I’m not sure if my algorithm is trying to tell me something, but lately my feeds have been full of people documenting their journeys with “bleph” — short for upper and lower blepharoplasty, eyelid-sagging surgical corrections, and persistent dark circles. And it’s not just anecdotal: the most recent audit by the British Association of Aesthetic Plastic Surgeons (BAAPS) shows that blepharoplasty procedures will increase by 13% between 2023 and 2024. On a global scale, blepharoplasty has established itself as one of the most sought-after cosmetic procedures — 27 million cosmetic procedures performed 1% worldwide. the previous year.
The wave doesn’t surprise me. I have never found non-surgical solutions for tired eyes to be convincing. Dermal fillers, for example, can help with hollowing, but they only address certain concerns, and when used in such a sensitive area, they carry a host of risks. Think vascular occlusion, long-term swelling, and in the worst case scenario, even blindness.
Surgery, then, may seem like a bigger leap — and its risks certainly shouldn’t be underestimated — but it’s clear that more people are deciding it’s the most definitive option when it comes to targeting eye concerns. Blepharoplasty offers a long-term, more complete solution to drooping eyelids and bags under the eyes, but it also requires a higher initial cost, recovery time, and acceptance of surgical risk. Non-surgical treatments such as fillers or Energy-based devices, on the other hand, are faster, less invasive, and often more affordable, but their effects are temporary, limited in scope, and not without complications of their own.
For clarity beyond the TikTok testimonials, we turned to plastic surgeons Mr. Dan Marsh and Mr. Mo Akhavani, co-founders of Plastic Surgery Groupto reveal everything you really need to know.
What does upper or lower blepharoplasty treat and who is the right candidate?
According to Mr. Akhavani, blepharoplasty can be done for both functional and aesthetic reasons. “Sometimes it is performed to prevent eyelids from restricting vision, but more often it is used to rejuvenate the eye area by treating damaged upper eyelids, puffy lower eyelids or bags under the eyes.’
He adds that adults who feel their eyes look tired due to excess skin, fine lines or bulging fat are ideal candidates, although a full consultation is necessary to determine suitability.
What does surgery achieve that non-surgical options can’t?
When it comes to surgical and non-surgical options, the most important distinction is permanence. “Blepharoplasty can remove skin, whereas fillers cannot,” says Mr Marsh. “Fillers can temporarily restore volume, but surgery goes further by removing or repositioning fat, removing loose skin, and restoring lost volume in a lasting way.”
While dermal fillers may help with hollows or dark circles, he notes that blepharoplasty addresses structural changes at the root, “offering a more complete and long-lasting result.”
What does the process actually involve?
“Upper eyelid blepharoplasty can often be done under local anaesthetic, while lower eyelid surgery is usually done generally,” explains Mr Akhavani. “Many patients choose to have all four eyelids treated in one procedure.”
Mr Marsh adds that the process is precise and tailored. “We start by marking the skin and fat that needs to be removed,” he says. “For the upper eyelids, the incision is hidden in the natural crease, for the lower eyelids, it is placed just under the lashes or inside the eyelid. We can also collect fat from the abdomen and re-inject it into hollow areas under the eyes or eyebrows. The wounds should then be kept clean, with cold compresses helping to reduce blackheads.”
How is the downtime?
Recovery is relatively quick, says Mr. Akhavani: “Most patients go home the same day. Expect swelling and bruising for the first week or two, and plan to take about two weeks off work. Sleeping propped up helps, and light exercise can usually be resumed after four weeks.”
How long until you see the final results?
Patience is key, according to Mr Marsh. “Most patients see significant improvement within a month or two, but the swelling can take up to a year to fully subside. Scarring will continue to fade, and the speed of healing depends on age, genetics and lifestyle.”
What are the possible complications?
While the procedure is generally safe, Mr. Akhavani notes that risks include “temporary blurred vision, swelling, bruising, minor infection or scar asymmetry. Some patients may also experience temporary difficulty closing their eyes completely during sleep.” Choosing an experienced, qualified surgeon, he stresses, is the best way to minimize complications.
Are the results permanent or will the concerns return over time?
Blepharoplasty offers long-lasting results, says Mr Marsh, but it doesn’t completely freeze the clock. “Surgery can have an immediate and rejuvenating effect,” she says, “but it can’t stop natural aging. Some patients may need additional procedures in the future, such as a brow lift, if scrunching occurs again.”
As with any aesthetic treatment, research is everything—and nothing replaces a proper consultation with an experienced, qualified surgeon.
