The swollen, bloated, “tired” eyelids (eyebags in common jargon) are the common features of many faces in different life ages. Many people say they have the feeling of “weight” in the eyelids and state that they look tired and sleepy during the whole day. The reasons for the emergence of the swolen eyelids are various: the heritage, the aging process and the specific situation or  chronic diseases of the organism. The hereditary factors are most often manifested in young women, first in adolescence, then in the late twenties and thirties. Anatomically, it is a hereditary excess of the adipose tissue in the orbit, which penetrates forward into the tissue of the eyelids. The mentioned changes mainly affect the lower eyelids.


Aging process and disease

The aging process can not be stopped, although it is very individual with regard to the speed and intensity, that is, not all men grow older in the same way. In the aging process the eyelid skin loses elasticity and stiffness (declining of the collagen and elastic fibers) and creates a visible excess of skin. In addition, the orbicular muscle (its function is to close the eyelids) becomes flabby or thicker, while the supportive-connective tissue of the eyelid weakens and the orbital fat penetrates forward, which creates  typical “eyebags”. Sometimes, the skin excess, the weakened orbicular muscle, the protruding orbital fat  (blepharochalasis) and the possibly lowered (ptotic) lacrimal gland create the fold of the upper lid which overlaps the eyelashes line, and narrows the upper and lateral part of the visual field. For this reason, people often lift the brows to expand the visual field, which furrows the forehead and magnifies the horizontal wrinkles and is often the cause of the frontal headaches. Some chronic diseases of the organism can also cause puffiness of the eyelids, for example, chronic kidney and heart diseases. The increased activity of the thyroid gland (hyperthyreosis) can result in the visible protrusion of the eyeballs (proptosis), and the reduction of the thyroid activity (hypothyreosis) can lead to the facial and lid edema (myxedema). Sometimes allergies, then changes in the hormonal status of women throughout the cycle or the chronic lack of sleep can create a temporary puffiness of the eyelids. In these chronic diseases or conditions the swollen eyelids are mainly the result of the excess of the intercellular fluid in the loose tissue of the eyelid (edema). A therapy of the chronic diseases is also a therapy of the edematic  eyelids. The “eyebags” caused by the hereditary factors or aging process can be successfully and permanently resolved only by the aesthetic procedure- blepharoplasty. Blepharoplasty is a very common and successful method of the aesthetic surgery, and the procedure is usually performed under local anesthesia and takes an average of 1-2 hours, depending on the number of the eyelids being corrected. The operation is completely painless, and the scar is completely invisible, because the eyelid skin is very thin and heals very fast. After the surgery, the patient has to be under medical observation for several hours, and then goes on home care. There is no postoperative pain, and the dry and cold packs are applied locally in the first 12 hours. The sutures are taken out after 3-5 days. The majority of the patients experience the increased production of tears and the feeling of a foreign body in the eye for the average of two postoperative weeks. Usually the antibiotic therapy with the eyes ointment and drops is prescribed. The patient returns to her/his usual activities in 7-14 days, sometimes even earlier. Blepharoplasty is a permanent method, which means that a successfully performed surgery eliminates the need to repeat the procedure in the near or distant future. It achieves the fresher appearance of the face and rejuvenates a patient for 5-6 years in average. To conclude, the aim of blepharoplasty of the upper eyelids is the formation of smooth, horizontal surface of the eyelid from the eyelash line to the natural lid crease, which is in average ten millimeters wide, and which is especially important for women when applying make-up. In blepharoplasty of the lower eyelids the “eyebags” are being removed, and the surface of the eyelid is smoothened, or a slightly concave shape of the eyelid in the profile projection is formed. The invisibility of the scar and rare postoperative complications (usually bleeding in the early postoperative period) make this method one of the most elegant in the aesthetic surgery. In addition, blepharoplasty can have a functional effect, because in certain cases it can extend the visual field narrowed due to abundant folds of the upper eyelids.



The first step is preoperative consultation with the patients. The approach to each patient is strictly individual. A thorough family and personal history has to be taken in order to determine whether a patient suffers from any allergies, chronic diseases of the thyroid gland, kidneys and cardiovascular system. Wishes and expectations of the patient are carefully observed. Then follows the preoperative examination. The examination of the upper lids includes the assessment of the structures of which the upper lids fold consists, or the relation of the upper lids to the superior orbital rim, and then determines the position of the eyebrows and measures the range of maximum “top-down” view with the fixed eyebrows (normal range varies from 10-14 mm), which directly confirms the normal function of the levator muscle of the eyelid and its aponeurosis (tendon). When examining the lower eyelids, the eyelid tension or tonus and the possible excess of flabby skin must be detected. It is important to accurately assess the anatomic relation of the lower lid to the eyeball and malar eminence (zygomatic) area in the profile projection. With the “distraction” and “snap back” tests the tension of the lower lids is estimated. Also, an important part of the examination is the psychological evaluation of each patient. It is necessary to detect preoperatively any possible asymmetry of the eyelids, eyelid aperture and eyebrows, which is a relatively common case.


Surgical procedure

The preoperative “marking”: on the upper eyelids an excessive part of the flabby skin to be removed is marked. On the lower eyelids the bulged orbital fat pads are shown, which form the eyebags. The antibiotic ointment for the eyes is locally applied into the eyelid aperture before the procedure to prevent the corneal and conjunctival irritation with the solutions which are used preoperatively to clean the face.

Applying the local anesthetic in the upper lid. The procedure is usually done under local anesthesia in which the patient feels no pain and is relaxed because of the intravenous applications of sedatives (short acting hypnotic). In most cases, a patient sleeps during the entire operation, after which she/he is in a state of complete loss of memory (amnesia) for a few hours.

Our chief surgeon Dr Ostojić carefully approaches the procedure using the latest equipment for the aesthetic surgery.

The superior and inferior cuts of skin marked by the lines are completed. The bloodless incisions are visible, which is the usual characteristics of the eyelids correction. The incision extends deep only through the skin, which is the thinnest in the whole organism. As a result, the incisions heal extremely well, and the scars are almost invisible.

Cutting out the excessive skin of the upper eyelid.

The upper lid after the complete removal of the redundant skin. In the bottom of the operative field the horizontal muscular fibers of the orbicular ocular muscle are visible. The following procedure is the removal of the equally wide part of the muscle because it contributes to the creation of the unaesthetic fold above the upper eyelids.

The condition after the resection of a  part of the orbicular ocular muscle. In the bottom of the operative field the orbital fat pads, which contribute the most to the “fullness” of the upper eyelids, are visible.

Removal of the fat pads at the time of the operation. During the aging process the supportive tissue of the eyelids weakens, which allows penetration or protrusion of  the adipose tissue from the orbit forward and forming of typical folds on the eyelids which give a patient a weary and care-worn appearance.

The removed excessive tissue of the upper eyelids; a part of the orbicular ocular muscle (above), the excessive skin (middle) and the excessive orbital adipose tissue (below).

The incision is precisely sewn according to the principles of the aesthetic surgery, and located in the natural crease of the eyelid (the “lid crease”), which is 9-11 mm far away from the lashline. The scar will be completely invisible.

The eyebags correction will be made through the conjunctiva, on the inner side of the lower eyelids (transconjunctival blepharoplasty). The incisions will be made with a radiowave knife that stops bleeding so the operational area is almost bloodless.

The eyebags correction will be made through the conjunctiva, on the inner side of the lower eyelids (transconjunctival blepharoplasty). The incisions will be made with a radiowave knife that stops bleeding so the operational area is almost bloodless.

After a complete radiowave knife incision through the three layers of the lower eyelids (conjunctiva, muscle, fascia) is finished, there comes the protrusion of excessive orbital fat, which formes the eyebags. The excessive part of the orbital fat is being removed to the level of the inferior orbital rim. The incision is not sewn, so to avoid irritation of the conjunctiva and cornea.

After the resection or removal of the abundant orbital adipose tissue, the lower lid is pulled up with forceps to show the contours of the lower eyelid. It is evident that the eyebags are removed. The lower lid has a normal, slightly concave shape.

The direct cutting out of the redundant skin of the lower eyelids (“pinch” technique). Then this incision is closed with the intracutaneous suture (thread Prolene 5-0).

In the end of the operational procedure the special steri-strip plasters are being put, which excellently immobilize the incisions and eyelids, enable quick healing and reduce the emergence of postoperative swelling and bruises. The plasters are held on the eyelids for five days, then they are taken off, together with the sutures, and in that period the eyelids can not be wetted.


Postoperative period

Blepharoplasty is usually done under reinforced local anaesthesia and the patient has to be under medical observation for a few hours after the procedure, and then she/he is discharged for home care. A patient may have the increased production of tears and/or foreign body sensation in the eyes for about two weeks. Bruises and swelling usually disappear in 10-14 days. The characteristic of this procedure is the complete absence of the postoperative pain and there is no need for the application of analgetics. The patients may feel a mild strain in the projection of the eyelids. The heavy pain in the early postoperative period alarms the physician, and it may be due to the corneal injury or bleeding in the orbit (which is a very rare postoperative complication). There is no need for the preventive application of antibiotics because the postoperative infections in the area of the face and neck are very rare. The patients usually sleep on their back with a high pillow for a few postoperative weeks. The patients usually return to work after ten days, some even earlier with the use of the sun glasses.



The complications of the blepharoplasty procedure are very rare, because it is an elegant and almost bloodless operation. Possible complications include:

  • infection
  • bleeding ili hematoma
  • asymmetry of the eyelid aperture, eyelids and/or eyebrows (very rare and it can be corrected later)
  • eye dryness (occurs with  the patients who suffer from similar disorders preoperatively)
  • prolonged increased production of tears

What are the causes of puffy eyelids? Can expressed dark circles be inherited?

Puffy dark circles can arise from  a variety of reasons, the most common are hereditary along with the aging process and chronic illness. Hereditary dark circles are already apparent in younger age, first in adolescence, then in the late twenties and thirties. In this case, it is a hereditary excess of the fat tissue of the cavity that penetrates the eyelid tissue forward. The lower eyelids are mostly affected.

Aging is the most common cause of puffy eyelids, in which the skin of the eyelid loses its elasticity and firmness, thereby creating visible skin excess. Additionally, the orbicular muscle that has the lid closure function becomes flabby and the connective tissue of the eyelid is weak, with the eye fat penetrating forward.

Chronic diseases of the kidneys and heart can be mentioned as causes for puffy eyelids, they increase the activity of the thyroid gland and allergies. Chronic insomnia is certainly one of the common causes of swollen eyelids.

Can dark circles be permanently solved by other methods other than the aesthetic procedure?

Dark circles caused by the aging process or hereditary factors can only be permanently solved by blepharoplasty, that is, the aesthetic procedure of the correction of the eyelids. It is a permanent method that achieves a fresher look of the face and rejuvenates the patient for five to six years.

The great advantage of this method is that it forms a smooth, horizontal eyelid fleece from the eyelash line to a natural eyelid wrinkle, which is on average about ten millimeters wide, which is especially important for women when applying make up. Blepharoplasty of the lower eyelids removes the “dark circles” and smoothes the surface of the eyelid, it forms a slightly concave contour of the eyelid in the profile projection.

This is one of the most common and “most elegant” methods in aesthetic surgery, postoperative complications are extremely rare, there are no scars and in some cases it can extend the narrower field of vision (caused by abundant creases of the upper eyelid).

How do the preparations and aesthetic correction of the eyelids look like?

Preoperative examination is the first step in the correction procedure of the eyelids. Each patient is treated individually, carefully listening to the wishes and expectations of the patient and openly discussing the history, the state of health, the possible medications that are being taken.

A further examination determines the position of the brow, the crease structure, the eyelid tightness, the possible excess of the flabby skin, and measures the range from the maximum up-and-down glance. Also, the possible asymmetry of the eyelids, eye slit and eyebrows should be established. An important part of the review is the psychological evaluation of patients.

The procedure itself is usually done in local anesthesia. Depending on the number of lids that are being corrected, it can usually take one to two hours. The operation is painless, and as the skin of the eyelid is very thin and quickly heals, no scarring remains visible.

How long does the recovery take?

Bruises and swellings fade on average after ten to fourteen days. In the postoperative period, analgesics are not used because there is no postoperative pain. Also, as postoperative infections in the area of ​​the face are extremely rare, there is no need for antibiotics. In several postoperative weeks, patients are recommended to sleep on their back with a slightly raised head.

What complications can occur in or after aesthetic correction of the lids?

Possible complications include infection, bleeding or hematoma, asymmetry of eye dislocations, eyelids or eyebrows, dry eyes and prolonged increased tear production. It should be noted that these complications are extremely rare and can all be subsequently treated and removed.