Blepharoplasty is eyelid surgery that corrects many of the signs of aging around the eyes. It can involve upper eyelid surgery and/or lower eyelid surgery.

If you have sagging upper eyelids or bags under the eyes, this procedure is a great way to look younger and bring your eyes out of hiding. Dr. Velargo has extensive experience with blepharoplasty, customizing each surgery for the needs of the patient. This involves an examination of the skin and muscles of the eyelids to determine where and how much excess skin and fat should be removed to create a younger but natural-looking appearance.

Lower eyelid surgery, in particular, is delicate and requires special training and skill. For this reason, your choice of surgeon is important. Dr. Velargo will spend time with you to hear your concerns about the appearance of your eyes and tell you exactly what you can expect from your surgery.

Blepharoplasty is often performed in conjunction with other procedures, such as a facelift or brow lift. Other patients opt for dermal fillers, Botox®, or a skin resurfacing procedure to soften more of the lines and wrinkles surrounding the eyes.

You should inform the doctor of any eye conditions, dry eyes, or visual impairments that you have, and it is recommended that you have an eye examination prior to eyelid surgery.


In upper blepharoplasty, an incision is made in the crease of the eyelid so that the tiny scar will be camouflaged. Excess skin and fat (if indicated) are removed, and the new skin edges are sutured together for a tighter but natural-looking result.

In lower blepharoplasty, the incision is variable. If excess skin needs to be removed, the incision is made in the first wrinkle line under the lower eyelashes. Placement of the incision here not only camouflages the scar but also preserves the integrity of the muscle surrounding the eye near the lid margin to help prevent downward pulling of the eyelid (ectropion) that may sometimes result when the incision is placed too close to the eyelashes.

If no excess skin is present in the lower lid, the incision can be made inside the eyelid in what is called a transconjunctival blepharoplasty. This results in no visible scar.

upper blepharoplasty brow lift and hairline lowering before & after

In both techniques, the protruding fat in the under-eye bags is either removed or repositioned to create a more youthful midface. Following fat removal or repositioning, excess skin is removed if the external approach has been chosen. Both techniques can be combined with skin resurfacing procedures (e.g. laser or peel) and/ or Botox to address the wrinkles that may be present around the eyes.

Depending on your particular case, your eyelid surgery for both eyes can be completed in approximately 30-45 minutes.

Blepharoplasty is an outpatient procedure that is usually performed under a local anesthetic with intravenous or oral sedation so that you are not fully asleep but completely relaxed with the eyelids numbed. In some cases, however, the surgery is performed under general anesthesia. Either way, you will be drowsy after your procedure and will need someone to take you home.


Asian eyelid surgery is a surgery performed to transform eyelids with classic Asian features into more Caucasian-appearing eyelids. The surgery centers around creating a natural-looking crease in the upper eyelid, which Asians classically lack because of their anatomy. Other maneuvers involve removing the excess fat found in the upper lids of Asians.

The incision required for this surgery and the setting in which surgery is performed is the same as standard blepharoplasty, as described above. If desired, Dr. Velargo can also address the epicanthal fold found in most Asians, which is a web of skin that connects the medial portion of the upper lid to the side of the nose. Correcting this fold of tissue allows the medial corner of the eyelid to become more visible. It is accomplished by a small “z” pattern incision, and the scar usually heals in an inconspicuous way.

You will feel some tightness when the anesthetic wears off. You may also experience some eye dryness and excessive tearing, as well as bruising and swelling. These symptoms will gradually subside in the weeks following your surgery. Frequent application of cool compresses for the first 72 hours helps to speed the healing process along, as well as the application of topical Arnica Montana for visible bruising.

Incisions are cared for 4-6 times per day by cleansing the incision lines with hydrogen peroxide, followed by application of an eye lubricant to the incisions themselves.

A tiny blue suture is used to close the upper eyelid incision, and an even smaller suture is used to close the lower eyelid incision (if an external incision is made). All sutures are removed between 5-7 days following your surgery.

Most patients take 7-10 days off from work after eyelid surgery and are able to wear contact lenses again after about 10 days. You should be able to exercise within 3 weeks.

With some make-up and/ or thick-rimmed glasses, you should be able to go out in public with minimal attention drawn to yourself in just 2-3 days.

Depending on the skin type, lumps and bumps may be present along the incision lines in the initial phases of healing. These usually go away with time, but we can often speed the healing process along with local injections of steroids. Occasionally, milia (plugged up oil glands) will be present, and these can be easily treated in the clinic as well.

As a rule, 80% of swelling is gone in 2 weeks and 90% of swelling is generally gone by 2 months, so do not try to evaluate the results of surgery too soon.

The results of blepharoplasty are permanent in the sense that your eyes will always look more youthful than if you never had the procedure done. However, as the aging process continues, skin will continue to sag, and bags will continue to develop. “Tuck-up” procedures may be necessary after some years, and Dr. Velargo is very experienced in revision blepharoplasty as well.

In our experience, it is getting more and more difficult to convince insurance companies to defray any costs associated with blepharoplasty except in the rare instance of severe visual obstruction from upper lid hooding. Even then, the process to obtain insurance coverage is onerous and often futile, as the patient nearly always obtains some cosmetic improvement.

Upper eyelid surgery can correct:

  • Drooping/sagging upper eyelids (note that in some cases, this may be partially due to a drooping eyebrow, which may be corrected simultaneously)
  • Puffiness in the upper eyelids
  • Loose skin under the eyebrows

Lower eyelid surgery can correct:

  • Undereye bags
  • Sagging skin/drooping lower eyelid

Contact the New Orleans Center for Aesthetics and Plastic Surgery today to find out more about expert upper and/or lower eyelid surgery.