Upper and lower eyelid surgery

Dr Richard Parker

Dr Richard Parker

Understanding blepharoplasty

Blepharoplasty is a surgical procedure that involves reshaping the eyelids. Blepharoplasty typically involves reduction of excess skin folds, repositioning of skin creases, and reduction or repositioning of fat around the eyelids.

People often have upper and lower eyelid surgery to eliminate a tired appearance or remove bags under their eyes.

As well as making you look older than you feel, droopy eyelids can make it difficult to apply eyeshadow to your upper eyelids. In severe cases, your eyesight may be impeded.

Lower eyelid complaints often include the appearance of eye bags and excessive wrinkles.

Blepharoplasty can be performed for medical reasons in cases of impaired vision, changes due to certain eye diseases, or scarring. It can also be performed for cosmetic reasons.

Various medical professionals, including GPs, cosmetic doctors and plastic surgeons offer blepharoplasty surgery. However, to ensure the best outcome, a comprehensive understanding of the unique anatomy of the eyelid and your specific eye condition is critical during the surgical assessment and planning. For this reason, a specialist ophthalmologist with oculoplastic surgery expertise, like Dr Parker, is well placed to ensure an optimal outcome.

What happens at the initial consultation for blepharoplasty

Before planning the surgery, Dr Parker will discuss with you in detail what problems you are having with your eyelids and what changes you would like to be made. He will examine your eyes and eyelids fully, including testing your vision, corneal health, and how well your eyelids close. He will discuss your general medical history, including a list of your current medications, as this can affect the outcome of surgery. He may perform a visual field test to determine your eligibility for private health fund or Medicare rebates. He will also take photographs of your eyelids.

If you’re seeking surgery for cosmetic reasons, you’ll need to have a second consultation (in line with new Medical Board of Australia cosmetic surgery guidelines).

Dr Parker may advise you to hold off taking certain medications if they could affect bleeding. Often this is in consultation with your prescribing specialist or GP.

How is blepharoplasty performed?

Dr Parker usually performs upper and lower eyelid surgery in the operating theatre. In certain cases the procedure can be done in-office as a day procedure. Lower eyelid blepharoplasty is not performed in-office.

After marking the area to be treated, Dr Parker will instil anaesthetic drops into your eyes. Local anaesthetic will then be injected into the eyelids. Once the anaesthetic takes effect, the area around your eyes will feel numb.

The surgery involves removing skin and, in some cases, underlying muscle and fat. The fat can be repositioned to achieve a fuller and more youthful appearance.

Upper eyelid blepharoplasty

For upper eyelid surgery, Dr Parker makes a curved incision through your natural upper eyelid crease with some extension into the ‘smile lines’ on the outer corner of the eyelid. A crescent-shaped piece of skin is removed. He may also remove a small strip of underlying muscle and fat. The natural skin crease is then reformed, and the skin is closed with sutures.

Upper eyelid blepharoplasty

Lower eyelid surgery can be performed in one of two ways: Dr Parker may remove the bags via the inside of your eyelid, avoiding a scar. But if you have prominent bags or skin folds under your eyes, he will make an incision on the front of your lower eyelid. The fat which is causing the bulges can then be reduced or repositioned to create a smoother appearance.

What happens after the surgery?

You will need transport to and from the operating theatre or clinic. You will not be able to drive yourself home.

Postoperative recovery from blepharoplasty involves:

  • Keeping the area clean and dry
  • Applying ice for the first 3 days
  • Using an antibiotic ointment
  • Using lubricating eye drops.
  • Not using eye makeup for two weeks
You should also avoid swimming and active exercise for up to four weeks.
The sutures are removed at a follow-up consultation within one to two weeks.

Recovery time for eyelid surgery

Recovery time varies depending your body’s response and the extent of the surgery. Plan to take one week off work. Swelling and bruising are common but usually subside within four weeks, with subtle swelling persisting for a few months. It is not appropriate to plan eyelid surgery for the weeks prior to an important professional or social event.

The risks with blepharoplasty

As with all surgeries, there are possible risks and complications, such as dry eyes, bleeding, and infection.

Everyone has some degree of dry eye after surgery. Most people recover well and have no ongoing dry eye symptoms after one month. Dr Parker will prescribe lubricating drops to use if required. The risk of persistent dry eye is higher if larger amounts of tissue are removed, or in revision surgery.

Infection after blepharoplasty is uncommon and rarely severe. Oral antibiotics are not normally required, but will be prescribed if signs of infection develop.

There is an extremely small risk that vision could be affected, possibility permanently, if there is uncontrolled bleeding. This is very, very rare, the but the risk is higher if the orbital fat pads require debulking.

Most patients are very happy after blepharoplasty surgery. Occasionally, under-correction or over-correction can occur, or adjustments may be necessary. In these cases, further surgery may be required.

Over time, you may notice further drooping of the skin and recurrence of under-eye bags. This is part of your body’s ageing process and you may consider having further surgery in the future.

Is blepharoplasty covered by Medicare or private health insurance?

There are strict criteria for eligibility for Medicare or private health insurance rebates for blepharoplasty. Dr Parker will advise you whether these criteria apply to you.

In general, if there is a medical reason for blepharoplasty — such as restoring vision or following thyroid eye surgery — it may be partly covered by Medicare and private health insurance. A gap payment will be necessary. Rebate amounts vary widely between different patients and policies. Dr Parker will advise you of all expected out-of-pocket costs before surgery.

If the surgery is purely for cosmetic reasons, rebates will not apply, and you will be required to pay all the costs of the surgery as well and private hospital and anaesthetic costs.

Ask your GP for a referral to Dr Parker to assess you for a blepharoplasty procedure.

Ask your GP for a referral to Dr Parker to assess you for a blepharoplasty procedure.