Eyelid surgery, eyelid procedures, and blepharoplasty—cosmetic and surgical procedures on the eyelids

Disorders of the eyelid muscles are often responsible for eyelid malpositions:

• Ptosis

Ptosis is a condition in which one or both upper eyelids droop. This can restrict the field of vision and, in severe cases, lead to reduced vision if the drooping eyelid covers the pupil.

This malposition has various causes:

• A disorder of the levator muscle
• Disorder of the associated nerve
• Diseases of the entire muscular system
• Poisoning resulting from a snake bite or spoiled food
• Decreased skin elasticity with advancing age

Depending on the cause, various treatments are available in ophthalmology to address the underlying cause. In medical eyelid surgery, a common approach is to shorten and tighten the levator muscle.

In young children, the corrective procedure should be performed as early as possible to prevent the development of visual impairment.

If the visual axis is obstructed, this constitutes an emergency that requires immediate treatment. The visual axis is the direct line of sight between the point of sharpest vision and the object being focused on.

Incomplete ptosis of the right eye @ Angelina /AdobeStock

• Entropion

Entropion (also known as a “rolled eyelid”) is an eyelid that turns inward. This condition usually affects the lower eyelid. As a result, the eyelashes rest on the eye and rub against it, leading to a persistent sensation of a foreign body in the eye. 

Itching, stinging, and redness may also occur. If the condition persists, it can lead to inflammation, ulcers, scarring, and reduced visual acuity. Vision can be at serious risk if the cornea becomes severely abraded, blood vessels grow onto the cornea, and the cornea becomes scarred.

Corrective surgery takes about 10–15 minutes.

• Ectropion

Ectropion is an eyelid that turns outward. The lower eyelid is usually affected. The lower eyelid does not lie directly against the eyeball but protrudes slightly from the eye. It hangs downward.

This condition is usually acquired and not congenital. 

The causes are:

• Muscle weakness due to aging
• A paralyzed nerve in the eye, which also leads to muscle weakness
• Injury to the eyelid, resulting in a distortion of the lid after scarring

Since the eyelid does not lie flush against the eye, tears cannot drain through the tear ducts at the inner corner of the eye. The eyes water excessively, and those affected must frequently wipe away the tears. This often leads to conjunctivitis.

Vision can be at serious risk if the cornea dries out, blood vessels grow onto the cornea, and the cornea becomes scarred.

This corrective procedure is also completed in about 10–15 minutes.

• Chalazion

A chalazion, better known as a stye, is a painless, slowly developing inflammation at the edge of the eyelid. The inflammation is usually caused by blocked sebaceous glands. Often, the inflammation heals on its own within a few months or years, even without treatment.

To rule out a malignant tumor, you should have it examined. For larger chalazions or if treatment is unsuccessful, doctors can surgically remove the inflammation through eyelid surgery.

The procedure takes about 10 minutes.

Chalazion on the upper eyelid @ Heiko Barth /AdobeStock

• Eyelid Tumor

Tumors can also occur on the eyelid. The most common malignant tumor that occurs on the eyelid is basal cell carcinoma, a form of skin cancer. Doctors surgically remove this tumor.

Medical eyelid surgery is recommended if:

• There is a condition affecting the eye area
• There are limitations and/or a reduced quality of life
• Conventional treatment is not possible

Before eyelid surgery, you should keep the following in mind:

• First, discuss your medical history with the surgeon and let them know if you have any allergies to medications or latex. 
• Let the surgeon know if you are taking any medications. You may need to stop taking them beforehand.
• The surgeon will explain what you need to do in the days leading up to the surgery. If you smoke, you’ll need to stop temporarily. 
• Stop taking blood thinners such as aspirin 10 days to two weeks before your eyelid surgery. Your doctor can advise you on this.
• On the day of the surgery, you should arrange to be picked up from the clinic, as you will not be allowed to drive.
• Wear loose, comfortable clothing so you can quickly change into a surgical gown.
• Make sure to wear a loose-fitting top so the anesthesiologist can insert an IV.

Complications are rare during medical eyelid surgery. However, they cannot be ruled out entirely. Unwanted effects may also occur during the healing process.

Below are some possible risks and side effects:

• Infections
• Poor healing
• Risks associated with anesthesia
• Pain
• Swelling
• Skin discoloration
• Dry eyes
• Blurred spots
• Vision problems
• Difficulty closing the eyes
• Blood clots
• Numbness

Small milia (whiteheads) may appear near the incision site. Your eyes may itch, burn, and feel dry. 

Your vision may also be impaired for a few days. If these symptoms persist, you should contact your doctor.

Every surgery carries a risk of nerve damage. The eye area is very sensitive, so eyelid surgery can cause irritation. 

You may feel a sensation of coldness, numbness, or tingling in your eyes. These symptoms usually go away on their own.

Excessive bleeding is a common side effect of medical eyelid surgery. The incision may begin to bleed, especially if you have a bleeding disorder or anemia. 

In addition, a retrobulbar hematoma may develop in very rare cases. This occurs when blood accumulates behind the eye, which can result in blurred vision or even blindness.

Occasionally, some people are left with scars after medical eyelid surgery. The scars usually appear at the incision site. At the ophthalmologist’s office 

Visible scars will fade over time. However, if an infection develops after eyelid surgery, a larger scar may remain.

You will receive a local injection of a sedative and anti-anxiety medication to help you relax. Alternatively, you will be sedated via an IV, which also induces a twilight sleep-like state.

During the medical eyelid surgery, the surgeon uses a CO2 laser, a needle electrocautery device, or a scalpel.

Although every patient recovers differently, you should plan for at least half a week of recovery time. 

Please follow these guidelines during your recovery:

• Keep your head elevated, even while sleeping
• Apply cold compresses
• Avoid taking aspirin or anti-inflammatory medications. If you experience pain, your doctor will prescribe medication
• Apply the antibiotic ointment recommended by your doctor to the operated area
• Expect swelling and bruising
• Avoid wearing makeup for one week
• Avoid physical exertion during the first few days after surgery
• Expect to experience temporary blurred vision and sensitivity to light
• Protect your eyes with dark sunglasses
• Contact your surgeon if your vision worsens, you experience new pain, or you notice a sudden negative change in your appearance

The surgical stitches will be removed after one week. By this time, any bruising will have subsided.

Your final follow-up appointment with the ophthalmologist is scheduled for three months later. By then, the healing process should be complete. During this appointment, the final photos for the before-and-after comparison are usually taken.

Eyelid surgery encompasses a wide range of surgical procedures involving the eyelids and serves both functional and aesthetic purposes. Drooping eyelids and under-eye bags, in particular, are often caused by excess skin as the skin loses elasticity with age. Conditions such as dermatochalasis or blepharochalasis, as well as drooping of the upper eyelid due to ptosis, may also require treatment. In such cases, surgery is necessary to restore eyelid function and ensure the protection of the eyes.

Eyelid surgery is usually performed under local anesthesia, with targeted tightening of the upper and lower eyelids. During the procedure, excess eyelid skin is removed and the connective tissue is tightened to achieve a natural-looking result. Surgical procedures may also be necessary for eyelid malpositions such as entropion or ectropion, as well as for other eyelid abnormalities. The surgical removal of eyelid tumors and the treatment of conditions such as chalazia are also part of the range of procedures offered.

Swelling may occur immediately after surgery, but this can be effectively managed with cold compresses and eye drops. Careful postoperative care is crucial to prevent complications and support healing. In rare cases, further surgical procedures may be necessary, such as in cases of persistent malposition or functional limitations.

The correction of eyelid deformities and the removal of eyelid tumors are often performed for medical or aesthetic reasons. Specialists in eyelid surgery and experienced ophthalmologists make the clinical decision regarding the appropriate treatment. In certain cases, the cost of treatment may be covered by health insurance, particularly when functional symptoms are present. Overall, facial surgery involving the eyelids is an effective way to improve both appearance and function in the long term.