SALM TEAM 
When gymnastics icon Simone Biles casually revealed on TikTok, and later confirmed in interviews, that she’d had eyelid surgery to fix what she jokingly calls the “Biles eye bags”, which sparked widespread conversations online. Overnight, a procedure most people couldn’t pronounce, blepharoplasty, was being Googled and discussed around the world.
The renewed attention comes at a time when the procedure is booming worldwide. According to the latest International Society of Aesthetic Plastic Surgery (ISAPS) Global Survey, eyelid surgery is currently the most-performed cosmetic surgery worldwide, with more than 2.1 million procedures in 2024 – a 13.4% increase in a single year. And South Africa is very much part of that story.
Locally, ISAPS data show that the number of eyelid procedures rose from 5,864 in 2023 to 6,945 in 2024, an 18.4% surge, making it South Africa’s most common cosmetic surgical procedure by volume.
“In the past, many patients were somewhat hesitant to raise the subject of eyelid surgery,” says Professor Chrysis Sofianos, a leading plastic and reconstructive surgeon based in Johannesburg.
“Now, they openly present very clear goals. They’re tired of looking fatigued in photographs or video calls, or, like Simone Biles, they want to address hereditary lower-lid bags. The conversation has become far more informed and transparent – and that’s a very positive shift.”
More than a ‘tired eyes’ tweak
For many people, drooping lids or puffy under-eyes feel like a purely cosmetic complaint. In reality, the upper eyelids in particular can have a very real impact on how we see and function day to day, he explains.
“Ageing, genetics and sun exposure can cause the upper eyelid skin to stretch and fold over. Patients repeatedly describe forehead tension, difficulty keeping their eyes open while reading or driving at night, and a constant sense of strain. Some think it’s just what getting older feels like, but often it’s a mechanical problem that can be corrected.”
Excess upper eyelid skin can narrow the upper field of vision, forcing people to raise their brows subconsciously just to see clearly. Over time, that can contribute to headaches, neck tension, and eye fatigue – especially in a world where many South Africans are glued to screens for work, socialising, and entertainment.
A carefully planned blepharoplasty removes or reshapes that excess skin and fat, lifting the lid out of the line of sight. “The most common thing patients tell me afterwards is not, ‘I look younger,’ but ‘I can see the traffic lights properly again’ or ‘I don’t feel like I’m fighting for my eyes to stay open,’” he says.
A small operation with meaningful results
So, what actually happens in eyelid surgery?
Blepharoplasty is typically done as a day procedure under sedation or general anaesthetic. For upper lids, the incision is placed in the natural crease so that, once healed, it’s barely visible. For lower lids, the approach may be just under the lashes or hidden inside the eyelid, depending on whether skin needs to be tightened or mainly fat repositioned.
“Every eyelid is different. We look at skin quality, muscle tone, fat pads, and how much the lid is encroaching on the visual field. The goal is always a refreshed, natural outcome. It should help you see more clearly, feel more comfortable, and recognise yourself in the mirror – just with a little more ease,” notes Professor Sofianos.
Most patients can work from home within a few days and feel “socially presentable” after about 10 to 14 days, once bruising and swelling have settled. The full result continues to refine over a few months.
All plastic surgery procedures require follow-up to maintain their lasting effects, however, Blepharoplasty is longer-lasting than many other procedures. “If you do it at the right time, in the right hands, it’s usually a long-term solution.”
With eyelid surgery now leading global and South African procedure statistics, it’s clear that for many, it’s proving to be a small intervention with an unexpectedly meaningful impact on how they move through the world.
