BLEPHAROPLASTY (EYELID SURGERY)
What is an Upper Blepharoplasty?
Upper blepharoplasty is a surgical procedure focused on the upper eyelids. Upper blepharoplasty involves removing excess skin and sometimes fat from the upper eyelid area. Any hooding on the outer corners of the eyes can also be addressed during the procedure.
If the upper eyelid skin touches the eyelashes and obstructs vision, a Medicare item number may apply.
How to Achieve Optimal Outcomes
In the past, blepharoplasty surgery often involved removing significant amounts of skin and fat, which in some cases resulted in a hollow appearance around the eyes. Current techniques focus on repositioning tissues rather than excessive removal, aiming to preserve eyelid structure and function. This approach is based on updated anatomical knowledge and clinical experience to support improved surgical results.
How to Get the Best Results
A thorough assessment is essential before surgery to identify any underlying conditions that may affect the outcome. These include eyebrow ptosis (where the frontalis muscle compensates to lift the eyebrows), eyelid ptosis (which may require a separate surgical repair), and eyelid asymmetry. Addressing these factors during surgery can help achieve the intended surgical goals.
What is a Browpexy?
A browpexy is a surgical technique used to help raise and support the brow by securing it internally through an incision in the upper eyelid skin. This procedure is often performed alongside an upper blepharoplasty. Recovery may take longer than a standard upper blepharoplasty because sutures are anchored to the bone, and additional sutures are used to help define the upper eyelid crease.
How Do I Know If I Need Upper Eyelid Surgery or a Brow Lift? Do I Need a Browpexy?
Everyone’s facial anatomy is different, including the shape of the eyes, eyelids, eye sockets, and brow position. These factors influence which procedure might be suitable.
- Checking for excess eyelid skin: Gently pinch the skin of your upper eyelid and close one eye. This can give an idea of how much skin may be present and whether upper blepharoplasty might be helpful.
- Assessing hooding: Excess skin on the outer part of the eyelid, often called hooding, can sometimes be addressed during surgery.
- Evaluating brow position: Observe where your eyebrows naturally sit. If lifting the eyebrows improves their position, a browpexy might be appropriate.
A browpexy is a technique sometimes used during upper eyelid surgery to support the brow internally, but whether this is needed depends on individual anatomy and surgical planning.
For an accurate assessment and personalized advice, a consultation with a qualified specialist is recommended.
Brow Lift
A brow lift can be performed using different techniques:
- Hairline brow lift: The incision is made within the hairline to lift the brow.
- Direct brow lift: The incision is made along the eyebrow line, with the scar hidden within the brow hairs. This method may require makeup such as feathering or brow pencil to further conceal the scar.
- Browpexy: This technique involves placing deep sutures to support and lift the brow through an incision in the upper eyelid.
To assess if there is excess fat around the eyes, gentle pressure on the eyelid can help detect any bulging. Surgical removal of fat is generally performed under general anaesthetic in a hospital setting. It is important to note that current approaches aim to preserve fat to avoid a hollowed appearance over time.
Where Can Upper Blepharoplasty Be Performed?
Upper blepharoplasty can be performed either our clinic or in a hospital as day surgery, depending on the extent of the procedure needed.
- For cases involving only removal of excess skin and a small strip of muscle, the procedure can typically be completed in the clinic. The surgery usually takes about one hour.
- Some patients may be eligible for a Medicare rebate if the excess upper eyelid skin touches the eyelashes and affects forward vision or reading.
- When there are bulging fat pockets, the procedure is usually performed in hospital under general anaesthesia. During this, the eyelid structures are carefully protected while the fat pads are repositioned with minimal removal to maintain a balanced appearance.
Upper blepharoplasty is sometimes combined with other procedures such as browpexy, lower eyelid surgery, brow lift, or fat grafting to the cheeks. Additionally, non-surgical treatments like anti-wrinkle injections may be used alongside surgery to enhance overall results.
Lower Blepharoplasty
Lower blepharoplasty surgery is designed to address excess skin and fat deposits around the lower eyelids. This procedure can be combined with other treatments for comprehensive results.
The surgery involves repositioning or removing excess fat and reducing extra skin. This helps reshape the area around the eyes and improves definition.
Typically, a lateral canthopexy or canthoplasty is performed alongside the lower blepharoplasty. These techniques support and anchor the outer corner of the eye, helping to maintain the results over time.
Fat Graft
If volume loss in the cheekbones is contributing to concerns around your eyes, fat grafting may be beneficial. This procedure involves transferring your own fat to areas around the orbital rim and cheekbones.
One benefit of fat grafting is that a significant portion of the transferred fat - typically between 50-80% - can remain long term, using your body’s own tissues.
Procedure
This procedure is performed under general anaesthetic or sedation at The Swan Clinic or in hospital. It takes 1-2 hours and is performed as day stay. The sutures are removed after one week.
Potential Risks – Upper Blepharoplasty
Upper blepharoplasty is a surgical procedure that involves removing excess skin, muscle, and sometimes fat from the upper eyelids. It is commonly performed to address functional concerns, such as obstruction of the upper visual field caused by drooping eyelid skin. It may also be undertaken for cosmetic reasons, such as altering the shape of the upper eyelids. As with any surgery, this procedure carries general and procedure-specific risks, including:
- Infection at the incision site, which may require antibiotics or further treatment
- Bleeding or haematoma, which may need medical intervention
- Scarring, typically hidden in the natural crease of the eyelid, but in rare cases may be raised, thickened, or pigmented
- Asymmetry in eyelid shape, contour, or crease position
- Dry eyes, tearing, or irritation, which may be temporary or persist longer
- Temporary blurred vision or light sensitivity due to swelling
- Eyelid tightness, pulling sensation, or difficulty fully closing the eyelids (usually temporary, but in rare cases may be persistent)
- Changes in sensation, such as numbness or tingling near the eyelids or brow
- Excess removal of skin, which can lead to eyelid retraction or difficulty blinking (rare and may require revision)
- Allergic reaction to dressings, sutures, or medications
- Anaesthesia-related risks, especially with sedation or local anaesthetic, including allergic reaction or other complications
Recovery and Aftercare – Upper Blepharoplasty
Healing after upper eyelid surgery is generally well tolerated, but outcomes and recovery time can vary between individuals. Below is a general guide to the recovery process:
- Swelling and bruising around the eyes and upper face are common, typically peaking in the first few days and improving over 1–2 weeks
- Mild discomfort, tightness, or dryness in the eyelids is normal and can usually be managed with prescribed or over-the-counter pain relief
- Cold compresses may be used in the first 48 hours (as directed) to help reduce swelling and bruising
- Keeping the head elevated, including during sleep, is recommended to minimise swelling
- Eye drops or ointment may be prescribed to keep the eyes lubricated and prevent dryness
- Avoid rubbing the eyes, wearing contact lenses, or using eye makeup until approved by your surgeon
- Strenuous activity, bending, or heavy lifting should be avoided for at least 1–2 weeks
- Sutures (if non-dissolvable) are typically removed within 5–7 days
- Sun protection is essential after surgery, as the eyelid skin may be more sensitive to sun exposure
- Smoking and alcohol should be avoided during recovery, as they can delay healing and increase risk of complications
- Scars may remain pink or slightly raised for several weeks but generally fade over time
- Final results may take months to become apparent, as swelling subsides and eyelid contours settle
- Follow-up appointments are important to monitor healing and address any concerns
If you have any questions or wish to discuss blepharoplasty options, please contact our clinic to schedule a consultation with Dr Reema Hadi.