Overview
Eyelid surgery — or blepharoplasty — corrects drooping upper eyelids, puffy under-eye bags, and excess eyelid skin that can make you look older, more tired, or less alert than you feel. Because the eyes are the focal point of the face, even small improvements to the eyelid area can produce a dramatic overall rejuvenation — often more noticeable than procedures that address larger areas of the face.
At The Ferguson Clinic in Honolulu, Dr. John C. Ferguson, MD, FACS, performs upper and lower blepharoplasty with the precision of a surgeon whose primary training is in head and neck surgery — the specialty with the deepest understanding of periorbital anatomy. As a quintuple board-certified cosmetic and facial plastic surgeon, Dr. Ferguson combines this anatomical foundation with refined aesthetic judgment to produce eyelid surgery results that look natural, rested, and refreshed.
For patients in Honolulu and throughout Hawaii who are considering eyelid surgery — whether for cosmetic improvement, functional vision correction, or both — Dr. Ferguson offers the unique advantage of a surgeon trained at the intersection of facial anatomy, cosmetic surgery, and reconstructive technique.
Am I a Good Candidate?
You may be a good candidate for eyelid surgery if you have excess skin on the upper eyelids that creates a hooded or heavy appearance; upper eyelid skin that droops enough to impair your peripheral vision; puffy bags beneath the eyes caused by herniated orbital fat; lower eyelid skin laxity or wrinkling; or a tired or aged appearance around the eyes that does not reflect how you feel.
Good candidates are in overall good health and have realistic expectations. Patients with certain eye conditions, including dry eye syndrome, glaucoma, or thyroid eye disease, should discuss these conditions with Dr. Ferguson during their consultation, as they may affect surgical planning.
Upper blepharoplasty is one of the few cosmetic procedures that may qualify for insurance coverage when the excess skin demonstrably impairs vision. Dr. Ferguson’s office can assist with documentation and insurance submissions when functional impairment is present.
The Procedure — What to Expect
Dr. Ferguson performs blepharoplasty at his AAAHC-accredited facility in Honolulu, typically under local anesthesia with light sedation. The procedure takes approximately one to two hours, depending on whether upper eyelids, lower eyelids, or both are treated.
Upper Blepharoplasty
An incision is made within the natural crease of the upper eyelid. Through this incision, Dr. Ferguson removes precisely measured amounts of excess skin and, when appropriate, small amounts of protruding orbital fat. The incision is closed with fine sutures that are concealed within the eyelid crease, making them virtually undetectable once healed.
Lower Blepharoplasty
For lower eyelid surgery, Dr. Ferguson uses either a transconjunctival approach (incision inside the lower eyelid, leaving no visible scar) or a subciliary approach (incision just below the lash line) depending on the patient’s anatomy and the degree of correction needed. The transconjunctival approach is ideal for patients whose primary concern is fat herniation (under-eye bags) without significant excess skin. Fat may be removed, repositioned, or a combination of both to smooth the lower lid-cheek junction.
Combined Upper and Lower Blepharoplasty
Many patients benefit from addressing both upper and lower eyelids simultaneously for a comprehensive rejuvenation of the entire eye area. This can be performed in a single session and is frequently combined with other facial procedures such as facelift, brow lift, or laser skin resurfacing.
Recovery and Results
Blepharoplasty has one of the shortest recovery timelines of any facial surgery, which is part of its enduring appeal.
Days 1–3: Cold compresses and head elevation are used to minimize swelling and bruising. Eyes may feel tight and mildly sore. Lubricating eye drops are used to prevent dryness. Most patients describe the discomfort as minimal.
Days 4–7: Sutures are typically removed between days five and seven for upper blepharoplasty. Bruising and swelling decrease rapidly. Many patients feel comfortable going out in public with sunglasses by day four or five.
Weeks 2–3: Most visible bruising has resolved. Patients commonly return to work and normal activities within ten to fourteen days. The incision lines are pink but fading.
Weeks 4–6: Incision scars continue to mature and become increasingly difficult to see. Results are well-established, with the eyes appearing more open, rested, and youthful.
Months 3–6: Final results are fully apparent. Upper eyelid incisions are hidden within the natural crease and are essentially invisible. Lower eyelid scars (if a subciliary approach was used) blend seamlessly with the lash line.
Blepharoplasty results are long-lasting. Upper eyelid surgery typically maintains its results for seven to fifteen years or more, while lower eyelid fat repositioning provides essentially permanent improvement.
Frequently Asked Questions
Is eyelid surgery painful?
Most patients report minimal discomfort after blepharoplasty. The procedure is typically performed under local anesthesia with light sedation, and recovery discomfort is described as mild tightness or soreness, easily managed with over-the-counter pain relief and cold compresses. Dr. Ferguson ensures that his patients in Honolulu are comfortable throughout the process.
Will eyelid surgery change the shape of my eyes?
Blepharoplasty is designed to rejuvenate the eye area while preserving your natural eye shape. Dr. Ferguson’s surgical approach emphasizes conservative, precise tissue removal to produce a refreshed appearance — not an altered one.
Can eyelid surgery be covered by insurance?
Upper blepharoplasty may be covered by insurance when excess eyelid skin demonstrably impairs your field of vision. This requires documentation including visual field testing. Dr. Ferguson’s office in Honolulu can assist with the insurance documentation process and guide you through the approval steps.
Can blepharoplasty be combined with other procedures?
Yes. Eyelid surgery is frequently combined with facelift, brow lift, laser skin resurfacing, or injectable treatments for a comprehensive facial rejuvenation. Combining procedures reduces total recovery time and produces a more harmonious overall result.
How long do eyelid surgery results last?
Upper blepharoplasty results typically last seven to fifteen years. Lower eyelid surgery results — particularly fat repositioning — can be essentially permanent. While the natural aging process continues, most patients find that their eyes look significantly better for many years after surgery.
What is the difference between functional and cosmetic blepharoplasty?
Functional blepharoplasty corrects eyelid drooping that impairs vision, which may be covered by insurance. Cosmetic blepharoplasty improves appearance without a functional component. Dr. Ferguson can perform either or both, and will help determine whether your case has a functional component during your consultation at The Ferguson Clinic in Hawaii.
Why Choose Dr. Ferguson for Eyelid Surgery
The tissue around the eyes is among the most delicate in the body. Successful blepharoplasty requires sub-millimeter precision, an intimate understanding of periorbital anatomy, and the aesthetic judgment to know exactly how much tissue to remove — enough to produce a visible improvement, but not so much as to create a hollow or “surprised” look. Dr. Ferguson’s head and neck surgery training gives him the anatomical foundation that makes this precision natural rather than learned. His additional certifications in facial plastics and cosmetic surgery add the refined aesthetic sense that ensures results look refreshed and natural. Combined with the safety of his AAAHC-accredited facility in Honolulu, this makes Dr. Ferguson one of the most qualified blepharoplasty surgeons available in Hawaii.
Schedule a consultation with Dr. Ferguson at The Ferguson Clinic in Honolulu. Call (808) 521-1999 or book online.