Blepharoplasty (Eyelid Surgery)

Blepharoplasty, commonly called eyelid surgery, is a procedure to address changes in the appearance of the upper eyelids, lower eyelids, or both. Upper blepharoplasty removes excess skin and, in some cases, adjusts the underlying muscle and fat to address heavy or hooded upper eyelids. Lower blepharoplasty addresses puffiness, hollowing, or excess skin in the lower eyelid. The two operations are performed either together or separately, depending on what’s being addressed.

It’s one of the more commonly performed operations in facial plastic surgery. The area of anatomy is small and delicate, but the visual impact of even small changes can be significant. That precision also means the tolerances between a good result and a poor one are narrow, and the risks specific to operating around the eye (including changes in eyelid shape, dry eye, and rare but serious complications affecting vision) need to be understood before any decision is made.

Upper blepharoplasty addresses heaviness or hooding of the upper eyelid, most commonly caused by loose skin that has developed with age. In some patients the heaviness is significant enough to affect the visual field, particularly the outer edges of vision, and in this situation the operation may be performed for functional rather than purely cosmetic reasons.

The technique involves a small incision along the natural crease of the upper eyelid, through which excess skin is removed. In some patients, a small strip of the underlying muscle is also removed, and pockets of fat are adjusted where they contribute to the heaviness. The incision is closed with fine sutures, and the resulting scar sits within the eyelid crease, where it’s typically well concealed once healed.

Where the primary problem isn’t the eyelid itself but a descended eyebrow that’s pushing the eyelid tissue downward, a brow lift or temple lift may be more appropriate than or in addition to upper blepharoplasty. This is a distinction that’s assessed carefully at consultation because operating on the eyelid alone in a patient whose main issue is brow descent doesn’t address the underlying cause and can produce a disappointing result.

Lower blepharoplasty addresses different concerns depending on the specific anatomy involved. The most common concerns are puffiness (typically caused by fat that's protruding forward through the lower eyelid), hollowing beneath the eye (where volume has been lost), and excess or crepey skin. These concerns often occur in combination, and the surgical approach is matched to the specific pattern.

Blepharoplasty can be performed under local anaesthesia with sedation or under general anaesthesia, depending on the extent of the operation and patient preference. The operation usually takes between one and two hours for upper or lower blepharoplasty alone, and two to three hours when both are combined or when blepharoplasty is combined with other face surgery.

Most patients go home the same day. In some cases, particularly when blepharoplasty is combined with other operations, an overnight stay is appropriate. Cold compresses are applied in the early hours after surgery to reduce swelling, and patients are typically advised to keep their head elevated in the first few days to help with fluid drainage.

Bruising and swelling are expected after blepharoplasty, and the extent varies between patients. Most bruising settles over one to two weeks, with the majority of the visible bruising gone by about ten days. Swelling settles progressively over several weeks. Sutures are typically removed within the first week.

Vision may be blurry in the first few days, and eye drops are commonly prescribed to keep the eyes lubricated during the early healing period. Reading, screen use and other activities that involve prolonged eye focus can be more tiring than usual in the first week or two. Most patients with desk-based work return after one to two weeks, with concealing makeup applied over any residual bruising.

Vigorous exercise, heavy lifting and any activity that raises blood pressure significantly are restricted for two to three weeks because of the risk of bleeding into the operated area. Contact lens wear is generally not resumed for two to four weeks. Final results develop over several months as swelling settles fully and the tissues consolidate. Scars take 12 to 18 months to reach their final appearance.

The recognised risks include:

Upper blepharoplasty may attract a Medicare rebate where the patient’s visual field is affected by heavy upper eyelid tissue and specific clinical criteria are met. This typically requires documented visual field testing and other assessments that confirm the eyelid heaviness is meeting the relevant criteria. Cosmetic blepharoplasty (where the visual field isn’t affected or the criteria aren’t met) isn’t covered. Lower blepharoplasty is generally cosmetic and isn’t covered by Medicare, other than in specific circumstances such as ectropion repair or lower eyelid reconstruction after skin cancer surgery.

We’ll assess your likely eligibility at consultation, including arranging any required visual field testing where appropriate, and provide a written quote covering all costs.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545