Upper eyelid surgery: how much skin can safely be removed

The measurement that sets the limit

The safe answer is whatever leaves at least twenty millimetres of skin between the lower border of the eyebrow and the lash line once the eyelid is closed. Below that the lid cannot close fully, and a lid that does not close dries the cornea. Most surgeons also preserve at least ten millimetres above the crease. The amount actually removed is typically eight to twelve millimetres of skin, marked with the patient sitting upright and rechecked with a pinch test.

The pinch test, and why you sit up

Marking is done with forceps gently pinching the excess until the lashes just begin to turn outward. That point is the maximum, and we mark inside it. It has to be done sitting upright, because lying flat changes how the brow sits and how the skin falls. Anyone who marks an upper lid on a reclined patient is guessing. The lower mark follows your natural crease, which is why two eyelids are never marked to identical numbers.

When the problem is the brow, not the lid

A significant minority of patients who ask for eyelid surgery actually have a descended eyebrow, and removing lid skin in that situation pulls the brow down further and makes the face look heavier. The test is simple: lift the brow gently with a finger to its natural position and see how much hooding remains. If most of it disappears, the operation you need is a brow lift, or both together. We say this even when it means quoting a different procedure.

What the operation involves and costs

Upper eyelid surgery takes about forty-five minutes per side under local anaesthesia with light sedation, and you walk out the same day. Stitches come out at day five to seven, bruising fades over ten to fourteen days, and most patients are presentable for work in about a week. Eyelid surgery is €1,800 here, including the assessment, the procedure and follow-up. Fat is removed only where it genuinely bulges, because a hollow upper lid ages a face rather than rejuvenating it.

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