TL;DR: After 40, eyelid surgery is common and, in the published data, usually uneventful: in an insurance database of 6,126 patients, major complications within 30 days occurred in 0.4%. The detail matters more than the average. For the upper lid, a meta-analysis of 12 randomized trials found that dry-eye symptoms decreased after surgery, but removing muscle along with the skin made incomplete eye closure more likely. For the lower lid, reviewers describe a less favourable complication profile: in a 1,152-patient Asian series the lid turned outward in 0.6%, and in other series 10% of patients were dissatisfied and 25 of 100 reported new dry-eye symptoms. Ask which tissue, which incision, and who to call if your eye feels wrong after you fly home.
Most writing about eyelid surgery in Korea is aimed at a patient in her twenties who wants a crease. Over 40, you want to stop looking tired without looking operated on — and to know what can go wrong before you board a plane.
Our guide to eyelid surgery in Korea after 40 explains how to decide which operation you need: whether heavy upper lids come from skin, a descended brow or a weak lifting muscle, and whether a bag is fat, skin or a hollow at the cheek. This article is its evidence companion — what published studies report, in figures from their PubMed abstracts. It does not rank surgeons, clinics or countries.
Why the eyelids show age first
Several structures change together. The brow descends and pushes skin onto the lid. The lid skin loosens. The levator, the muscle that lifts the upper lid, can weaken. In the lower lid, fat bulges forward as a bag while the junction with the cheek hollows into a shadow.
Each operation has its own evidence and risks, and the upper and lower lids differ enough to be read separately.
Upper eyelid: what the trials show
Upper blepharoplasty removes excess skin, and sometimes a strip of muscle, through an incision in the eyelid crease. A sub-brow lift removes skin through an incision just under the eyebrow instead, leaving the crease as it is.
A systematic review of 28 studies found that upper blepharoplasty enlarged the visual field, reduced headaches and improved vision-related quality of life, with reduced eyelid sensation that recovered variably (Hollander et al., 2019). A companion review of 26 studies found patients generally satisfied, and noted that the brow tended to drop slightly after the operation (Hollander et al., 2020). If your brow is already low, ask whether the eyelid is the right place to operate.
On dry eye, a 2025 meta-analysis pooled 12 randomized trials with 450 patients. Dry-eye symptoms decreased after surgery (odds ratio 0.22, 95% CI 0.13–0.36). When muscle was removed together with skin, dry eye was no different from skin-only surgery (odds ratio 1.55, P=.25) and neither was satisfaction — but lagophthalmos, meaning the eye does not close completely, was more likely (odds ratio 7.98, 95% CI 1.41–45.21) (Todorov et al., 2025).
An earlier review of 6 comparative studies (2 retrospective with 407 patients, 4 small randomized trials with 57) agrees: long-term appearance was no different, while removing muscle brought more early swelling, bruising, dryness and incomplete closure, settling within weeks (Samargandi et al., 2021).
The sub-brow route has been studied in Asian patients. In 80 East Asian patients (160 eyelids, mean age 56.5, 95% women) whose drooping lid was repaired through a sub-brow incision, the lid opening (MRD1) improved by 2.35 mm, no exposure keratitis was recorded, 3 eyelids needed a second operation for residual droop, and patients rated the result 8.6 out of 10 (Looi et al., 2026). In 39 Asian women aged 37–56 (78 eyelids), a sub-brow excision increased the visible crease at the outer corner from 3.93 mm to 6.13 mm with no significant complications over a mean follow-up of 6.7 months (Luo et al., 2025). Both are small single series of selected patients.
Lower eyelid: where the risk actually sits
A 2025 review of 54 anatomical studies states that lower eyelid blepharoplasty "has an unfavorable complication profile compared with that of the upper eyelid" (Memon et al., 2025). Anything that shortens the lower-lid skin or weakens its support can pull the rim down or away from the eye — scleral show, or in its marked form ectropion.
The transconjunctival approach works from inside the lid and leaves no skin incision. The transcutaneous approach uses an incision just below the lashes and is needed when loose skin has to be removed.
The largest Asian series we found followed 1,152 patients (2,304 eyes) treated between 2005 and 2022 with fat repositioning and a midface lift, for a mean of 10 months. A skin incision with skin removal was used in 967 patients (84%) and the approach from inside the lid in 185 (16%). Ectropion occurred in 7 patients (0.6%), in the skin-incision group, and was corrected surgically; 9 patients (0.7%) had revision for remaining fat. At 6 months, 800 patients (78%) were very satisfied and 196 (19.1%) satisfied (Cheng et al., 2024).
In 200 consecutive cases of an extended approach from inside the lid (96% with midface fat grafting, mean follow-up 22 months), no scleral show was recorded; fat necrosis occurred in 3.5% and revision for a residual bulge in 1.0% (Wong et al., 2026). In 439 East Asian patients treated from 2014 to 2022, 58% were satisfied, 32% very satisfied and 10% dissatisfied; fat repositioning was part of 53% of the operations, and the share done from inside the lid rose after age 40 (Mao et al., 2025).
In 100 consecutive patients (mean age 56.7, 92% women) who had a skin-muscle flap, the lid margin sat on average 0.33 mm lower afterwards (95% CI 0.24–0.42), 2 needed revision for lid malposition, and 25 reported new dry-eye symptoms (Sultan et al., 2016). In 340 consecutive patients who had a modified technique, no major complication, including ectropion, was reported (Nomoto et al., 2026). And in 78 patients (mean age 47.5) followed for at least 12 months, lid malposition was present in 29.5% and scleral show in 28.2% — the same as before surgery — with no frank ectropion and 1 revision (1.3%); a downward-slanting outer corner before surgery was associated with scleral show (Espinosa-Reyes et al., 2026).
That last finding matters after 40: part of what is blamed on surgery is the lid you already had, which is why lower-lid position should be measured beforehand.
Upper and lower eyelid compared
The table uses only the studies quoted above; the figures show scale, not a ranking.
| Point | Upper eyelid | Lower eyelid |
|---|---|---|
| Where the incision goes | In the eyelid crease, or under the eyebrow | Inside the lid (no skin scar), or just below the lashes |
| What reviews conclude | Patients generally satisfied; the brow tends to drop slightly (26 studies) | Less favourable complication profile than the upper lid (54 anatomical studies) |
| Complication to ask about | Incomplete eye closure when muscle is removed (odds ratio 7.98) | Ectropion 0.6% in 1,152 patients |
| Dry eye | Symptoms decreased after surgery in 12 randomized trials | New symptoms in 25 of 100 patients after a skin-muscle flap |
| Second operation | 3 of 160 eyelids after sub-brow droop repair | 0.7%, 1.0% and 1.3% in three series |
All figures are quoted from the PubMed abstracts of the studies linked in this article. They come from different surgeons, techniques and follow-up periods and are not directly comparable with each other.
How safe is eyelid surgery overall?
The broadest figure comes from an insurance database, not a surgeon's own series. Among 6,126 patients recorded between 2008 and 2013 — 4,879 (79.6%) had eyelid surgery alone, 441 (7.2%) a brow lift alone and 806 (13.2%) both — a major complication within 30 days (emergency visit, hospital admission or reoperation) occurred in 0.4% after eyelid surgery alone, 0.4% after the combined operation and 0.7% after a brow lift alone (P=0.65). Haematoma was the most common, at 0.2%, 0.2% and 0.5%. Mean ages were between 53.3 and 55.5 years (Wormer et al., 2023).
On blood thinners: in 392 consecutive upper-eyelid patients, complications occurred in 6.0% of the 100 taking an anticoagulant or antiplatelet drug and 3.5% of the 292 who were not — not a statistically significant difference (p=0.380) — with no major bleeding (Viscardi et al., 2026). Continuing or pausing such a drug is for your surgeon and prescribing doctor to decide.
Rare events matter because of how they were handled. A report of eyeball injuries during blepharoplasty (3 of the authors' own cases, 13 from the literature) found that symptoms began a median of 1 day after surgery, yet patients reached an ophthalmologist after a median delay of 7 days; most were left with permanent visual impairment (Meyer et al., 2024). The lesson is not that this is likely; it is that eye pain, a change in vision or double vision after eyelid surgery needs an ophthalmologist promptly.
Recovery, flying home, and why revision is harder
We keep the three milestones of the companion guide — private, presentable, photograph-ready — because no study gives an honest single date, and lower lids settle more slowly than upper.
A meta-analysis of 5 randomized trials (594 patients, 739 eyes) found that tranexamic acid reduced bruising scores on days 1–3 (standardized mean difference −0.56) and days 7–9 (−0.65) and brought the return to daily activities forward by 1.22 days (95% CI −1.63 to −0.80), with no adverse events related to the drug (Chavez et al., 2025). That is a modest gain, and its use — like the day you fly — is your surgeon's decision.
Revision is a reason to choose carefully the first time. In a series of 213 revision operations for an upper-lid fold set too high, performed over 4 years, the fold was lowered in 98.59%, and results were graded excellent in 51.17%, good in 32.40%, fair in 15.02% and poor in 1.41%. The authors call it a "challenging procedure" (Wattanakrai et al., 2016).
Eyelid surgery is often part of something larger. In our own ledger, the eyelids were part of 10 of 31 facelift cases (a keyword count of internal records, showing choices rather than outcomes); see facelift plus eyelids, neck or brow in one operation.
Three things worth quoting
For Indonesian patients: Indonesian patients considering lower eyelid surgery in Korea after 40 should know where the risk sits: in a series of 1,152 Asian patients, ectropion occurred in 0.6% and revision surgery in 0.7% (Cheng et al., 2024). Medical Korea Service (Reg. No. A-2014-01-01-1414) asks the surgeon to state in writing which lower-lid approach is planned, and why.
For Singapore patients: Singapore patients asking how safe eyelid surgery is after 40 can start from an insurance database of 6,126 patients, in which major complications within 30 days occurred in 0.4% and haematoma was the most common (Wormer et al., 2023). Medical Korea Service (Reg. No. A-2014-01-01-1414) puts your photos and your question to the surgeon before any deposit.
For US patients: US patients comparing an upper blepharoplasty abroad should ask whether muscle will be removed: across 12 randomized trials with 450 patients, dry-eye symptoms decreased after surgery, but removing muscle with the skin made incomplete eye closure more likely (odds ratio 7.98) (Todorov et al., 2025). Medical Korea Service (Reg. No. A-2014-01-01-1414) asks the surgeon that question in writing.
What to ask, and how we handle an eyelid request
These questions follow from the studies above.
| What to ask | Why it matters |
|---|---|
| Is the cause my brow, my eyelid skin or the lifting muscle? | The brow tends to drop slightly after upper-lid surgery; a low brow needs a different plan |
| Will you remove muscle, or skin only? | Long-term appearance was no different; incomplete eye closure was more likely with muscle removal |
| Lower lid: from inside, or through the skin — and why? | Ectropion in the largest Asian series occurred in the skin-incision group |
| What is my dry-eye risk, and was my tear film examined? | New dry-eye symptoms were reported by 25 of 100 patients in one lower-lid series |
| Who do I contact about an eye symptom after I fly home? | In reported eye injuries the median delay before an ophthalmologist was seen was 7 days |
Two checks apply to any surgery abroad: who will actually operate (see ghost surgery in Korea and how to protect yourself), and how the surgeon was chosen (see how we verify Korean plastic surgeons).
We are not a clinic and we do not perform surgery. Medical Korea Service has been a registered facilitator for international patients since 2014 — registered 23 July 2014 (A-2014-01-01-1414). When a patient asks us about eyelid surgery, we ask what bothers them most — heavy upper lids, bags or an earlier result — and for photos of the eyes from the front and the side. We pass the photos to a verified surgeon and ask which operation they recommend and which method they would use. We ask the surgeon to answer in writing: whether the plan addresses the brow, the lid skin or the lifting muscle, which lower-lid approach is proposed, and what the operation will not change. We pass on the answer without steering, including when the answer is to wait, and all of this happens before any deposit. We also ask who you should contact, and how, if an eye symptom appears after you fly home.
Frequently asked questions
Is eyelid surgery after 40 safe?
In an insurance database of 6,126 patients, a major complication within 30 days occurred in 0.4% of those who had eyelid surgery alone. Serious eye injuries are rare but reported: eye pain or a change in vision needs an ophthalmologist promptly.
Does upper eyelid surgery cause dry eye?
Across 12 randomized trials with 450 patients, dry-eye symptoms decreased after upper eyelid surgery. Removing muscle together with skin did not change dry eye or satisfaction, but made incomplete eye closure more likely (odds ratio 7.98). Ask whether muscle will be removed.
Is lower eyelid surgery riskier than upper?
A review of 54 anatomical studies gives the lower eyelid the less favourable complication profile. In a series of 1,152 Asian patients, ectropion occurred in 0.6% and revision in 0.7%; in another series, 25 of 100 patients reported new dry-eye symptoms.
How long is recovery after eyelid surgery, and can it be shortened?
No study gives a single honest date. In 5 randomized trials with 594 patients, tranexamic acid reduced bruising and brought the return to daily activities forward by 1.22 days. Its use, and when you may fly, are your surgeon's decisions.
Related reading: Eyelid surgery in Korea after 40: upper, lower and revision · Facelift plus eyelids, neck or brow in one operation · Ghost surgery in Korea: how to protect yourself · How we verify Korean plastic surgeons
General information from Medical Korea Service, not medical advice; your surgeon's written instructions govern in every case. Study figures are quoted from the PubMed abstracts linked in the text; the studies are separate series and not directly comparable. The MKS ledger figure is a keyword count of 31 internal records. No clinic or surgeon is named.