I’m not sure if my algorithm is trying to tell me something, but lately my feeds are awash with people documenting their “bleph” journeys—shorthand for upper and lower blepharoplasty, the surgical fixes for sagging eyelids and stubborn dark circles. And it’s not just anecdotal: the latest audit from the British Association of Aesthetic Plastic Surgeons (BAAPS) shows blepharoplasty procedures rose by 13% between 2023 and 2024. On a global scale, eyelid surgery has cemented itself as one of the most in-demand aesthetic procedures, with 1.7 million performed worldwide last year—a striking 24% jump on the year before.
The surge doesn’t surprise me. I’ve never found non-surgical solutions for tired eyes to be convincing. Dermal fillers, for example, can help with tear-trough hollowing, but they only address certain concerns, and when used in such a delicate area, they come with a plethora of risks. Think vascular occlusion, long-lasting swelling and in the worst-case scenario, even blindness.
Surgery, then, may feel like a bigger leap—and its risks certainly shouldn’t be underestimated—but it’s clear more people are deciding it’s the more definitive option when it comes to targeting eye concerns. Blepharoplasty offers a long-lasting, more comprehensive solution to drooping lids and under-eye bags, but it also demands higher upfront costs, recovery time and the acceptance of surgical risk. Non-surgical treatments like fillers or energy-based devices, on the other hand, are quicker, less invasive and often more affordable, but their results 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 The Plastic Surgery Group, to uncover everything you really need to know.
What does an upper or lower blepharoplasty treat, and who is a suitable candidate?
According to Mr Akhavani, blepharoplasty can be performed for both functional and cosmetic reasons. “Sometimes it’s carried out to stop the eyelids from limiting vision, but more often it’s used to rejuvenate the eye area by addressing sagging upper lids, puffy lower lids or under-eye bags.”
He adds that ideal candidates are adults who feel their eyes look tired due to excess skin, fine wrinkles or bulging fat pads, though a full consultation is essential to determine suitability.
What does surgery achieve that non-surgical options can’t?
When it comes to surgical and non-surgical options, the most significant distinction is permanence. “Blepharoplasty can remove skin, whereas fillers can’t,” says Mr Marsh. “Fillers may restore volume temporarily, but surgery goes further by removing or repositioning fat, excising loose skin and restoring lost volume in a way that lasts.”
While dermal fillers may help with tear-trough hollowing or dark circles, he notes that blepharoplasty addresses the root structural changes, “offering a more comprehensive and longer-lasting result.”
What does the procedure actually involve?
“Upper eyelid blepharoplasty can often be performed under local anaesthetic, while lower eyelid surgery is usually done under general,” Mr Akhavani explains. “Many patients opt to have all four eyelids treated in one procedure.”
Mr Marsh adds that the process is precise and tailored. “We begin by marking the skin and fat to be removed,” he says. “For upper lids, the incision is hidden in the natural crease; for lower lids, it’s placed just beneath the lashes or inside the lid. We may also harvest fat from the tummy and re-inject it into hollow areas beneath the eyes or brows. Afterwards, wounds must be kept clean, with cold compresses helping to reduce bruising.”
What is the downtime like?
Recovery is relatively swift, says Mr Akhavani: “Most patients go home the same day. Expect swelling and bruising in the first week or two, and plan to take around 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 notice a significant improvement within a month or two, but swelling can take up to a year to fully resolve. Scars will continue to fade, and healing speed depends on age, genetics and lifestyle.”
What are the possible complications?
Although the procedure is generally safe, Mr Akhavani notes that risks include “temporary blurred vision, swelling, bruising, minor infection or asymmetry of scars. Some patients may also experience temporary difficulty closing their eyes fully during sleep.” Choosing an experienced, qualified surgeon, he stresses, is the best way to minimise complications.
Are the results permanent, or will concerns return over time?
Blepharoplasty delivers long-lasting results, says Mr Marsh, but it doesn’t freeze the clock entirely. “The surgery can have an immediate and rejuvenating effect,” he says, “but it can’t stop natural ageing. Some patients may need additional procedures in the future, such as a brow lift, if droopiness develops again.”
As with any aesthetic treatment, research is everything—and nothing replaces a proper consultation with an experienced, qualified surgeon.