What Is Needed Before Eyelid Surgery: A Comprehensive Patient Guide
- Chris Thiagarajah MD
- 15 hours ago
- 4 min read
Eyelid surgery, or blepharoplasty, is one of the most commonly performed facial procedures worldwide. Whether done for cosmetic reasons (to enhance appearance) or functional purposes (to improve vision), the success of the surgery often depends on thorough preoperative preparation.
This article provides a comprehensive overview of everything that is typically needed before undergoing eyelid surgery, from medical evaluations and measurements to emotional readiness and logistical planning.
Table of Contents
What is Eyelid Surgery?
Types of Eyelid Surgery
Cosmetic vs Functional Blepharoplasty
Medical Evaluations Before Surgery
Required Diagnostic Tests (MRD, Visual Field, Photographs)
Insurance Requirements (for Functional Surgery)
Surgeon Consultation and Customization
Medication Review and Discontinuation
Lifestyle Preparation and Planning
Mental and Emotional Readiness
Home Preparation and Recovery Setup
Final Preoperative Checklist
Conclusion
1. What Is Eyelid Surgery?
Eyelid surgery, or blepharoplasty, is a procedure that removes or repositions excess skin, fat, or muscle from the eyelids. The goal may be to restore vision blocked by sagging eyelids, reduce puffiness, or create a more youthful and rested appearance.
2. Types of Eyelid Surgery
There are several variations of eyelid surgery, including:
Upper blepharoplasty – removes drooping skin on the upper eyelids.
Lower blepharoplasty – addresses under-eye bags or hollowing.
Ptosis repair – tightens muscles that lift the upper eyelid.
Canthoplasty/canthopexy – reshapes the outer corners of the eyes.
3. Cosmetic vs Functional Blepharoplasty
Cosmetic Blepharoplasty:
Done for aesthetic reasons (e.g., rejuvenation, symmetry).
Typically not covered by insurance.
Out-of-pocket expense.
Functional Blepharoplasty:
Done to improve field of vision or address chronic discomfort.
May be covered by insurance if specific criteria are met.
Understanding the purpose of your surgery determines the preoperative steps needed, especially regarding insurance and diagnostic tests.
4. Medical Evaluations Before Surgery
Prior to scheduling surgery, your surgeon will complete a detailed medical and ophthalmologic evaluation, including:
Medical history (e.g., diabetes, hypertension, thyroid disease)
Ocular history (dry eye, LASIK, glaucoma, visual changes)
Allergies and previous surgeries
Bleeding disorders or use of anticoagulants
Smoking or alcohol use
Patients with underlying autoimmune, thyroid, or clotting disorders may need additional clearance or modifications in surgical planning.
5. Required Diagnostic Tests
For both cosmetic and functional eyelid surgery, specific eyelid and vision assessments are crucial:
1. MRD1 Measurement (Margin Reflex Distance 1)
Measures the distance from the center of the pupil to the upper eyelid margin.
MRD ≤ 2.0 mm is often required for insurance-covered functional blepharoplasty.
2. Levator Function Test
Measures the strength of the muscle responsible for lifting the eyelid.
Determines whether blepharoplasty or ptosis repair is more appropriate.
3. Visual Field Testing (Taped vs. Untaped)
Documents how much of your upper visual field is blocked by drooping lids.
Improvement with taping supports the functional need for surgery.
4. Clinical Photography
High-resolution frontal and side-view photographs document eyelid position.
Required for insurance preauthorization and surgical planning.
6. Insurance Requirements (for Functional Surgery)
If you’re pursuing surgery for functional reasons, insurance companies (including Medicare, Cigna, Aetna, and others) require:
MRD1 ≤ 2.0 mm
Documentation of symptoms interfering with ADLs (reading, driving, etc.)
Visual field testing showing 30% or more improvement with taping
Photographs clearly showing eyelid obstruction
Important: If your MRD is greater than 2.0 mm, insurance will almost always deny coverage regardless of your symptoms or test results.
7. Surgeon Consultation and Customization
Every eyelid surgery is customized based on individual anatomy and goals. Your consultation will involve:
Review of clinical findings and test results
Decision on upper vs. lower eyelids, ptosis repair, or adjunct procedures (e.g., brow lift)
Explanation of risks, benefits, and recovery expectations
Custom surgical plan tailored to facial features and goals
If you are in Denver, Colorado, seeking a highly specialized evaluation, surgeons like Dr. Chris Thiagarajah, a board-certified oculoplastic surgeon, offer tailored assessments for both functional and cosmetic needs.
8. Medication Review and Discontinuation
Certain medications and supplements increase bleeding risk and should be discontinued 7–10 days prior to surgery. These include:
Anticoagulants:
Aspirin
Plavix (clopidogrel)
Coumadin (warfarin)
Eliquis, Xarelto (after approval by prescribing physician)
Supplements:
Vitamin E
Fish oil (omega-3s)
Ginkgo biloba
Garlic or ginger extracts
Always follow your surgeon’s protocol and consult with your primary care physician or cardiologist before stopping any medication.
9. Lifestyle Preparation and Planning
Smoking:
Smoking impairs healing and increases risk of complications.
Stop smoking at least 3–4 weeks before surgery.
Alcohol:
Should be avoided for 48–72 hours prior to surgery.
Sleep and Hydration:
Begin optimizing your rest and hydration at least one week before.
Avoid excessive salt to reduce baseline eyelid swelling.
10. Mental and Emotional Readiness
Undergoing facial surgery—especially around the eyes—can be emotionally charged. Patients should be mentally prepared for:
Swelling and bruising during recovery
Temporary asymmetry
A few weeks of visual and social downtime
Discuss any concerns openly with your surgeon. Patients with unrealistic expectations or untreated body dysmorphic tendencies may be advised to delay surgery.
11. Home Preparation and Recovery Setup
Prepare your home and responsibilities before surgery to ensure a smooth recovery.
Set Up:
Ice packs or gel masks
Prescribed medications
Elevating pillows (for sleeping upright)
Easy-prep meals and groceries
Arrange for someone to drive you home after surgery
Time Off:
Plan for 7–10 days off work or social events
Avoid exercise and heavy lifting for 2–3 weeks
12. Final Preoperative Checklist
Here’s a summary of what you’ll need before your blepharoplasty:
✅ Consultation with a qualified oculoplastic or facial plastic surgeon✅ MRD1 measurement and eyelid evaluation✅ Visual field testing (for insurance cases)✅ Clinical photos✅ Pre-op labs or medical clearance (if over 60 or with health conditions)✅ Medication review and discontinuation✅ Written surgical consent and post-op instructions✅ Transportation and recovery planning
13. Conclusion
Eyelid surgery is one of the most effective ways to improve vision and restore youthful contours to the face—but careful preoperative preparation is essential. Whether you're pursuing it for medical or aesthetic reasons, knowing what’s required in advance will increase your chances of a smooth, successful outcome.
Patients considering blepharoplasty should work closely with a board-certified surgeon—preferably an oculoplastic specialist—to ensure the procedure is safe, effective, and fully tailored to their needs.
Thinking of Eyelid Surgery in Denver?
If you’re in Denver, Colorado, consider scheduling a consultation with Dr. Chris Thiagarajah, MD—a fellowship-trained oculoplastic surgeon known for both cosmetic and functional eyelid surgery. His team provides comprehensive preoperative assessments, insurance support, and customized treatment plans that align with each patient’s goals and anatomy.