Eyebags (Puffy Lids) or Hooded Eyelids:

The eyes, eyelid skin and contours produced by the fat pockets around the eyes are responsible for much of our facial expression.

The eyelids can sag or bulge with age and so the face may project an inappropriate tired look despite adequate rest and good health.

Upper eyelid hooding is also known as dermatochalasis.


Also known as blepharoplasty, cosmetic eyelid surgery improves the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

Blepharoplasty is the most sought-after facial cosmetic surgical procedure.

Upper eyelid blepharoplasty can:

  • Correct loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid
  • Improve vision if the sagging upper lid skin is hooding over the eyes
  • Remove excess fatty deposits that appear as puffiness in the upper eyelids

Lower eyelid blepharoplasty can:

  • Remove excess skin and wrinkles of the lower eyelid
  • Remove bags under the eyes
  • Correct sagging of the lower eyelids which can reveal the white below the iris (coloured part of the eye)

Blepharoplasty surgery steps:

Step 1 – Anaesthesia

Your comfort during your eyelid surgery is of paramount importance and the type of anaesthesia you have will be discussed in detail prior to you booking your surgery. Local anaesthesia with intravenous sedation (“Twilight anaesthesia”) administered by a consultant anaesthetist is often the best combination for blepharoplasty surgery. You can be assured you are in the best care whilst the intravenous sedation makes you calm and relaxed during your procedure. It avoids the need for a general anaesthetic in the vast majority of people. If, however, you prefer the option of having a general anaesthetic then this can also be arranged.

Step 2 – The incision

The incision lines for eyelid surgery are designed for scars to be well concealed within the natural structures of the eyelid region.

Upper eyelid blepharoplasty can be performed through an incision within the natural crease of the upper eyelid allowing removal or repositioning of fat, tightening of muscles and tissue, and  removal of excess skin.

Lower eyelid blepharoplasty may or may not involve a skin incision. When sagging or excessive wrinkling of the lower eyelid skin needs to be corrected then an incision just below the lower lash line can be made.

When the main problem is a puffy lower eyelid a transconjunctival incision (one hidden inside the lower eyelid) can be used. Fat can be removed or repositioned through this incision to help create a smoother more youthful lower eyelid appearance

Step 3 – Closing the incisions

Eyelid skin incisions are usually closed with removable sutures. These are usually removed at 5-7 days after surgery. Transconjunctival incisions (through the inside of the lower eyelid) usually do not need a suture.

Step 4 –Results

The results of eyelid surgery will appear gradually as swelling and bruising subside to reveal a smooth better-defined eyelid and surrounding region. The vast majority of bruising will settle over the first 2 weeks. Depending on the type and extent of the surgery it can take from 2 weeks to 4 months to see the full outcome of surgery.

What are the risks?

The decision to have cosmetic surgery is extremely personal and after your consultation and advice offered to you, you will have to decide if the benefits will achieve your goals and if the risks and potential blepharoplasty complications are acceptable to you.

I will  explain potential eyelid surgery complications in detail to you. You will be asked to sign a consent form to ensure that you fully understand the procedure you will undergo and any risks or potential complications which can include: 

  • Unfavourable scarring
  • Temporarily blurred or impaired vision
  • Dry eyes
  • Difficulty closing your eyes
  • Lower eyelid retraction  (a pulling down of the lower eyelid) may occur and is often temporary
  • Ectropion (rolling of the eyelid outwards away from the eyeball)
  • Bleeding (haematoma)
  • Poor wound healing
  • Infection
  • Fluid accumulation
  • Blood clots
  • Numbness and other changes in skin sensation
  • Anaesthesia risks
  • Eyelid disorders that involve drooping of the upper eyelids (eyelid ptosis) or abnormal laxity of the lower eyelid (ectropion) can coexist. Additional surgery may be required to correct these if they are present.
  • Pain, which may persist
  • Skin discoloration and swelling
  • Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Possibility of revision surgery if the outcome is not as expected
  • Loss of eyesight (approx 1:20,000 risk of blindness)

Be sure to ask questions:

It’s very important to ask  any question you have about your proposed eyelid procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. I’ll do my best to address any concerns you may have.

A special note about the use of fibrin sealants (tissue glue)

Fibrin sealants (made from heat-treated human blood components to inactivate virus transmission) are used to hold tissue layers together at surgery and to diminish post-operative bruising following surgery.

This product has been carefully produced from screened donor blood plasma for hepatitis, syphilis, and human immunodeficiency virus (HIV). These products have been used safely for many years as sealants in cardiovascular and general surgery. This product is thought to be of help in diminishing surgical bleeding and by adhering layers of tissue together.

When you go home

If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

Upper & Lower Eyelid Blepharoplasty


Lower lid eyebags with redundant lower lid skin & upper lid mild skin sag


Following upper & lower eyelid transcutaneous blepharoplasties with arcus marginalis release, septal reset with orbicularis suspension & lateral canthopexies

Your consultation

The success and safety of your eyelid surgery procedure depends very much on your complete candidness during your cosmetic eyelid surgery consultation. You'll be asked a number of questions about your health, desires and lifestyle.

Please be prepared to discuss:

  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and previous medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol & tobacco
  • Previous surgeries

The following will also take place at your consultation

  • Evaluation of your general health and any pre-existing health conditions or risk factors
  • An assessment of your vision and a thorough eye examination including a slit-lamp examination of the eye.
  • Photographs for your medical record
  • A discussion about treatment options
  • Recommendations for treatment most appropriate for you
  • Discussion about likely outcomes of eyelid surgery and risks or potential complications
  • The type of anaesthesia that will be used (This is usually “Twilight anaesthesia” using local anaesthesia with intravenous sedation administered by a consultant anaesthetist. However, a full general anaesthetic can be arranged if you prefer this option)

After the consultation I will send you a letter summarising your concerns and desires relating to your appearance along with my assessment and advice to you regarding treatment options.

You will also receive a quote for your proposed surgery and have the opportunity to attend for a further consultation prior to proceeding should you wish to ask any further questions.

Arrange a consultation