Puffy Upper Eyelids (Excess Skin)

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(Pictured Above: Bilateral Upper Eyelid Blepharoplasty and Ptosis Repair)

The upper eyelid skin is the thinnest in the body. As we age the eyelid skin stretches, the fat in the eyelid bulges, and the muscles weaken. The eyebrows may also droop contributing to the heavy sensation noted by people with significant excess upper eyelid skin (dermatochalasis). Age, heredity, sun exposure, and smoking all contribute to the process.

Blepharoplasty surgery is performed through an incision made in the skin of the upper eyelid. The incision is placed in the crease of the upper eyelid. Excess skin can be removed as well as underlying muscle and fat. Ptosis repair (droop of eyelid margin) or Brow lift can be done at the time of blepharoplasty if needed. No two patients are exactly the same, and surgery should be individualized to your needs and underlying eye and medical history.

Blepharoplasty is not just removal of skin, but also sculpting of fat pads and even re-creation of the eyelid crease. In some cases the lacrimal gland, the gland which makes tears, has to be repositioned.

Insurance carriers do cover blepharoplasty surgery but only when the excess upper eyelid skin is significantly affecting vision. Most patients do not qualify for a medical blepharoplasty. Insurance carriers require photos and visual fields(test to check peripheral vision) prior to any procedure to pre-authorize the procedure.

The goal of a medical (functional) blepharoplasty is to improve the patient’s peripheral vision while the goal of a cosmetic blepharoplasty is to rejuvenate the eyelid appearance.

A medical blepharoplasty procedure is not the same procedure as a cosmetic blepharoplasty. A medical blepharoplasty is done to improve peripheral vision. Because of this Dr. Ahmad will remove only enough tissue to improve the visual field. Some fatty tissue may need to be removed but only enough to lighten the eyelid so that it opens the visual field. A cosmetic blepharoplasty is done to improve the overall appearance of the eyelids. A cosmetic blepharoplasty can also improve peripheral vision and make the eyelid feel lighter!! A cosmetic blepharoplasty involves skin removal and fat removal but also can involve re-establishing the sharpness of the eyelid crease. Dr. Ahmad taylors the cosmetic blepharoplasty to your individual facial features.


Eyelid bruising after surgery is very common and some people bruise more than others. The worst swelling is within 7-10 days from the procedure. Most people have minimal pain after surgery, which can be controlled with oral pain medication and ice application.

We usually recommend taking several days off from work because of the bruising. Most eyelids will look good at about four weeks, but in some individuals it can take longer to regain a natural look. Eyelid make-up should be avoided for two to four weeks but can be applied to the rest of the face within a few days.


Blepharoplasty surgery can be performed in the office under a local anesthetic or in an outpatient surgery center under intravenous (twilight) sedation or general anesthesia. Some patients are not good candidates for office surgery because of underlying medical problems, anxiety or even intolerance to local anesthetics. Dr. Ahmad will discuss where he can perform the procedure with you.

Risks of Surgery include bleeding, infection, asymmetry, inability to close the eyes fully, and eye irritation.

Eyelid numbness occurs in all patients but will improve in 6-12 months.

Patients can have blurry vision from the ointments that are being placed on the incisions. A small percentage of patients can have a change in their eyelid prescription because of a change in the shape of the eye itself.

Patients are recommended to stop their aspirin for 10-14 days prior to surgery, nsaids(motrin, ibuprofen) 5-7 days, plavix 5-7 days, coumadin 5 days prior. Usually we can restart the blood thinners several days after surgery depending on Dr. Ahmad‘s recommendation. Remember no blood thinners should be stopped until you have discussed this with your general medical provider.

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    We are happy to explain about cosmetic surgery (Puffy Upper Eyelids, Puffy Lower Eyelids, Droopy Lids, Cosmetic Complication, Heavy Brows, Eyelid Bump, Wrinkled or Discolored Eyelids and Dark Circles under Eyes surgery) and reconstructive surgery like Eyelid Reconstruction, Eyelid Trauma, Lower Eyelid Issues, Tear Duct Issures and Graves Eye Disease surgeries. Please contact us today for consultation.

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