eyelid surgery

Blepharoplasty, also known as eyelid surgery, is a cosmetic procedure that addresses concerns such as droopy eyelids, excess skin around the eyes, and puffy eyes. As we age, the delicate skin in this area can lose elasticity, resulting in sagging or hooded upper eyelids and bags or wrinkles on the lower eyelids. These changes can make us appear tired and aged, or even affect our vision.

With his extensive experience and advanced skills, board-certified plastic surgeon Dr. Joseph Michaels strives to provide his patients with exceptional results and minimal downtime. He will guide you through every step of the process, explaining the procedure in detail and answering any questions or concerns you may have. As an assistant professor at Johns Hopkins School of Medicine, he only practices the latest techniques that produce quality results. If you want to find out more about eyelid surgery, contact Michaels Aesthetic & Reconstructive Plastic Surgery in Fairfax, VA at (703) 957-8610 or Rockville, MD at (301) 468-5991. You can also reach out to a staff member and request a consultation through our contact form.

About the Blepharoplasty 

As time passes, constant exposure to the sun and pollution as well as the effect of gravity can cause signs of aging to develop around the eyes. The natural aging process can compound this effect. Over time, the skin loses its elasticity as the body generates less collagen and elastin, two proteins that are important for healthy skin. Fat migrates to undesirable areas of the face, and youthful contours are lost. 

Dr. Salvador Castañaresis was the first to introduce blepharoplasties to medical research in 1951. Between 1951 and 1967, his research consisted of detailed descriptions of the fat deposits around the orbital region. Using his newfound knowledge, he developed safe and effective methods of correcting the signs of aging prevalent in this area. (1)  Since these first advancements in the field of cosmetic eyelid surgeries, surgeons have found various ways to utilize the smallest and most subtle incisions possible. After a blepharoplasty, you can reap the benefits of: 

  • Younger-looking, more expressive eyes 
  • More space in the upper eyelid for makeup applications 
  • Less fat in both the upper and lower eyelids 
  • Improved, clear vision that isn’t obscured by hanging skin 
  • Reduced eye bags 
  • Incisions that are discreetly hidden within eyelid creases 

Eyelid surgeries are considered minimally invasive and only take 1 to 2 hours to complete– depending on whether or not both the upper and lower eyelids are being treated. 

Candidates for Eyelid Surgery

Eyelid surgeries are performed for patients who have no underlying health conditions that can interfere with recovery. For example, depending on the severity of their condition, those with diabetes, high blood pressure, glaucoma, and vascular conditions may or may not qualify for the procedure. Patients with Graves’ disease should completely avoid any type of cosmetic surgery to the eye, since their blood vessels in this area are more prominent and could pose a complication risk. The ideal candidate is a non-smoker, but Dr. Michaels will consider those who are willing to stop for a few weeks before and after the procedure. Nicotine and other chemicals in cigarettes/vapes can slow down the healing process and affect the quality of the results. 

Personal Consultation

Through open and transparent communication, Dr. Michaels aims to establish a trusting and comfortable relationship with each patient, fostering a positive surgical experience. During your consultation, he will closely examine the quality of your eyelid skin, surrounding fat deposits, and the entire periorbital region of the face. He will discuss, in detail, his plan for your procedure, as well as preparation and recovery instructions. He will carefully choose the best method that suits your facial symmetry and appearance overall. Finally, he will ensure that all of your questions and concerns about the procedure are addressed properly

If you are looking for premium care when it comes to your blepharoplasty, please contact his office in Rockville, MD at (301) 468-5991 or Fairfax, VA at (703) 957-8610. For your convenience, you may also use our contact page available online. A member of the team will be happy to assist you with your inquiry.


Prior to an eyelid lift, Dr. Michaels will evaluate the functioning and aesthetics of your eyes. He will require blood tests to make sure you are healthy enough to undergo surgery. If you consume any type of nicotine product, you should aim to quit at least 1 month before your scheduled surgery. Nicotine causes vasoconstriction, or constriction of the blood vessels. By avoiding it, you can optimize your circulatory system and reduce your risk of complications during recovery. A couple of weeks before your eyelid lift, you should stop taking all blood thinners and anti-inflammatory medications that can contribute to more bleeding and/or bruising. 

To better prepare for the first few days post-procedure, you should pick up all prescriptions and/or over-the-counter medications that Dr. Michaels approves of. You may want to buy a cold compress to ease the swelling during the initial healing period. Finally, since it’s an outpatient procedure, you should speak to a trusted individual who will be able to drive you home. 


Extensive eyelid surgery procedures are performed under general anesthesia. However, for patients undergoing less complex eyelid surgery, Dr. Michaels prefers to use local anesthesia and perform the procedure in his office. By doing so, the patient does not incur any additional general anesthesia or hospital costs.

If Dr. Michaels is treating all four lids (quad blepharoplasty), he will start with the upper eyelids. He makes incisions in the crease of the upper eyelid and removes the desired amount of excess skin. He then removes any bulging fat and other tissue from this area to optimize the contour. He may modify and tighten the orbicularis oculi muscle that surrounds each eye. Dr. Michaels then closes the incision with sutures. 

Next, he will address the lower eyelids, as needed. He positions the incision either directly inside the lower eyelid or just beneath the lower eyelashes. He again eliminates any extra fat, skin, or other tissue from this area and modifies the lower lid tarsoligamentous complex, a layer of thin connective tissue. (2) He concludes by closing the incisions with dissolvable sutures.

Ptosis Surgery

Ptosis surgery is medically necessary due to the fact that severe ptosis, or sagging, interferes with the patient’s vision. It is covered by insurance since it’s not considered a cosmetic procedure. This type of eyelid surgery often requires tightening of the levator palpebrae superioris muscle, the muscle that controls upper eyelid positioning and movement. 

Recovery and Results

The most common symptoms that patients experience are temporary bruising, swelling, and pain. Dr. Michaels will ensure that you get the proper prescription medications to make your recovery as easy as possible. The sutures of the upper eyelid are removed about 5 to 6 days after the procedure, but the sutures placed inside the lower eyelid are dissolvable. Within 1 week, most patients feel well enough to return to work. Within 1 to 2 weeks, they can begin light exercise, but they should postpone strenuous exercise for 2 to 3 weeks. Any scars resulting from the incisions should fade with proper care over a few months and become nearly imperceptible once the eyelids have healed.

Corresponding & Complementary Procedures 

Depending on your unique anatomy, Dr. Michaels may recommend a brow lift or facelift surgery in conjunction with eyelid surgery to achieve optimal aesthetic results.

Brow Lift 

A brow lift repositions the brows to a more lifted, youthful place, eliminates deep folds and wrinkles in the forehead, and can reduce excess tissue of the upper eyelids. This is a more comprehensive procedure if you are looking for a full upper face rejuvenation that includes the benefits of an upper blepharoplasty. In some cases, it can be performed utilizing the same incision as well. 


For those looking to tighten sagging skin in the lower half of the face, a blepharoplasty or brow lift can be paired with a facelift procedure. The mid-facelift, in particular, is designed to accentuate the contours of the cheeks and cheekbones, reposition the face in this area, and reduce the appearance of nasolabial folds. Results look incredibly natural due to the fact that the SMAS (superficial musculoaponeurotic system) layer of connective tissue is tightened and altered, not the overlying skin. The results of the mid-facelift can last up to 15 years. (3)

Cost of a Blepharoplasty in Rockville, MD 

The cost of a blepharoplasty procedure may vary depending on various factors related to your specific treatment plan. Each patient’s case is unique and requires individualized attention to ensure the best possible outcome. Dr. Michaels offers various financing options to make this procedure as affordable as possible. 

If you are frustrated with the look of your sagging upper and/or lower eyelids and do not feel that they express your happy, youthful energy, you may benefit from eyelid surgery. After your personal consultation with Dr. Michaels, you will receive a total cost estimate. At Michaels Aesthetic and Reconstructive Plastic Surgery, we have helped countless patients achieve revitalized confidence with blepharoplasties. We can do the same for you.

If you are interested in finding out more about our other procedures, please take a look through Dr. Michaels’ blog


  1. Espinoza GM, Holds JB. Evolution of Eyelid Surgery. Facial Plastic Surgery Clinics of North America. 2005;13(4):505-510. doi:https://doi.org/10.1016/j.fsc.2005.09.001
  2.  Rebowe RE, Runyan C. Blepharoplasty. PubMed. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK482381/  
  3. Shtraks JP, Fundakowski C, Yu D, et al. Investigation of the Longevity of the Endoscopic Midface Lift. JAMA Facial Plastic Surgery. 2019;21(6):535-541. doi:https://doi.org/10.1001/jamafacial.2019.1015