Dr. Griffiths is a well credentialed and an excellent physician. Her staff are pleasant and professional. The office runs like a well-oiled machine. Kudos to them for providing such excellent care.
Holly Horn
Am I a Good Candidate for Blepharoplasty?
Indications for Upper Blepharoplasty
Upper blepharoplasty addresses two main structural issues that develop with age: excess skin and fat prolapse. In some cases, these problems cross the line from cosmetic concerns into functional ones that affect everyday life.
Age-related excess upper lid skin, called dermatochalasis, is the most common reason patients seek upper blepharoplasty. Over time, skin droops over the lid crease, drapes onto the lashes, and can partially cover the eye. Removing this excess tissue is the central goal of upper eyelid surgery.
The orbital septum is a thin layer of tissue that holds back the fat surrounding the eye. As it weakens with age, fat pushes forward and creates fullness or bulging in the upper lids, a condition called steatoblepharon. Blepharoplasty addresses this by carefully removing or repositioning the fat during the procedure.
When upper lid excess crosses into functional territory, insurance coverage may be available. Typical criteria that our eye doctors document include a significant degree of superior visual field loss (the area of vision blocked from above), chin-up head positioning to see clearly, and patient-reported difficulty with tasks like reading or driving. A formal visual field test is required as part of this documentation. Your specific coverage eligibility is reviewed during your consultation.
Many patients with heavy upper lids also have true ptosis, a condition where the lid margin itself sits too low rather than just having excess skin resting on top of it. Assessing for both conditions before surgery is essential. Treating excess skin alone when ptosis is also present can produce incomplete results, so combined repair may be recommended when both problems are identified.
Indications for Lower Blepharoplasty
Lower blepharoplasty targets the structural changes beneath the eye that create a tired or aged appearance. The right approach depends on whether the primary concern is fat, skin, hollow contours, or a combination of these.
The most common reason for lower blepharoplasty is herniated orbital fat below the eye, which creates the characteristic puffy or baggy appearance. Modern surgical technique generally favors repositioning this fat rather than simply removing it. The fat is moved as a tissue flap into adjacent hollow areas to restore a smoother, more youthful contour.
Loose, crepey skin along the lower lid can be addressed through a transcutaneous approach, which uses a small incision placed just beneath the lash line. In some cases, laser resurfacing or fractional laser treatment can tighten mild lower lid skin without the need for skin excision, depending on the degree of laxity involved.
- Fat herniation causing visible under-eye bags
- Excess lower lid skin and wrinkling
- Tear trough hollows with volume loss
- Lid laxity contributing to a tired appearance
The tear trough is the hollow groove that forms at the junction of the lower eyelid and the cheek. When fat pockets above bulge while the area below is hollow, the contrast creates a shadowed, sunken look. Surgical repositioning of the fat or carefully placed filler injections can smooth this transition and restore a more rested appearance.
Some patients benefit from addressing both the upper and lower lids in a single session, which reduces overall recovery time. However, combining both procedures raises the risk of post-operative dry eye. For patients with significant pre-existing dry eye or notable lid laxity, staging the surgeries separately is often the safer choice.
Who Is a Good Candidate
Candidacy for blepharoplasty depends on a combination of general health, eye health, and personal readiness. Most healthy adults with realistic goals are good candidates, though certain conditions require attention before moving forward.
Good candidates are generally healthy adults without uncontrolled systemic conditions. Well-managed chronic conditions such as hypertension or diabetes are not barriers to surgery, but they should be under stable control beforehand. A full review of medications, including blood thinners and supplements, is part of every preoperative workup.
A healthy ocular surface is an important prerequisite. Significant dry eye, blepharitis (inflammation along the lid margins), ocular rosacea, or eye allergies should be treated and stabilized before surgery is performed. A comprehensive eye exam helps identify any issues that need to be addressed in advance.
- No significant uncontrolled dry eye
- Active lid margin inflammation treated before surgery
- Healthy cornea and tear film
- No active eye infection
The goal of blepharoplasty is a refreshed, rested appearance, not a dramatic transformation. Good candidates understand what the surgery can realistically achieve and are not expecting perfect symmetry, a complete reversal of aging, or results that eliminate the need for ongoing skincare. Patients with grounded expectations tend to be more satisfied with their outcomes.
Surgery should be chosen for the patient's own reasons, not in response to pressure from others. It also helps to be in a stable life situation, able to take adequate recovery time, and comfortable with the risks that come with any surgical procedure. Patients going through significant personal stress may find it worthwhile to wait until circumstances are more settled.
Contraindications and Risk Factors
Very few conditions make blepharoplasty completely off the table. More often, certain factors raise the complexity of the procedure and require the surgical plan to be adjusted accordingly.
Active infection near the surgical site, severe uncontrolled medical illness, and grossly unrealistic expectations generally mean surgery should be postponed. These are not permanent barriers in most cases. Once the underlying issue is resolved or managed, candidacy can be reassessed.
Several factors increase the risk of complications without making surgery impossible. Our team evaluates each one carefully and adapts the plan as needed to minimize risk.
- Use of anticoagulant medications, which increases bleeding risk
- History of cold urticaria (hives triggered by cold), which may worsen swelling
- Pre-existing dry eye syndrome
- Lower lid laxity, which raises the risk of lid malposition after surgery
- Previous eye surgery including LASIK
- Active thyroid eye disease
- History of keloid scarring
Smoking significantly impairs the body's ability to heal after surgery and raises the risk of infection and poor scar formation. Most surgeons ask patients to stop smoking at least four weeks before surgery and to remain smoke-free throughout the recovery period. Nicotine replacement products carry similar effects on blood vessels and should also be avoided during this time.
Blood thinners including warfarin, apixaban, rivaroxaban, clopidogrel, and aspirin, as well as common over-the-counter anti-inflammatory medications like ibuprofen, increase the risk of surgical bleeding. Your prescribing doctor and our surgical team coordinate safe temporary discontinuation before your procedure. It is essential never to stop a prescribed blood thinner without explicit guidance from your medical providers.
The Pre-Op Evaluation
A thorough preoperative evaluation is what allows us to confirm candidacy, plan the procedure precisely, and build the documentation needed for any insurance claim. The consultation covers your goals, your measurements, and the health of your eyes.
The consultation begins with a detailed discussion of your concerns, whether they are functional, cosmetic, or both. Functional symptoms such as difficulty with overhead tasks, a tendency to tilt the chin upward to see clearly, or brow heaviness by the end of the day are all important for insurance documentation. Cosmetic goals help shape the surgical approach.
Our eye doctors take a series of precise measurements to evaluate your lids and surrounding structures. Standardized photographs document your baseline appearance and are used for surgical planning and insurance purposes.
- Margin reflex distance (the measurement from the center of the pupil to the upper or lower lid margin)
- Levator function (how much the upper lid travels from looking down to looking up)
- Brow position and height
- Lid crease height and symmetry
- Lower lid tone and laxity
- Tear film stability and production
For functional upper blepharoplasty, insurance requires formal visual field testing. The test is typically performed twice: once with the lids in their natural position and once with the excess skin gently taped up to simulate the effect of surgery. A threshold of superior field loss is used to determine whether coverage criteria are met. Your results are reviewed with you during your evaluation.
Bring a complete list of all medications to your consultation, including over-the-counter drugs, vitamins, and supplements. Many common supplements such as fish oil, vitamin E, ginkgo biloba, and garlic can thin the blood and affect surgical safety. Your consultation is the right time to develop a plan for what to stop, when to stop it, and how to do so safely.
Preparing for Surgery
Preparing carefully for blepharoplasty improves both the safety of the procedure and the quality of your recovery. Your surgical team provides specific instructions tailored to your situation, but the following areas apply to most patients.
Your surgeon will provide a detailed plan for adjusting medications before your procedure. This typically involves stopping blood thinners (with approval from the prescribing doctor), avoiding aspirin and anti-inflammatory pain relievers, and discontinuing any herbal supplements that affect bleeding. The timing for stopping each medication varies depending on the specific drug.
Several lifestyle adjustments in the weeks before surgery can meaningfully reduce the risk of complications and support better healing.
- Stop smoking at least four weeks before surgery and throughout recovery
- Limit alcohol consumption for one week before the procedure
- Stop aspirin and NSAIDs approximately two weeks before surgery
- Arrange for a driver and a support person to stay with you the first night
- Plan for seven to fourteen days away from work
- Stock up on ice packs and preservative-free artificial tears in advance
Arrive with clean skin and no makeup on the day of surgery. Wear comfortable clothing with a front opening so you do not have to pull anything over your head. Bring sunglasses for the ride home. Your driver must stay with you through the first night after the procedure.
Knowing what to expect during recovery makes the experience less stressful. Significant swelling and bruising in the first one to two weeks are normal and expected. Final results settle gradually over several months as the tissues heal and the swelling fully resolves. Patients who anticipate the recovery period tend to feel more at ease throughout the process.
Frequently Asked Questions
Here are answers to some of the questions we hear most often during blepharoplasty consultations. These address situations that may not be covered fully in the sections above.
There is no set age requirement. Some patients in their late twenties seek surgery for inherited excess lid skin or prominent fat pockets. Most patients are in their forties through seventies, but the deciding factor at the upper end is medical health rather than age on a calendar. Patients in their eighties can have successful outcomes when their overall health supports it.
Many patients with mild dry eye go on to have blepharoplasty after their eye surface is stabilized with drops, lid hygiene, and sometimes prescription treatments. Moderate to severe dry eye requires more extensive management before any procedure and may influence the surgical plan, for example by staging upper and lower surgery separately rather than combining them. A full dry eye evaluation during your consultation guides these decisions.
Low brow position pushes forehead and brow tissue downward onto the upper lid, which can mimic the appearance of excess lid skin. If your heaviness is mainly coming from a drooping brow, a brow lift is the more targeted solution. If the excess originates in the upper lid skin itself, blepharoplasty is appropriate. Our eye doctors assess brow position as part of every upper lid evaluation, and many patients ultimately benefit from both procedures, done together or in stages.
Coverage is possible for the upper lids when documented functional impairment is present, including visual field loss, physical symptoms, and photographic evidence. The process involves preauthorization and specific clinical documentation that our team handles on your behalf. Cosmetic surgery on either the upper or lower lids is not covered by insurance. Before your procedure, you will receive a clear breakdown of your expected out-of-pocket costs.
Not everyone is ready for surgery at their first consultation, and that is a normal outcome. For some patients, optimizing dry eye, getting a medical condition under better control, or stopping smoking is what makes candidacy achievable in the near future. For others, non-surgical options such as neuromodulators, dermal fillers, or laser treatments may address some concerns in the meantime. A consultation gives you a clear picture of your options and a realistic timeline.
Look for board certification in ophthalmology with specific training in oculoplastic surgery, or board certification in plastic surgery with a demonstrated focus on eyelid procedures. Reviewing before-and-after photographs from patients with concerns similar to yours is helpful. Choose a surgeon who takes time to answer your questions clearly and who discusses both surgical and non-surgical options so you can make an informed decision.
Schedule Your Blepharoplasty Consultation
If heavy eyelids or under-eye bags are affecting your vision, your daily life, or simply the way you feel when you look in the mirror, we encourage you to schedule a consultation with our team at NewView Eye Center. We provide thorough evaluations that clarify whether you are a good candidate, what the procedure can realistically achieve, and whether insurance coverage may apply to your situation. Our practice serves patients across Northern Virginia with personalized, expert care from the initial consultation through every step of your recovery.
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