Blepharoplasty, also known as eyelid surgery, aims to improve the appearance of the eyelids and surrounding area. Many patients notice their eyes look different after surgery. There are several reasons why your eyes may look different after blepharoplasty.
Swelling
Swelling is normal after blepharoplasty. It is caused by trauma from the surgical process as well as inflammation triggered by the procedure. Swelling peaks at around 48 hours after surgery and can last 2-4 weeks. In some cases, minor swelling persists for several months.
Swelling can make the eyelids and area around the eyes look puffy, swollen or enlarged. This temporarily changes the look of your eyes until the swelling subsides. Patience is required as you wait for swelling to resolve.
Bruising
Bruising is also common after blepharoplasty due to bleeding under the skin caused by surgical trauma. Bruises often start off reddish-purple then change to greenish-yellow as they heal over 1-2 weeks.
Bruising can make the eyelids and undereye area look discolored. This alters the appearance of the eyes until bruises fully fade. Using cold compresses can help minimize bruising.
Scarring
As with any surgery, blepharoplasty causes some permanent scarring where incisions are made. Incision locations include:
- In the natural creases of the upper eyelids
- Inside the lower eyelid
- Below the lower lashes
Scars from blepharoplasty incisions are typically thin and fade well over time. However, scars can sometimes be raised, red or thickened. In some cases, scars can distort the shape of the eyelid.
Asymmetry
It’s common to have minor differences between the eyes after blepharoplasty. One eye may heal faster or have less scarring. Swelling and bruising may resolve sooner on one side. Muscle function may be impacted more in one eye.
Mild asymmetry between the eyes is normal. Significant asymmetry should be discussed with your surgeon, though revision surgery is sometimes needed to improve symmetry.
Almond-shaped eyes
Many patients want more almond-shaped eyes after blepharoplasty. This desired shape can be created by:
- Removing excess upper eyelid skin
- Reshaping fat pads in the upper eyelids
- Lifting the outer eyelids
Almond-shaped eyes have a distinct archedappearance and are considered aesthetically pleasing. Discuss your desired eye shape with your surgeon beforehand.
Over- or under-correction
In some cases, the eyes may look over- or under-corrected after surgery:
- Over-correction – the eyes appear smaller, more “hollowed out”, or too almond-shaped.
- Under-correction – excess skin, fat pads or sagging persist, preventing optimal rejuvenation.
If you are unhappy with your results, discuss revision surgery with your surgeon to adjust the changes made during your initial blepharoplasty.
Drooping eyebrows or eyelids
Removing excess upper eyelid skin can cause the eyebrows to descend or the upper eyelids to start drooping again sooner. This gives the eyes a more hooded, sleepy appearance.
Preventative brow lift or ptosis repair can be done along with blepharoplasty to mitigate these effects and achieve long-lasting eyebrow and eyelid height.
Dry eyes
Removing excess upper eyelid skin reduces coverage of the eyeball. This exposes more of the surface of the eye to air, increasing tear film evaporation and dry eye symptoms like:
- Irritation or itchiness
- Gritty, scratchy sensation
- Redness
- Burning
- Light sensitivity
- Watery eyes
Dry eyes can create the illusion of more protruding eyes or sclera show. Use artificial tears frequently after surgery to hydrate the ocular surface.
Scleral show
Scleral show is increased visibility of the white part of the eye (sclera) between the iris and lower eyelid. It occurs when:
- Too much lower eyelid skin is removed
- Lower eyelid muscles descend
- The midface sags
Scleral show can make the eyes appear more protruding, rounded, and wide. It generally requires revision surgery to correct.
Ectropion
Ectropion is outward sagging or eversion of the lower eyelids away from the eyeballs. It happens when:
- Lower eyelid support is compromised during surgery
- Scarring causes downward pulling on the lower lids
- Lower eyelid muscles descend
Ectropion exposes more of the interior surface of the eyelid. It gives the eyes a round, wide-open look. Additional surgery is typically needed to repair ectropion and tighten the lower eyelids.
Conclusion
Blepharoplasty can transform tired-looking eyes, but surgery does alter their appearance. Knowledge of the common postoperative changes allows patients to realistically plan for recovery. Keep an open dialogue with your plastic surgeon about maximizing results and managing side effects.
| Reason | Appearance Changes | Management |
|---|---|---|
| Swelling | Puffy, enlarged eyes | Cold compresses, head elevation, wait for resolution |
| Bruising | Discolored eyelids/undereye | Cold compresses, wait for fading |
| Scarring | Distortion of eyelid shape | Massage, silicone sheeting, possible revision |
| Asymmetry | Difference between eyes | Possible revision to improve symmetry |
| Almond shape | Arched, narrower eyes | Intentional change, discuss desired shape with surgeon |
| Over-correction | Smaller, hollowed, almond eyes | Possible revision to soften appearance |
| Under-correction | Excess skin, fat, sagging persists | Possible revision to further rejuvenate eyes |
| Drooping eyelids/brows | More hooded, sleepy eyes | Combine blepharoplasty with brow lift or ptosis repair |
| Dry eyes | Irritated, red, watery eyes | Use frequent artificial tears |
| Scleral show | More protruding, rounded eyes | Possible revision to tighten lower lids |
| Ectropion | Round, wide eyes | Revision to repair and tighten lower lids |
