Blepharoplasty in Vancouver

Blepharoplasty, also called eyelid surgery, can treat heavy or hooded upper eyelids, under-eye bags and loose eyelid skin. Surgery may involve the upper eyelids, lower eyelids or both, depending on what is causing the concern and what you would like to improve. Not every heavy eyelid is caused by extra skin. The eyebrow can sit lower with age, the upper eyelid itself can droop, and dry eyes or other eye conditions can affect whether surgery is appropriate. For lower eyelids, I also look at the amount of loose skin, the position of the fat and how well the eyelid is supported. The goal is to improve the eyelid area while keeping the eyes looking natural and allowing the eyelids to close comfortably.

Upper blepharoplasty removes a carefully measured amount of extra upper-eyelid skin. In some patients, a small amount of muscle or fat may also be treated. When excess skin is severe enough to block part of the visual field, surgery may also have a functional benefit.

Lower blepharoplasty is used to treat under-eye bags, loose lower-eyelid skin and changes in the contour between the lower eyelid and cheek. Depending on the problem, fat may be repositioned, removed conservatively or, in selected patients, supplemented with fat grafting.

Blepharoplasty does not correct every cause of a tired or heavy appearance around the eyes. Dark circles, crow’s feet, a low brow, true eyelid drooping and loss of facial volume may need a different treatment. The consultation is important because the right operation depends on what is actually causing the concern.

Blepharoplasty may be appropriate if you have heavy or hooded upper-eyelid skin, under-eye bags, loose lower-eyelid skin or a combination of these concerns. Your general health and eye health also need to be suitable for surgery.

Sometimes another assessment or treatment makes more sense. For example, a low eyebrow or true eyelid droop may be the main reason an upper eyelid looks heavy. Significant dry-eye symptoms, a new change in one eyelid or a change in vision should also be assessed before cosmetic eyelid surgery.

Upper and lower blepharoplasty treat different problems. Some patients need only upper eyelid surgery, some only lower eyelid surgery, and some benefit from treating both areas.

Upper Blepharoplasty

For upper blepharoplasty, I mark the eyelid crease while you are sitting upright so I can see the natural fold and any difference between the two sides. The area is numbed, and the incision is placed in the natural crease. I remove a carefully planned amount of skin and, when needed, a small amount of muscle or fat. Fine sutures are used to close the incision and are generally removed about 5 to 7 days later.

The aim is to reduce heaviness without removing too much tissue or making it difficult to close the eyes comfortably.

Lower Blepharoplasty and Under-Eye Bags

Lower blepharoplasty may be used to treat under-eye bags, puffiness and loose skin. The operation is planned differently depending on whether the main problem is bulging fat, extra skin or both.

Two Ways to Perform Lower Blepharoplasty

If loose skin needs to be removed, the incision is usually placed just below the lower eyelashes. This is called a transcutaneous approach. Through this incision, the skin and underlying tissue can be adjusted and the lower-eyelid fat can be repositioned or removed conservatively. Extra skin is trimmed carefully because removing too much can pull the lower eyelid downward.

If the main concern is under-eye bags and there is very little extra skin, the incision can sometimes be hidden inside the lower eyelid. This is called a transconjunctival approach. Because the incision is inside the eyelid, there is no external skin scar from this part of the procedure.

In selected patients, fat grafting may be added if hollowing is also part of the problem. Some lower eyelids also need additional support at the outer corner of the eye.

Is the Heaviness Coming From the Eyelid or the Brow?

A heavy upper eyelid is not always caused by extra eyelid skin. Sometimes the eyebrow has dropped and pushes more skin toward the eyelid. In other patients, the eyelid itself sits too low because the muscle that lifts it is not working normally. This is called ptosis. These problems may need a different operation rather than simply removing more skin.

Dry Eyes and Eye Health

Dry eyes, irritation, previous eye or eyelid surgery, thyroid eye disease, glaucoma and other eye conditions can affect both the surgical plan and recovery. I also check whether you can close your eyes comfortably and whether an eye assessment is needed before surgery.

Lower Eyelid Support

The lower eyelid should sit snugly against the eye. If it is loose or already sits lower than expected, I may need to add support or remove less skin to reduce the risk of the eyelid pulling downward after surgery.

Natural Asymmetry and Previous Surgery

No two eyes are perfectly identical. Differences in eyelid crease height, previous scars, laser treatment or prior eye and eyelid surgery can all affect the plan and how each side heals.

1. Consultation and markings: I review your medical history, eye history, medications and symptoms, then assess the eyelids and eyebrows. Surgical markings are made while you are upright.
2. Anesthesia and eye protection: the type of anesthesia depends on whether upper, lower or combined blepharoplasty is being performed and where the surgery takes place. The eyes are protected and lubricated when needed.
3. Eyelid surgery: the planned skin, muscle and fat are treated according to your anatomy. For lower eyelid surgery, fat may be repositioned or removed, and selected patients may benefit from fat grafting.
4. Support and closure: if the lower eyelid needs extra support, this is added before the incisions are closed with fine sutures.
5. After surgery: you receive instructions about cold compresses, incision care, activity and follow-up before you leave.

Swelling and bruising are expected after eyelid surgery. Cold compresses are usually used early, and you will receive instructions about cleaning the incisions and applying ointment.

External sutures are generally removed about 5 to 7 days after surgery. Many patients plan about 1 to 2 weeks away from work or social activities. Bruising may remain visible for 2 to 4 weeks, and swelling continues to improve over several weeks. Walking is encouraged, but strenuous exercise is generally avoided for about 2 weeks. Normal activity is usually resumed gradually as healing progresses.

Your eyes may temporarily feel dry, watery, tight or sensitive to light. Ointment can blur the vision for a short time, and some patients notice numbness, mild discomfort or temporary double vision. Early swelling can also make the two sides look different. These changes should not be judged as the final result because the eyelids continue to settle for several months.

Blepharoplasty leaves permanent scars. Upper-eyelid scars are placed within the natural crease. If a lower-eyelid skin incision is needed, it is usually placed just below the eyelashes. An incision made inside the lower eyelid does not leave an external skin scar.

Scars are often pink or firm early on and usually become less noticeable as they mature. The goal is not an invisible scar or perfect symmetry. It is to place and manage the scars carefully while improving the eyelid concern in a way that respects your anatomy and eye function.

Blepharoplasty can improve excess skin, under-eye bags and eyelid contour, but it may not remove dark pigmentation, visible blood vessels, crow’s feet or every fine wrinkle. The normal aging process also continues after surgery.

As with any surgery, blepharoplasty can cause bleeding, infection, delayed healing, bruising, asymmetry, scarring, discomfort, anesthesia-related problems or the need for further surgery.

Because the surgery is close to the eye, there are additional risks. These can include dryness, irritation, watering, blurred or double vision, difficulty closing the eyes, numbness or a change in lower-eyelid position. Rarely, bleeding can occur behind the eye and affect vision. Permanent visual loss is very rare but is a serious recognized complication. I review the risks that are relevant to your anatomy and planned procedure before surgery.

Before-and-after photographs can help show the types of changes that eyelid surgery may produce, but every patient starts with different anatomy. Eyelid shape, brow position, skin quality, fat distribution and healing all affect the result, so photographs should not be viewed as a guarantee of a specific outcome.

View Dr. Ho’s Blepharoplasty Before & After Gallery.

I am a plastic and reconstructive surgeon and a Fellow of the Royal College of Physicians and Surgeons of Canada. When planning blepharoplasty, I look beyond the amount of eyelid skin. I also assess the eyebrows, whether the eyelid itself is drooping, eye health, dry-eye symptoms, fat distribution, lower-eyelid support and natural differences between the two sides.

The goal is not to perform the same eyelid operation on every patient. It is to identify what is causing the concern, treat what needs to be treated and preserve what should be left alone.

If you are considering blepharoplasty, the first step is to determine what is actually causing the change around your eyes. During consultation, I assess the upper and lower eyelids, eyebrow position, eye health and your goals. We can then discuss whether upper, lower or combined blepharoplasty is appropriate, where the scars would be placed, what recovery is likely to involve and what surgery can realistically improve.

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Medically reviewed by Dr. Adelyn Ho, MD, MPH, FRCSC | Plastic and Reconstructive Surgeon | Last reviewed: August 2026