Upper Eyelid Surgery for Hooded Eyelids in Toronto: What to Expect Under Local Anesthetic

If your eyeshadow disappears into a fold of skin by midday, or people keep asking whether you're tired, you're not imagining it. Hooded upper eyelids are one of the most common reasons patients come to see Dr. Power about eyelid surgery.

The good news is that an upper eyelid lift (upper blepharoplasty) is one of the more straightforward cosmetic procedures. At Power Plastic Surgery it is most commonly done while you're awake under local anesthetic, it takes about an hour, and the scar sits in your natural eyelid crease. Here's what causes hooding, how the surgery works, and what recovery really looks like.

"The best eyelid results are the ones where no one can tell anything was done. You just look natural and refreshed."

– Dr. Stephanie Power

"At the first follow-up, even a week after surgery, my patients often tell me their eyelids feel lighter and they feel more refreshed."

– Dr. Stephanie Power

What Causes Hooded Upper Eyelids?

The skin of the eyelids is some of the thinnest on the body, so it's often one of the first places to show change. As skin loses elasticity, extra skin can fold over the upper lid crease, and fat pads, especially toward the inner corner of the eye, can become more prominent.

Some people see this in their 50s and 60s. Others notice heavy lids much earlier, because excess upper eyelid skin can run in families. Either way, common signs include:

• A fold of skin that sits on or over your lashes or crease
• Eyeshadow or eyeliner that smudges or disappears into the fold
• Puffiness toward the inner corner of the upper lid
• Looking tired, sad or older than you feel, even after a good night's sleep
• In more advanced cases, skin that feels heavy or sits in your upper field of vision

Is It Your Eyelids, Your Brows, or Both?

Not every heavy upper lid is caused by eyelid skin. Two other things can look very similar, and Dr. Power checks for both at your consultation:

• A low brow. When the eyebrows sit lower than they used to, they push skin down onto the upper lid. Removing eyelid skin alone won't fix this, and a brow lift may be the better choice. For some patients, a Botox brow lift can help.
• A droopy eyelid margin (ptosis). Here the lid itself sits too low because of the muscle that lifts it. The most common cause of a droopy lid after eyelid surgery is ptosis that wasn't recognized beforehand, so Dr. Power carefully assesses your eyelid position and muscle function, and will let you know if ptosis may be contributing. Dr. Power does not perform ptosis repair herself. If it's needed, she will refer you to an ophthalmologist, and ptosis repair may be covered by OHIP.

If you've had Botox in your forehead or between your brows recently, let us know, since it can change your brow position and how your upper lids look at the consultation.

Who Is a Good Candidate?

You may be a good candidate for upper eyelid surgery if you:

• Are bothered by extra upper eyelid skin or inner-corner puffiness
• Are in good general health, or your medical conditions are well controlled
• Don't smoke, or are willing to stop before and after surgery
• Have realistic goals: a fresher, more rested look, not a different face

Some eye conditions, particularly thyroid eye disease, can increase the risk of complications, so Dr. Power will ask about your eye health and If you have dry eye or another eye condition, she will ask you to see an optometrist or ophthalmologist before surgery.

How Upper Eyelid Surgery Is Done

Dr. Power marks a small incision along your natural upper eyelid crease while you're sitting up, so the scar will sit exactly where the fold falls. Through that incision she removes the extra skin and, where needed, a small amount of prominent fat, most often toward the inner corner. Fine stitches close the incision.

The goal is conservative: remove enough to open up and refresh the eye, without making it look hollow, surprised or "done".

Upper eyelid surgery can be combined with other procedures. Lower eyelid surgery for under-eye bags is a more extensive operation and is generally done under general anesthetic, as is a combined upper and lower eyelid lift. Fat grafting may also be added for some patients to restore volume around the eyes and midface.

Why Under Local Anesthetic?

Upper eyelid surgery is most commonly done under local anesthetic at Power Plastic Surgery. You're awake, the area is numbed, and you go home the same day. For many patients that means:

• No general anesthetic, and no anesthesia-related grogginess afterward
• A shorter visit: the surgery itself takes about an hour, and most patients are at the clinic for about two hours in total
• A lower cost than the same surgery under general anesthetic

Dr. Power freezes the upper eyelids with a local anesthetic injection. Once the area is frozen, most patients feel pressure and movement rather than pain. If you'd prefer to be asleep, or you're combining procedures, Dr. Power will talk with you about general anesthesia.

You'll need someone to drive you home. After upper eyelid surgery under local anesthetic alone, you don't necessarily need someone to stay with you overnight. If your surgery is done under general anesthetic, a responsible adult must stay with you for the first 24 hours.

Recovery After Upper Eyelid Surgery

You'll receive detailed written eye lift post-op instructions. A typical recovery looks like this:

• Day of surgery: You go home the same day. Rest with your head elevated.
• First 48 hours: Apply cold compresses frequently while awake, 15 minutes on and 15 minutes off, to reduce bruising and swelling. From the day after surgery you can shower and gently wash the incisions with soap and water, then apply the prescribed antibiotic ointment.
• First 3 to 4 weeks: Sleep on your back with your head raised on 2 to 3 pillows.
• 6 to 7 days: Follow-up visit and stitch removal.
• About 1 week: Most patients return to office-based work, though some take 10 to 14 days depending on their job and how comfortable they feel being seen with some bruising.
• 2 days after stitches come out: Makeup can usually be worn over the incisions.
• 1 to 2 weeks: Bruising fades. Avoid rubbing your eyes for at least 2 weeks.
• 4 weeks: Avoid strenuous activity, exercise, bending over and lifting more than 5 pounds until then.
• Up to 1 year: The scar matures and is generally subtle, hidden in the natural crease.

Discomfort is usually mild, and many patients manage with plain Tylenol after the first few days. Avoid driving while taking prescription pain medication. Call Dr. Power right away if you notice increasing pain, firm or excessive swelling, redness around the incisions, or any change in your vision.

Contact lenses: wear your glasses for the first month. Most patients can return to contact lenses about one month after surgery.

Planning around Toronto life: many patients book their upper eyelid surgery before a holiday break or a stretch of working from home, so the bruising stage passes quietly. Sunglasses help with both the bright winter glare and the curious looks on the TTC.

Risks to Discuss

Every surgery has risks, and Dr. Power will review them with you in detail. For upper eyelid surgery they include bleeding, infection, bruising and swelling, dry or irritated eyes, asymmetry, visible or thickened scarring, difficulty fully closing the eyes for a period after surgery, removing too little or too much skin, and the possibility that further surgery is needed. Rarely, bleeding behind the eye can threaten vision, which is why any sudden pain or change in vision needs to be reported immediately.

A thorough consent process is part of every surgery at Power Plastic Surgery, so you can make a fully informed decision.

Upper Eyelid Surgery Cost in Toronto

Cosmetic eyelid surgery is an elective procedure. Our starting fees, as listed on our eyelid surgery page:

• Upper eyelid surgery (most commonly under local anesthetic): from $5,720
• Lower eyelid surgery (generally under general anesthetic): from $8,480
• Upper and lower eyelid surgery together: from $10,380

Prices are starting fees, and HST is added on your quote. Your personalized written quote itemizes the fees that apply to your surgery and is valid for six months. A non-refundable 25% deposit secures your surgery date, and the balance is due three weeks before surgery. See our eyelid surgery cost guide and pricing page for more.

We partner with Beautifi to offer monthly payment plans for procedures of $1,000 and above. Learn more on our fees and financing page.

Why Patients Choose Dr. Power

Dr. Stephanie Power is a female plastic surgeon certified by the Royal College of Physicians and Surgeons of Canada (FRCSC), with fellowship training in Aesthetic Surgery and in Trauma and Reconstructive Surgery at the University of Toronto. She practises in Yorkville, and her approach to the face is understated: a natural, rested look rather than an obvious change.

At your consultation, Dr. Power will look at your eyelids, brows and overall face together, explain whether upper eyelid surgery, a brow procedure, both, or neither is right for you, and show you before and after photos of her own patients. Patients travelling from outside Toronto can ask about our fly-in program.

Upper Eyelid Surgery FAQs

Can hooded eyelids be fixed without surgery?

Not fully. Botox can sometimes lift the brow slightly, which may make mild hooding look a little better, but it doesn't remove extra eyelid skin. Upper eyelid surgery is the procedure that removes excess skin from the upper lid.

Am I awake during upper eyelid surgery?

Usually, yes. Upper eyelid surgery is most commonly done under local anesthetic, and the surgery takes about an hour. General anesthesia is used for lower eyelid surgery, combined upper and lower surgery, or when it's the better choice for you.

Will I have a visible scar?

The incision is placed in your natural upper eyelid crease. The scar is pink at first, then generally fades over about a year to a fine line hidden in the fold when your eyes are open.

How long until I can go back to work?

Most patients return to office-based work in about a week. Some prefer 10 to 14 days while bruising fades.

How long do results last?

The skin removed doesn't come back, and results are long-lasting. Your face will continue to age naturally, including your brows, so some patients consider further treatment many years later.

Is upper eyelid surgery covered by OHIP?

Cosmetic eyelid surgery is not covered by OHIP. In extreme cases, where a visual field test shows the upper eyelids block vision, eyelid surgery may be covered. Dr. Power does not perform surgery under OHIP, and all eyelid surgery at Power Plastic Surgery is performed privately. If you believe your eyelids are affecting your vision, speak with your family physician or optometrist about an assessment.

Can I combine upper eyelid surgery with another procedure?

Yes. It's commonly combined with lower eyelid surgery, and sometimes with fat grafting or other facial procedures. Combining changes the anesthetic and the cost, which Dr. Power will review with you.

Request a Consultation

If heavy, hooded upper eyelids are making you look more tired than you feel, a short procedure may make a real difference. Contact Power Plastic Surgery or call (416) 962-1010 to book a consultation with Dr. Stephanie Power in Toronto, and learn more on our eyelid surgery page.

This article is for general information only and is not a substitute for medical advice. Individual results vary. Please book a consultation for an assessment of your specific concerns.