Medical Encyclopaedia › Blepharoplasty (short definition)
In brief: In eyelid surgery (blepharoplasty), excess skin and, where necessary, fatty tissue on the upper or lower eyelids is removed or redistributed. The procedure can have aesthetic reasons, but also medical ones if drooping skin restricts the field of vision.
Upper lid and lower lid
On the upper lid, excess skin (hooded eyelids) is usually the main issue; the incision lies in the natural lid crease. On the lower lid, the concern is often so-called eye bags caused by bulging fatty tissue. Here, surgery is performed either through an incision just below the lash line or from the inside through the conjunctiva. It is important to distinguish this from a sagging eyebrow or a drooping lid due to a weak levator muscle (ptosis), which require different procedures.
When is it medically justified?
If the upper lid skin hangs down so far that it significantly restricts the upper field of vision, surgery may be medically necessary. This is usually documented by an ophthalmological visual field test. Whether German health insurance covers the costs is decided case by case; purely aesthetic lid corrections are paid for privately.
Procedure and healing
Upper lid surgery is usually performed as an outpatient procedure under local anaesthesia; lower lid operations more often under sedation or general anaesthesia. Swelling and bruising usually subside within one to three weeks; cooling and keeping the head raised help. The stitches are removed after a few days. Once healed, the scar on the upper lid is usually barely visible in the lid crease.
Risks
- temporarily dry, irritated eyes and incomplete lid closure
- asymmetries, conspicuous scars, too much or too little skin removed
- on the lower lid, sagging or outward turning of the lid margin (ectropion)
- very rarely, bleeding behind the eye with a risk to vision; increasing pain, pressure or deterioration in vision after surgery is an emergency
Important to know
Before the procedure, dry eyes, visual disturbances, thyroid diseases and anticoagulant medicines should be discussed. Consultation with specialists in plastic and aesthetic surgery, ophthalmology with a focus on eyelid surgery, or oral and maxillofacial surgery is advisable.
Related terms in the encyclopaedia
Blepharoplasty, Dermatochalasis, Brow ptosis, Ptosis, Ectropion, Lagophthalmos, Dry eye, Canthoplasty
Sources
- Berufsverband der Augenärzte Deutschlands und Deutsche Ophthalmologische Gesellschaft (BVA/DOG): Patienteninformationen zur Lidchirurgie
- Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC): Patienteninformationen
- American Academy of Ophthalmology: Blepharoplasty
Note: This article is for general information and does not replace advice, diagnosis or treatment from a doctor, dentist or pharmacist. Last updated: October 2026.