Blepharoplasty (eyelid surgery): what happens, risks and recovery

With age the skin around the eyes stretches, muscles weaken and fat pads bulge. The Leeds leaflet explains that excess upper eyelid tissue can obstruct the upper visual field or weigh the lid down so that eyes look tired. Most people, it says, choose surgery to improve appearance by making the area firmer; when it is done to improve vision it may be provided on the NHS.

It is not needed for mild puffiness that does not trouble you. NHS.UK suggests discussing plans with a GP first, as there may be a medical condition affecting your eyelids or a reason the operation is not suitable. It also asks you to be sure of your reasons and to bear in mind the cost, the risks and the fact that results cannot be guaranteed.

Sometimes the eyebrow is the real problem. The Cambridge leaflet notes that brow droop can cause or worsen overhanging upper lid skin, and then a brow lift may be required alone or with blepharoplasty. A drooping lid caused by a weak lifting muscle is a different condition, called ptosis, which is treated differently, and your surgeon should say which you have.

Non-surgical choices are limited. If dry eyes are already a problem, say so, because the leaflets warn that surgery can make dryness worse.

Bring a list of your medicines. NHS.UK says the surgeon needs to know about any blood-thinning medicines such as aspirin, warfarin or apixaban, and the Cambridge leaflet says aspirin-containing painkillers should be avoided afterwards to reduce bleeding and bruising. The Leeds leaflet says smokers are known to have healing problems, so tell your surgeon if you smoke or used to.

Under NHS.UK guidance, if you are having surgery privately in England, check the provider is registered with the Care Quality Commission and that the doctor is on the General Medical Council register, and ask about their complication rates and follow-up if things go wrong.

• Arrange transport home and some help for the first day or two.

• Have ice packs or a cold pack ready, and extra pillows to raise your head at night.

• Stock paracetamol and any prescribed ointment or drops.

For upper lids, the Cambridge leaflet describes numbing the eye with drops, marking the excess skin carefully so that eyelid function and comfort are not compromised, injecting a small amount of local anaesthetic, cutting along the natural skin crease, removing the marked skin and sometimes muscle or fat, then closing with fine stitches.

For lower lids NHS.UK describes an incision just below the lashes or inside the lid, repositioning or removing fat, sometimes a little skin, and supporting the lid if necessary. The Leeds leaflet adds that lower lid surgery often includes steps to tighten the lid to reduce the risk of the lid pulling down or turning outwards. Sticky strips may be applied afterwards, usually removed up to a week later, says NHS.UK. Most people go home the same day.

Swelling, bruising and blurred vision are common. NHS.UK lists puffy, numb lids that are hard to close and irritated, watery eyes lasting a few weeks, and says scars fade. Less commonly: double or blurred vision, uneven eyes, noticeable scarring and altered sensation. Rarely: injury to eye muscles, the lower lid drooping away from the eye, bleeding into the eye socket, and visual impairment.

The Cambridge leaflet says severe bleeding behind the eye is rare but can cause loss of vision if not managed rapidly, and puts the risk of vision loss at about 1 in 22,000 per side. Excessive skin removal can leave an eye that does not close fully and is dry. You should report severely impaired vision that lasts beyond 24 to 48 hours and does not clear with blinking.

One eye may be padded overnight, with ice packs and head elevation to ease swelling, says the Cambridge leaflet, which also says light exercise and a normal work pattern may resume within a few days and eyelid make-up about two weeks after surgery. NHS.UK says bruises and redness can take several weeks to fade and scars may feel tight for a few months. Avoid strenuous activity and swimming for a few days, smoking, contact lenses and rubbing the eyes.

You will not be able to drive for a number of days, NHS.UK says; the practical test is whether you can see clearly and safely, and GOV.UK expects the eyesight standard to be met at all times.

Severe pain, a rapidly swelling or tense eyelid, or sudden worsening of vision soon after surgery needs same-day contact with the surgical team, an emergency eye service, or A&E. Redness or discharge from a wound may signal infection. Persistent blurred vision beyond a day or two after surgery should be reported even if it is not painful.

Ask what is being removed and why, whether a visual field test supports it, which anaesthetic is planned, what the scar will look like, and what happens if the lid does not close well. For cosmetic surgery ask for the surgeon's own complication record and written aftercare.

The NHS pathway described by the Cambridge leaflet requires a documented visual problem, with funding applications for other situations that may not be granted. Cosmetic blepharoplasty is arranged privately, so ask for an itemised quote that includes follow-up visits and any revision policy.