What is it and how is it done?
The eyelids have the thinnest skin on the face, and the first signs of ageing often appear here. On the upper lid, excess skin folds down over the lashes and makes the eyes look heavy; on the lower lid, the fat around the eye bulges forwards and forms bags under the eyes. Eyelid surgery (blepharoplasty) aims to correct this excess without changing the shape of the eye or the person's expression.
In upper eyelid surgery, the incision is placed in the natural lid crease, where it cannot be seen when the eyes are open; excess skin and, if needed, part of the fat in the inner corner are removed. The procedure can often be done under local anaesthesia. What people call "droopy upper eyelids" can have different causes: excess skin, descended eyebrows, or weakness of the muscle that lifts the eyelid (ptosis). Ptosis is a muscle problem; removing skin does not correct it, and it needs a separate assessment and a different surgical method. If the eyebrows are noticeably low, the brow may be the source of the problem, and planning together with a brow lift may be needed.
In lower eyelid surgery for eye bags, the first step is to establish whether the problem is excess skin, a fat bag or a hollow under the eye. In people with good skin whose main concern is the bag, a transconjunctival approach can be used, which goes through the inside of the eyelid and needs no incision in the skin. If there is also excess skin, the incision is made just below the lashes. Excess fat is not always removed; to avoid a hollow look, part of it can be repositioned by spreading it into the groove beneath the eye. If the lower lid is lax, its supports are also strengthened.
Before surgery, you are asked about dry eyes, vision, contact lens use, previous eye surgery and thyroid disease, and an examination by an ophthalmologist is requested if needed. At the practice in Nişantaşı, Prof. Dr. İlker Yazıcı assesses the eyelid skin, the fat bags, the position of the brows and the strength of the eyelid muscle separately. 3D facial imaging helps in discussing how the eye area relates to the rest of the face. If the cheeks also sag, a combined plan with a facelift can be discussed. At the consultation you are told in detail which procedure is recommended and why, and how recovery will progress.
What are the aims?
- To reduce excess skin on the upper eyelid that hangs down towards the lashes.
- To correct under-eye bags and soften the transition between the lower eyelid and the cheek.
- To make a tired, sleepless or heavy-looking gaze look more rested.
- To open up the upper field of vision where sagging skin is narrowing it.
- To preserve the natural shape of the eye and the person's expression.
Who is it suitable for?
- People with excess skin on the upper eyelid that folds over the lashes
- People with noticeable bags under the eyes on the lower eyelids
- People who find it hard to apply eye make-up or to look upwards because of sagging eyelid skin
- People who, because their eyelids feel heavy, raise their eyebrows to see without realising it
- People with healthy eyes and no severe dry eye
- Adults in good general health with realistic expectations
When is it postponed or not recommended?
- People with untreated severe dry eye or an active eye infection
- People with eye changes due to thyroid disease that are in an active phase
- People whose concern is caused only by weakness of the muscle that lifts the eyelid (ptosis); in that case ptosis surgery is needed
- People whose problem is mainly caused by low eyebrows; removing skin alone can make the eyes look even heavier
- People with uncontrolled high blood pressure or a bleeding disorder
Alternatives
- Hyaluronic acid filler
- Can temporarily fill a hollow under the eye; it does not remove a prominent fat bag or excess skin.
- Brow lift
- If the heaviness of the lids is caused by low brows, raising the brows may be more appropriate instead of, or together with, eyelid surgery.
- Botulinum toxin
- Softens crow's feet at the outer corners of the eyes for a few months and can slightly lift the tail of the brow; it does not correct excess skin or bags.
- Ptosis surgery
- If the muscle that lifts the eyelid is weak, this muscle needs to be repaired, instead of or together with eyelid surgery.
The process step by step
- 1
First contact
You can send front-facing photos taken with your eyes open, closed and looking up, and a short description of your concerns, by WhatsApp or e-mail, or call the practice. This information gives you a general idea of the options and helps plan the examination; the medical assessment and the decision take place at the examination in Nişantaşı.
- 2
Consultation and eye assessment
Prof. Dr. İlker Yazıcı assesses the eyelid skin, the fat bags, the position of the brows and the eyelid muscle. You are asked about dry eyes, vision and previous eye surgery, and an ophthalmologist's examination is requested if needed.
- 3
Preparing for surgery
Blood thinners and herbal supplements are adjusted with your doctor's approval, and smoking is stopped. Cold compresses, rest and wearing glasses instead of contact lenses are planned for the first days.
- 4
Day of surgery
The operation is performed in an accredited partner hospital. The upper lids alone usually take around 1 hour, and the lower lids or all four lids together 2–3 hours; most patients go home the same day.
- 5
Stitch removal and check-ups
The stitches are usually removed on days 5–7. Later check-ups take place at 3 and 6 months, when the maturing of the scar and the position of the lids are monitored.
Recovery timeline
Days 1–3
There is swelling, bruising and tightness around the eyes; swelling is usually at its most noticeable on day 2–3. Cold compresses are applied and the head is kept raised. Vision may be blurred because of the ointment.
Days 5–7
The stitches are removed. The eyes may water, feel dry or be sensitive to light; use the recommended drops.
Week 2
Most of the bruising has faded, and most people return to desk work and social life. Eye make-up can be used again once the wounds have healed, as advised.
Weeks 2–4
Contact lenses and sport are resumed gradually, following the advice given at the check-up.
Month 3
Most of the swelling has gone; the scar fades from pink to a lighter colour.
Months 6–12
The scar matures and the final appearance settles.
Risks and possible complications
Every surgical procedure carries risks. Your personal risk is assessed in detail at the consultation.
- Dry eyes, burning, watering and sensitivity to light; usually temporary and eased with drops.
- Blurred vision in the first days and temporary difficulty closing the eyes fully.
- Swelling of the membrane that covers the white of the eye (the conjunctiva).
- The lower eyelid being pulled down or turning outwards; further treatment or a corrective operation is sometimes needed.
- Asymmetry between the two eyes, or over- or under-correction; a hollow look if too much fat is removed.
- A noticeable scar, or small white bumps along the incision line (milia).
- Bleeding, bruising and infection.
- Very rare but urgent, bleeding behind the eye: if pain increases suddenly, the eye feels tense or your vision decreases, contact the practice immediately and go to an emergency department.
What determines the cost?
The fee for eyelid surgery depends on whether the upper lids, the lower lids or all four lids are treated, the approach used for the lower lids, additional steps such as repositioning fat or supporting the lid, the type of anaesthesia and the length of the operation. Accompanying procedures such as ptosis repair or a brow lift also affect the plan and the fee.
Because the condition of the lids and brows only becomes clear at the examination, the fee is set after the examination. Following the assessment by Prof. Dr. İlker Yazıcı, you receive a written, itemised quote for the planned procedures that states what is included; it is a good idea to ask about the details of the quote before surgery.
If you are coming to Istanbul
The practice is authorised by the Turkish Ministry of Health for international health tourism (certificate no. ST-2365); help with accommodation near the clinic and airport transfer can be arranged through authorised partners. If you are travelling from abroad or from another city, plan to stay in Istanbul for 5–7 days after eyelid surgery; the stitches are removed at the end of this period, and the stay is reassessed at the consultation if a brow lift or another procedure is added. Back home, you stay in touch with the practice by sending photos and messages; if something needs to be examined, a check-up in Istanbul or a visit to a local doctor is arranged. Return visits are usually advised at 3 and 6 months.
Frequently asked questions
Is eyelid surgery painful?
Eyelid surgery is performed under local anaesthesia, sedation or general anaesthesia, so you feel no pain during the procedure; with local anaesthesia, only the numbing injection is felt briefly. After surgery the eyes may feel tight, gritty and watery; this usually eases with simple painkillers and cold compresses. If pain increases suddenly or your vision decreases, contact the practice straight away.
When can I go back to work after eyelid surgery?
After eyelid surgery, most people can return to desk work within 7–10 days; bruising usually fades noticeably within two weeks. If you work at a screen, rest your eyes often in the first days. Strenuous exercise, work that involves bending over and contact lenses usually wait 2–4 weeks; the exact time is decided at the check-up.
Does eye bag surgery leave a scar?
If there is no excess skin, eye bag surgery can use the transconjunctival approach through the inside of the eyelid, with no incision in the skin. If skin is also removed, the incision is made just below the lashes and fades over time to a fine line. In upper eyelid surgery, the scar sits inside the lid crease when the eyes are open. Scars can be pink in the first months and usually fade within a year.
Will eyelid surgery fix droopy upper eyelids?
If droopy upper eyelids are caused by excess skin, eyelid surgery can correct them. However, if the edge of the lid has dropped towards the pupil, the problem is often weakness of the muscle that lifts the eyelid (ptosis); this is not corrected by removing skin and needs a separate operation to repair the muscle. Low eyebrows can also create a similar appearance. An examination is needed to tell the causes apart.
When will I see the final result of eyelid surgery, and is it permanent?
After eyelid surgery, most of the swelling goes within 3 months; the scars can take 6–12 months to mature and the final appearance to settle. The fat and skin that have been removed do not come back, so the effect usually remains noticeable for many years. The eye area does, however, continue to age, and it is natural for some excess skin to form again on the upper lids over the years.
Who is suitable for eyelid surgery, and is there an age limit?
There is no set age limit for eyelid surgery; the decision depends on the condition of the eyelid skin, the fat bags and the health of the eyes. Under-eye bags can run in families and appear at a younger age. Suitable candidates are adults in good general health without severe dry eye and with realistic expectations. If you have dry eyes, thyroid disease or previous eye surgery, an ophthalmologist's assessment may be requested.
Can eyelid surgery be combined with a brow lift or a facelift?
Yes. If the brows are low, upper eyelid surgery is often planned in the same session as a brow lift, so that the brow and the lid are treated together. A facelift can be added if the cheeks and jawline sag, and fat grafting for volume loss under the eyes. Which procedures are appropriate to combine is decided at the examination, taking into account the position of the brows and your general health.
What does the cost of eyelid surgery depend on?
The cost of eyelid surgery depends on whether the upper lids, the lower lids or all four lids are treated, the approach used for the lower lids, additional steps such as repositioning fat, the type of anaesthesia and any accompanying procedures. An accurate fee cannot be set without an examination. After the examination with Prof. Dr. İlker Yazıcı, you receive a written quote that sets out the planned procedures.
Should I stop smoking and certain medicines before eyelid surgery?
Smoking slows wound healing and can make dry eyes worse, so it is advisable not to smoke before eyelid surgery or during recovery. Blood thinners such as aspirin, some painkillers and herbal supplements can increase bruising and the risk of bleeding; which ones to stop, and when, is discussed at the consultation. Prescription medicines and eye drops should not be stopped without consulting your doctor.
How many days should I stay in Istanbul if I travel for eyelid surgery?
Patients travelling to Istanbul for eyelid surgery are advised to plan a stay of 5–7 days after surgery; the stitches are removed at the end of this period. Because the eyes need rest and cold compresses in the first days, it is wise not to plan a busy schedule. Later check-ups usually take place at 3 and 6 months. If the operation is combined with a brow lift, the stay may be longer.
Last updated: · Responsible for content: Prof. Dr. İlker Yazıcı · info@ilkeryazici.com