What it changes
Heavy upper lid skin does two things at once. It reads as tiredness, and when the fold rests on the lashes it narrows what you can actually see — particularly upwards, which is why some patients notice it first while driving or reading a road sign. Removing the excess opens the eye again and gives the lid back its own height.
On the lower lid the problem is usually the opposite: not skin but fat, pushing forward into a bag and casting a shadow. That fat is often repositioned rather than removed, which softens the step between lid and cheek instead of leaving a hollow that looks worse in ten years than the bag did.
What it does not do is change the shape of your eye, lift the brow, or remove crow’s feet. Those are different problems with different answers, and a surgeon who tells you one operation fixes all of them is selling rather than planning.
Who it suits
The usual candidate is over forty, in reasonable health, and bothered by something specific rather than generally dissatisfied. Being able to say exactly what you want changed is the single best sign that surgery will make you happy.
It is delayed or reconsidered if you have significant dry eye, uncontrolled thyroid eye disease, or a brow that has descended enough that the eyelid is not the real problem. Smoking is asked about seriously, because nicotine narrows the small vessels that feed the thinnest skin on the body.
How the operation is done
Local anaesthetic with light sedation for most cases. You are comfortable and breathing on your own; a general anaesthetic is used only for larger combined procedures. Upper lids take about forty-five minutes, all four lids about two hours.
On the upper lid the incision follows the natural crease, so once the eye is open the line is not visible. A measured strip of excess skin is removed — measured, because taking too much is the one error in this operation that cannot be undone — along with only the fat that bulges.
On the lower lid the incision sits just beneath the lashes, or inside the lid with no external scar at all when only fat needs treating. Fine sutures come out at five to seven days. Most patients go home the same day.
Recovery
What actually happens, week by week
Recovery is part of the treatment rather than an afterthought, so it is described here in the same detail as the operation.
Day 0–2
Cold and restCool compresses, head raised, no bending. Bruising begins.
Day 3–7
Bruising peaksIt darkens before it fades. Stitches come out at five to seven days.
Week 2
PresentableMost patients are comfortable in company. Make-up from about ten days.
Week 3–6
SettlingResidual swelling drops. The scar is pink and still maturing.
Month 6
FinalThe line has faded into the crease. This is the honest end point.
Honesty
Risks, and what can go wrong
Every operation has them. They are listed here because a patient who has read them and still wants to proceed is a patient who will be content afterwards.
- Dry, gritty eyes for some weeks — common, and usually temporary.
- Bruising and asymmetric swelling in the early weeks; the two sides rarely settle at the same speed.
- A scar that stays pink longer than expected, particularly in darker skin.
- Rarely: a lower lid that sits slightly low, an over-corrected upper lid, or a bleed behind the eye — the one true emergency, which is why you are given a number to call.
Results
His own patients
Every photograph here is of Dr. ElKhoury’s own patients, taken at the same distance under the same light, before and after, and published unretouched apart from the masking that protects identity.
Results vary between patients. Shared with consent. More cases →
Take it away
The printed sheet
Everything on this page, on two sides of A4, written for patients and free to take from the clinic. It says what the operation does, what it costs you in time, and what it does not fix.
Blepharoplasty (eyelid surgery)
Patient information — PDF, 2 pages
Open the sheet →Questions
What patients ask
How long before I can go back to work?
Most patients take a week. You are usually presentable at ten to fourteen days, and make-up covers the rest. If your work is public-facing, plan two weeks rather than one.
Will the scar show?
On the upper lid the incision is placed inside the natural crease, so with the eye open it is not visible. It is pink for a few weeks and fades over about six months. On the lower lid it sits under the lashes, or inside the lid with no external scar at all.
Is it done under general anaesthetic?
Usually not. Local anaesthetic with light sedation is enough for most eyelid surgery, and you go home the same day. A general anaesthetic is reserved for larger combined procedures.
How long do the results last?
Upper lid surgery is generally long-lasting — most patients never need it repeated. The lids continue to age, but from a better starting point.
Does it get rid of crow’s feet or lift my eyebrows?
No. Crow’s feet are treated with botulinum toxin, and a heavy brow needs a brow procedure. Blepharoplasty addresses the eyelid itself. These are often planned together, but they are separate things.