Am I a Good Candidate for Eyelid Surgery?

Physician-Reviewed Content

Medical reviewer: Dr. Brian S. Coan, MD, FACS, double board-certified plastic surgeon (American Board of Plastic Surgery and American Board of Surgery) and Fellow of the American College of Surgeons. This article is based on current peer-reviewed medical literature and guidance from professional organizations, including the American Society of Plastic Surgeons, The Aesthetic Society, and the American Board of Plastic Surgery.

Last reviewed: October 2026 | Reading time: 9 minutes

Eyelid surgery, known medically as blepharoplasty, is one of the most sought-after facial procedures for patients who feel that the area around their eyes no longer reflects how rested or energetic they feel. Whether excess skin weighs down the upper lids, under-eye bags create a tired appearance, or loose lower-lid skin makes you look older than you feel, blepharoplasty may address these concerns with precision and subtlety. At CARE Plastic Surgery in Cary, NC, Dr. Brian S. Coan and our team walk you through exactly what candidacy looks like so you can move forward with clarity and confidence.

Quick Answer

Most healthy adults who have excess or sagging upper eyelid skin, under-eye bags caused by protruding fat, or loose lower eyelid skin may be good candidates for eyelid surgery, provided they do not smoke (or can stop), have no uncontrolled eye or medical conditions, and have realistic expectations. A personalized consultation that examines your eyelids, brow position, tear function, and overall health is the only way to confirm candidacy.

Evidence Snapshot: Eyelid Surgery Candidacy

• The American Society of Plastic Surgeons (ASPS) describes good candidates as healthy individuals without life-threatening illnesses or medical conditions that can impair healing, who do not smoke, and who have no serious eye conditions.
• Upper blepharoplasty addresses excess skin (and sometimes fat) of the upper lid; lower blepharoplasty addresses under-eye bags and loose lower-lid skin.
• A low or descended brow can mimic excess eyelid skin, so the brow must be evaluated before upper eyelid surgery is planned.
• A 2023 systematic review and meta-analysis of upper blepharoplasty techniques found that only a small number of complications were reported and that patients were satisfied with their aesthetic outcomes.
• Temporary dryness, irritation, swelling, and bruising are common early in healing; patients with pre-existing dry eye need careful evaluation.
• Eyelid surgery does not correct crow’s feet, dark circles caused by pigmentation, or a sagging brow on its own.

Eyelid Surgery at a Glance

Procedure	Upper and/or lower blepharoplasty
Anesthesia	Monitored anesthesia care (MAC, IV sedation) with local anesthetic at CARE Plastic Surgery
Return to Work	About one week for most patients
Bruising	Typically subsides within about two weeks
Strenuous Exercise	Avoided for about six weeks
Sleeping	Head elevated for approximately two weeks

What Makes Someone a Good Candidate for Eyelid Surgery?

Determining whether you are a good candidate for eyelid surgery involves evaluating several interconnected factors, from your physical health to your aesthetic goals. According to the American Society of Plastic Surgeons, ideal candidates are generally healthy adults without medical conditions that could impair healing, are non-smokers, and have no serious eye conditions.

Physical Health and Medical History

A comprehensive review of your medical history is a foundational part of the consultation process. Conditions such as dry eye syndrome, glaucoma, thyroid eye disease, high blood pressure, or diabetes may influence whether surgery is appropriate or require additional evaluation before proceeding. Patients who smoke or use nicotine are advised to stop well in advance of surgery, because nicotine constricts blood vessels and can slow healing, as the ASPS explains. Please share all medications and supplements, including blood thinners, during your consultation.

Specific Eyelid Concerns That May Respond Well

Patients who may benefit from upper blepharoplasty often have excess or drooping skin that creates a heavy, hooded appearance. In some cases, this overhanging skin can block part of the upper field of vision; when visual field testing documents this, the procedure may be considered functional, although insurance coverage depends on your plan. Lower blepharoplasty candidates commonly have under-eye bags caused by protruding fat, along with loose or crepey lower-lid skin. These are structural concerns that injectables cannot remove. Neuromodulators such as Botox injections are better suited to softening crow’s feet, while surgery addresses the skin and fat of the eyelids themselves.

It is also important to distinguish excess eyelid skin from blepharoptosis, a condition in which the eyelid margin itself sits low because the muscle that raises the lid has weakened. Ptosis is treated differently than cosmetic blepharoplasty, which is one reason an in-person examination matters.

Realistic Expectations

Candidates who tend to experience the most satisfying outcomes are those who understand what eyelid surgery can and cannot do. Blepharoplasty may help create a more refreshed, open, and well-rested appearance around the eyes. It does not address crow’s feet, a descended brow (brow ptosis), or mid-face changes, which may require complementary procedures such as a brow lift or facelift. During your consultation with Dr. Brian S. Coan, these nuances are discussed openly so that your surgical plan reflects your complete picture. Individual results may vary.

Who May Not Be an Ideal Candidate for Eyelid Surgery?

Understanding who may not be a good candidate for eyelid surgery is just as important as knowing who is. Dr. Brian S. Coan prioritizes this honest conversation in every consultation at CARE Plastic Surgery.

Uncontrolled Medical Conditions

Patients with unmanaged diabetes, uncontrolled high blood pressure, or bleeding disorders may face elevated surgical risk. In many cases, once a primary care physician or specialist stabilizes these conditions, surgery may become a viable option.

Significant Dry Eye or Other Eye Conditions

Because blepharoplasty changes the eyelid structure, patients with significant dry eye disease, a history of corneal problems, uncontrolled glaucoma, or prior eye surgery such as LASIK may need clearance from an ophthalmologist before proceeding. ASPS lists dry eyes, irritation, and difficulty closing the eyes among the potential risks of eyelid surgery. Removing too much upper-lid skin can make it harder to close the eyes fully, and over-resection in the lower lid can pull the lid downward or outward (lid malposition), both of which can worsen dryness. This is why conservative, precise planning by an experienced surgeon matters.

Patients Who Prefer Non-Surgical Options First

For patients who are not yet ready for surgery, or whose concerns are mild, non-surgical options may offer a meaningful starting point. Hyaluronic acid fillers such as Juvéderm Volbella XC, which is FDA-approved for under-eye hollows, can help soften the transition between the lower lid and cheek, while skin and laser treatments at skinCARE Medspa may improve surface texture and tone. These options cannot remove excess skin or fat, but they can be discussed during a consultation to help you choose the most appropriate path.

What to Expect During the Eyelid Surgery Candidacy Evaluation

The candidacy evaluation for eyelid surgery at CARE Plastic Surgery is designed to be thorough, unhurried, and collaborative. Dr. Brian S. Coan takes time to understand not only your anatomy but also your motivations, lifestyle, and desired outcomes.

The Consultation Process

During your consultation, Dr. Coan will examine your upper and lower eyelids, evaluate skin quality and elasticity, check lower-lid tone, assess the position of your brow, and consider how the eyelids relate to surrounding facial structures. You may be asked about vision, contact lens use, and dry eye symptoms. Photographs may be taken for surgical planning. You will have ample opportunity to ask questions in an environment that feels welcoming rather than clinical.

How Brow Position Affects Candidacy

One of the more nuanced aspects of eyelid surgery candidacy is the role of the brow. When the brow has descended with age, it can create the illusion of excess upper eyelid skin, and removing eyelid skin alone in this situation may not achieve the desired result. Dr. Coan carefully evaluates whether a brow lift procedure may complement or replace upper blepharoplasty. Patients interested in broader facial rejuvenation may also benefit from facial fat grafting, which can restore volume lost with age.

Recovery and Lifestyle Considerations

Candidacy is also shaped by your ability to plan for recovery. At CARE Plastic Surgery, most patients return to work in about a week, bruising typically subsides within about two weeks, and strenuous activity is avoided for about six weeks. Sleeping with your head elevated for approximately two weeks helps reduce swelling. ASPS notes that early healing can include swelling, bruising, irritation, and dry eyes that are managed with cold compresses, ointment, and medication, as outlined in its eyelid surgery recovery guidance. Following your post-operative instructions closely is one of the most important factors in a smooth recovery.

Why Choose CARE Plastic Surgery in Cary, NC?

Choosing the right surgeon is one of the most consequential decisions in your eyelid surgery journey. Dr. Brian S. Coan is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery and is a Fellow of the American College of Surgeons. Patients can verify a surgeon’s certification through the American Board of Plastic Surgery. Dr. Coan earned his undergraduate degree at MIT, attended medical school at the University of Chicago Pritzker School of Medicine, and completed his plastic surgery residency at Duke University Medical Center, where he served as chief resident.

He has been named Best Plastic Surgeon in Cary by Cary Magazine for eight consecutive years, Best Plastic Surgeon in Durham by readers of Durham Magazine every year since 2010, and earned Gold for Best Plastic Surgeon in the 2026 5-West Diamond Awards. Dr. Coan has also been sought after by surgical colleagues and plastic surgery residents to share his expertise. Procedures are performed in CARE’s QUAD A-accredited on-site surgical facility. We invite you to contact CARE Plastic Surgery to begin the conversation.

Frequently Asked Questions About Eyelid Surgery Candidacy

What is the difference between upper and lower eyelid surgery?

Upper blepharoplasty removes excess skin, and sometimes a small amount of fat, from the upper lid to reduce a hooded or heavy look. Lower blepharoplasty addresses under-eye bags by removing or repositioning fat and may tighten loose lower-lid skin. Some patients benefit from one; others from both in the same session.

Can eyelid surgery be combined with other procedures?

Yes. Eyelid surgery is commonly combined with a brow lift, facelift, or facial fat grafting when a patient’s concerns extend beyond the eyelids. Combining procedures can mean one recovery period, but it may also lengthen operative time. Dr. Coan will advise whether a combined approach is appropriate for you.

Is there a minimum or maximum age for blepharoplasty?

There is no fixed age limit. Most patients are in their 40s or older, but some younger patients have inherited puffiness or hooding. Health, anatomy, and goals matter more than age alone.

Will eyelid surgery leave visible scars?

Upper eyelid incisions are placed within the natural crease of the lid, and lower eyelid incisions are placed just below the lash line or inside the lower lid. Scars typically fade and become difficult to see over time, although healing varies from person to person.

Will I have dry eyes after eyelid surgery?

Temporary dryness and irritation are common during early healing and are usually managed with lubricating drops and ointment. Patients with pre-existing dry eye disease should mention it during consultation, as it may change the surgical plan or require an ophthalmology evaluation first.

How long do eyelid surgery results last?

Upper eyelid results are often long-lasting, and lower eyelid fat removal is rarely repeated. However, surgery does not stop the aging process, so skin and brow position will continue to change gradually over time.

Is eyelid surgery covered by insurance?

Cosmetic blepharoplasty is not covered by insurance. Upper eyelid surgery may be considered medically necessary when excess skin significantly obstructs vision and this is documented through testing, but coverage depends entirely on your plan’s criteria.

What if my eyelid itself droops rather than the skin?

A low eyelid margin may indicate blepharoptosis, which involves the muscle that lifts the eyelid rather than excess skin. Ptosis requires a different evaluation and repair, so Dr. Coan will assess lid position carefully before recommending treatment.

References and Supporting Evidence

• American Society of Plastic Surgeons. Eyelid Surgery.
• American Society of Plastic Surgeons. Eyelid Surgery Candidates.
• American Society of Plastic Surgeons. Eyelid Surgery Risks and Safety.
• American Society of Plastic Surgeons. Eyelid Surgery Recovery.
• American Society of Plastic Surgeons. How Nicotine Sabotages Plastic Surgery.
• The Aesthetic Society. Eyelid Surgery (Blepharoplasty).
• American Board of Plastic Surgery. Is Your Surgeon Certified?
• Rodrigues C, et al. Upper Eyelid Blepharoplasty: Surgical Techniques and Results—Systematic Review and Meta-analysis. Aesthetic Plastic Surgery. 2023.
• Chouksey G, et al. Review on the Impact of Smoking on Wound Healing Following Facial Procedures. Archives of Craniofacial Surgery. 2026.

Contact Us

If you are ready to find out whether you are a good candidate for eyelid surgery in Cary, NC, the team at CARE Plastic Surgery is here to help. Dr. Brian S. Coan brings over a decade of experience as a double board-certified plastic surgeon to every consultation. Contact CARE Plastic Surgery online or call 919-372-3125 to schedule your personalized evaluation.

Medical Review

This article has been medically reviewed by Dr. Brian S. Coan, MD, FACS, a double board-certified plastic surgeon and Fellow of the American College of Surgeons. It is intended to educate prospective patients and should not replace an in-person consultation or individualized medical advice.

Patient Education Disclaimer: This article is intended for informational and educational purposes only. It does not constitute medical advice, establish a physician-patient relationship, or replace an in-person consultation with a board-certified plastic surgeon. Candidacy, risks, recovery, and results vary by patient and should be discussed with a qualified medical professional.

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