes. With age, the skin above that crease starts to stretch. The underlying muscle can weaken. Fat deposits shift. The result is that extra skin begins to hang over the crease, sometimes so much that it rests on your upper lash line. In more significant cases, it can actually reduce your field of vision.

Upper blepharoplasty removes that excess skin — and sometimes a small amount of fat — through an incision placed directly in the natural eyelid crease. After healing, that incision is essentially invisible, hidden in the fold where your eye opens. The scar isn't on display. It's built into your anatomy. What you're left with is an eyelid that sits where it's supposed to sit. Eyes that look open. A resting expression that matches how you actually feel.

Am I a Good Candidate?

This is always the most important question — and I'd rather you walk in already thinking about it.

The patients who tend to be the best candidates for upper eyelid surgery are people who have noticeable excess skin on their upper eyelids that either affects their appearance, their confidence, or — in some cases — their vision. Most patients I see for this are in their late 30s through their 60s, though it's not purely an age-related procedure. Genetics play a big role.

Here's what I'm assessing beyond the obvious:

• Overall eye anatomy. I'm looking at how your brow sits relative to your eyelid. This is critical. Sometimes what looks like excess upper eyelid skin is actually a low or descended brow. If your brow position is the underlying driver, a blepharoplasty alone may not give you the result you're expecting — and I'd rather have that conversation in the consultation than have you surprised by the outcome.

  
  

• Skin quality and elasticity. Thin, sun-damaged skin behaves differently than thicker skin. It affects healing and long-term results.

  
  

• Dry eye history. This one matters. Certain patients with significant dry eye symptoms need to approach upper eyelid surgery carefully, because the procedure temporarily affects how the eye closes. I ask about this in every consultation.

  
  

• Realistic expectations. Upper eyelid surgery is excellent at creating a refreshed, natural appearance. It doesn't change the fundamental shape of your eyes, eliminate fine lines in the surrounding area, or turn back the clock twenty years. When patients understand what it does do — and that it does it very well — they're consistently happy.

  
  

What Happens at Your Consultation

Your upper eyelid consultation isn't just me looking at your eyes and saying yes or no. There's a real clinical evaluation happening.

i always approach my blepharoplasty consultations from the top down. I'll look at your brow position first, as I mentioned, because it changes the conversation. Then I'll assess how much redundant skin is present, whether there's a fat component contributing, and where your natural eyelid crease sits. I'll also look at the underlying muscle — specifically whether there's any true eyelid drooping (called ptosis) that's separate from the skin issue. Ptosis requires a slightly different surgical approach, and it's worth identifying upfront.

Next we'll talk about your goals. What bothers you specifically? Is it mostly about appearance? Is there a visual field component — do you feel like you're looking out from under a hood? The answers shape the plan.

By the end of the consultation, you'll know exactly what the procedure would involve for you, what the recovery looks like, and whether I think you're a good candidate. If I don't think surgery is the right answer for you, I'll say so.

The Procedure Itself

Upper blepharoplasty is almost always done under local anesthesia with sedation — meaning you're comfortable and relaxed, not fully under general anesthesia. For most patients, that's actually a significant relief. No breathing tube, no prolonged anesthesia recovery. Every once in a while (and in the right candidate), local anesthetic alone may be appropriate.

The procedure takes about 30 minutes to an hour for upper eyelids alone. If we're addressing both upper and lower eyelids in the same session, plan for at least two hours as lower lids are a different beast entirely.

Here's the sequence: the area is marked while you're sitting upright and awake, because gravity matters — your eyelids look different lying down than they do standing. Once you're comfortable and under IV sedation, the local anesthesia is injected. The eyelid skin is thin and the local takes effect quickly to help not only for pain control but mainly to reduce bleeding during the procedure.

The incision is made in the natural crease, the excess skin is removed, and any necessary fat is either removed or repositioned. Everything is sutured closed with very fine stitches that need to be removed in a week. Once done you head to recovery and will soon be ready for discharge.

Upper Eyelid Surgery Recovery: Week by Week

Days 1 through 3: This is the worst stretch — and it's still very manageable. Swelling and bruising are at their peak. Your eyelids will feel tight. You'll want to keep your head elevated, apply cool compresses regularly, and rest. Most patients describe the discomfort as a 2 or 3 out of 10 — not really pain, more like pressure and heaviness.

Days 5 through 7: Sutures come out. This is a fifteen minute appointment and patients are always relieved. The bruising starts shifting — that classic yellow-green stage. Swelling is noticeably reduced from where it was at day two or three.

Week two: Most patients look presentable enough for daily life. Makeup can go over the incision line starting around day 14, which covers a lot. If you have a work situation that requires you to look polished, two weeks is a reasonable estimate for most people, with the caveat that some residual puffiness may still be there. If you wear glasses, this can help tremendously to mask the area.

Weeks three and four: The swelling continues to settle. The incision line is still pink — that's normal. Don't panic about scar appearance at this stage; it hasn't finished healing.

Three months: This is when you see your real result. The swelling is gone, the scar has faded significantly, and the eyelid has fully settled into its new position. Most patients forget they even had surgery because the result has just become their normal.

Long-term: Results from upper eyelid surgery typically last ten years or more. The skin will continue to age — that's unavoidable — but for most patients, the improvement holds well. It's important to note that, as with every plastic surgery procedure, maintaining your results is key-- a good skin care routine with healthy habits go far in protecting your investment.

A Few Things That Surprise Patients

Your vision may feel different immediately post-op. Not worse — but different. The change in how your eyelid sits can make your visual field feel more open in a way that takes a few days to adjust to.

Asymmetry can be normal during healing. One eye almost always swells more than the other, and this creates asymmetry that resolves on its own. I tell every patient this upfront because it's alarming if you're not expecting it.

Sun protection matters for your results. The skin on your eyelids is thin. UV exposure accelerates skin aging and can affect how long your results last. Sunglasses are your best friend post-operatively and long-term.

You may feel emotional in the first week. This is incredibly common after any facial procedure. Being home, seeing swelling, not looking like yourself yet — it can stir up anxiety even when everything is going exactly as planned. I encourage patients to hold off on evaluating their results until at least the three-week mark.

Key Takeaways

• Upper eyelid surgery (blepharoplasty) removes excess skin from the upper eyelid through an incision hidden in the natural crease — the scar is essentially invisible after healing.

• Brow position must be evaluated first; a descended brow can mimic eyelid hooding and changes the surgical plan.

• The procedure is done under local anesthesia with sedation, typically takes under an hour, and is outpatient.

• Most patients can return to daily activities within seven to fourteen days; full results are visible at three months.

• Results commonly last ten or more years.

• Dry eye history and overall eye anatomy are important factors in candidacy — these will be discussed in your consultation.

  
  

Ready to Take the Next Step?

If you've been looking at your eyes in the mirror and thinking it's time — or even just wondering whether this is something that makes sense for you — the right first step is a conversation. I'm based in Seattle, and I work with patients from across the Pacific Northwest who are thoughtful about these decisions and want a surgeon who's equally thoughtful.

A consultation doesn't mean you're committing to surgery. It means you get real information about your specific anatomy, your specific concerns, and what's actually possible. Schedule yours at drmeganmd.com.

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Dr. Megan Dreveskracht is a board-certified plastic surgeon in Seattle, Washington. To schedule your consultation, click here to fill out a contact form online.