Patient Information >>
Blepharoplasty/ Eyelid surgery
Whilst the eyes themselves are expressionless, the eyelids are very
of our emotions. When heavy and baggy they portray a tired look; if
hooded with loose
skin, an aged look; if elongated and almond shaped with a smooth
contour, a fresh
Whilst the eyes themselves are expressionless, the eyelids are very
of our emotions. When heavy and baggy they portray a tired look; if
hooded with loose skin,
an aged look; if elongated and almond shaped with a smooth contour, a
fresh youthful look.
The eyes are the first facial feature people observe and
unfortunately they are also one of
the first to show the signs of ageing. Ageing is an irreversible,
relentless process of tissue degeneration resulting in loss of
elasticity and stretching of skin. The rate of this ageing
process varies from individual to individual and depends on the
determined constitutional clock. It is hastened by the effects of sun
and the stresses of daily life. Hooding of the upper eyelids is the
combined effect of
descent of the eyebrows into the lid area (blepharoptosis) and an
increase in the upper
eyelid skin due to loss of elasticity and stretching of the skin
Squinting into the sun with or without sunglass protection will,
over the years, lead to fine
lines which go on to form wrinkles and then furrows in the forehead
and about the eyes.
Loose skin in the upper eyelid will rest on the upper eyelashes giving
a heavy tired look.
It also makes it difficult to wear eye make-up. Fat pads in the inner
aspect of the upper
eyelid tend to bulge forward aggravating the aged look.
Lower eyelid skin as it ages becomes loose, tends to wrinkle and
eventually develops folds under the influence of gravity. The lower
eyelid muscle weakens and underlying fat pads
bulge forward producing bags.
Skin pigmentation occurs from the degenerating effects of the sun
on the skin. It can also
be a normal racial characteristic. This pigmentation can produce
shadowing of the lower
eyelid and contribute to the ageing non-youthful look.
Puffiness or swelling about the eyelids is
produced by any one or more of
three possible factors:
1. Weakened eyelid muscles (the
orbicularis muscles) allow the orbital fat to billow
forward under the influence of gravity. This produces puffiness of the
eyelids which is constantly present, but can be made to disappear by
standing in front of a mirror and contracting your eyelid muscles such
as in squinting. The problem can be surgically corrected by tightening
the muscle sling with resuspension in the outer aspect of the lower
eyelid (a procedure known as canthoplasty).
2. Excessive fatty deposits about
the eyeball produce bulges or bagginess. These fatty deposits are
compartmentalised and when present in excess, the fat pushes the
thin eyelid muscle and skin forward producing the baggy contour
defect. Removing the excessive fat or strengthening the retaining
walls (skin and muscle) corrects this problem.
3. Excessive fluid accumulation about the
eyes. This occurs commonly as a result of allergy and is
usually worse on getting up in the mornings and improves as the day
goes on - with the redistribution of body fluids on rising from the
recumbent to the erect posture. Fluid accumulation is not corrected by
surgery and if present may lead to a more protracted post surgery
recovery. Some morning swelling can be expected in all patients for
some variable time after eyelid surgery.
Evaluation prior to surgery includes your medical history,
especially in relation to
underlying allergies, visual problems, current medications, and known
history of scarring. Advise Your surgeon of your need to wear glasses
and the date of your most recent eye examination.
Eyelid examination allows assessment of skin quality and looseness,
muscle activity and
any excess orbital fat and its distribution. It is best not to wear
make up for this assessment.
It also includes an assessment of the contribution any eyebrow ptosis
is making to your
eyelid problem and the possible need for eyebrow repositioning to
achieve an optimal result.
Photographs are taken before and after surgery to plan the
procedure and record your
The surgery can be performed in hospital or at a Day Surgery
Centre. You have the
alternative of general anaesthesia in which you are profoundly asleep
and ventilated by a machine or the more modern alternative of
intravenous sedation and local anaesthesia
from which recovery is much more rapid. The anaesthetist will talk to
you prior to the
operation to help you decide what is best. Advancement in anaesthesia
over recent years
has meant more comfort for patients - i.e. pain-free surgery, with
minimal post operative sedation and almost no nausea, leading to a
quick recovery and "feeling normal". The anaesthetists in our team are
highly skilled and experienced in modern techniques and
devoted to keeping you comfortable.
Prior to the operation your eyelids will be marked out so that the
incisions follow natural
lines or creases and ultimately become “invisible”, and to allow the
determination of the
correct amount of skin to be removed. During the procedure the excess
skin is removed, muscle is tightened, and redundant orbital fat is
There are several tools that have been designed for use with eyelid
surgery. These include
fine knife blades, very fine tungsten tip diathermy points and lasers.
Despite what is written
in magazines, all achieve excellent results in experienced hands and
recovery times are identical. Your surgeon will happily discuss these
alternative surgical options with you.
The surgical incisions are sutured meticulously leaving hairline
scars that fade quickly, but probably never completely disappear. The
upper eyelid scar lies in a natural creaseline formed by the
attachment of your eyelid muscle to the skin at the upper level of the
tarsal plate (that structure that stiffens and support s the upper
eyelid). This is usually 8mm to 12mm above the eyelash line, but may
be higher as a normal variant, or non-existent as in Asians. This fold
can be created by a procedure termed supratarsal fixation and can
Europeanise the Asian eyelids. If eyelids are droopy (ptosis) this can
also be corrected by shortening the muscle (known as the “levator
muscles”) that raises your upper eyelid.
Upper Eyelid Reduction
Hanging loose skin develops with
Lower incision placed in crease line - 8-12mm
above the lash line.
Excess skin removed.
Fat pad reduced if bulging present.
Suture of upper eyelid wound after supratarsal
The lower eyelid scar lies immediately below the eyelashes and may
extend out onto the
crow's feet line for about 1 cm.
Lower Eyelid Reduction
Incision line marked under lash line and out from
corner of eye.
Skin and muscle elevated.
Fat pads reduced where necessary.
Excess skin and muscle removed level with initial
incision line after muscle tightening or canthopexy where needed.
If lower eyelid fat only is to be removed without the need for skin
or muscle adjustment, it is possible to perform this procedure without
any external lower eyelid scar. An incision is made on the inner
aspect of the lower eyelid and the excess fat removed. This is called
a transconjunctival blepharoplasty . This has application in very
selected cases and will be discussed with you by your surgeon if it is
an option for you.
Transconjunctival incision inside lower eyelid leaves no external
scar - only protruding fat
can be corrected in this way.
The specific procedure to be performed on the eyelids varies from
person to person and
will be discussed with you pre-operatively by your surgeon and his
Prior to surgery you may need to obtain artificial tears,
lubricating ointments, steroid
injections and medications to prevent or minimise bruising and
swelling. Make sure you
obtain these instructions from your surgeon's staff. Immediately after
your operation you will be nursed with your head up. Your vision will
be blurred by the presence of a lubricant in your eyes which is
inserted at the end of surgery. Ice packs may be used to limit the
swelling and bruising. It is not the practice of your surgeon to
bandage the eyes after surgery.
Sometimes dissolving sutures or glue will be used on the upper
eyelid to save them having to be removed. However more commonly a
running nylon suture is used and is removed with minimal discomfort
after two or three days.
The eyelids have a protective and lubricating role for your eyes.
After surgery, whilst the eyelids are swollen, this function is
compromised and so for a few weeks it will be necessary
for you to lubricate your eyes regularly with ointment or drops. The
nursing staff will instruct you about this.
W e all fear pain and have very different thresholds at which we
perceive pain. Your
eyelids may feel tight and sore as the anaesthesia wears off, but any
associated pain is
usually mild and should easily be relieved by mild analgesics such as
Panadeine. Your anaesthetist will ensure that you have prescriptions
for postoperative pain relief before
leaving the clinic or hospital.
Eyelid surgery will enhance your appearance but it won't
necessarily change your looks
to match your ideal or cause other people to treat you differently.
performed in patients with realistic expectations can do wonders for
self esteem and for self confidence.
Bruising and swelling obviously varies from person to person. It is
maximal in the first
three days and usually settles over seven to fourteen days. your
surgeon will show you photographs of the healing process to give you
some idea of what to expect.
Healing is a gradual process and your scars may remain slightly
pink for six months or
more. Scars vary greatly from person to person, but all go through an
initial red itchy
stage to a pink nodular and ultimately to a leathery stage at about
six to eight weeks,
before fading to a thin, nearly invisible white line. This line may be
visible in patients with
dark upper eyelid skin, but in most patients with white skin it will
not be seen. The ultimate quality of any scars is dependent on the
thickness of the skin. The eyelids have the thinnest skin in the body
and therefore the scars will mature more quickly and be less obvious
than anywhere else.
The positive results of your eyelid surgery will last for years.
Your eyes will look fresh and
with a smoother improved eyelid contour, ladies will be better able to
highlight their eyes
with makeup. Everyone should look more alert and youthful.
I t is usual to feel apprehensive about undergoing a surgical
procedure to improve
appearance. The usual dilemma is that on the one hand you want to
recapture youth and
look better, but on the other hand you do not want people to think
that you have had
surgery to achieve it, fearing that you will be perceived as vain. The
real situation is that
in our society we all care about how we look. This is reflected in our
hair styles, clothes etc.
It is interesting to note that one of the fastest growing industries
is the cosmetic industry,
where in the United States over 2 billion dollars a year is spent on
makeup. The vast majority of people are not so discerning and
surprisingly they will not notice even quite marked
changes to facial appearance. The usual comments you can expect are
that "you look
well" or "have you been on a holiday?"
T here is no particular age that is best for eyelid surgery. We all
age differently according
to a variety of factors: individual genetic makeup, and environmental
influences such as
sun exposure, skin care and smoking. In general a more youthful look
is maintained when eyelid surgery is performed on a younger patient
whereas in the older patient a more
dramatic change is noted. Deep furrows and wrinkles that have become
to be accepted, as they cannot be totally eradicated by surgery
directed solely to the eyelids.
The best candidates for eyelid surgery are men and women who are
physically healthy, psychologically stable and realistic about their
expectations. Most are in their mid-thirties or older, but if droopy,
baggy eyelids run in your family you may decide to have eyelid surgery
at a younger age.
Cosmetic surgery will not stop the biological clock, but will reset
it. Although there are many factors determining the overall individual
result, on average you can expect from six to ten years of
Unfortunately, the ageing process is progressive and after a period
of years you will again develop ageing facial features including a
recurrence of inelastic skin around the eyelids and perhaps weakened
eyelid muscles. Usually further improvement can be obtained by a redo
of your eyelid surgery which often needs to be less extensive than the
original procedure, or alternatively a forehead repositioning or
browlift may be indicated.
A misconception often heard is that one may age faster once you
have had eyelid surgery.
This is not true and although ageing continues post surgery, it is not
at an increased rate.
Eyelid surgery will not stop the rate at which the skin ages, but
certain lifestyles can
hasten the ageing process such as excessive sun exposure, smoking and
poor skin care. Attention to these areas can prolong the improvement
achieved by surgery.
Whilst eyelid contours are markedly improved, all wrinkles are not
removed. This applies especially in the crow's feet area which is not
addressed by a blepharoplasty. The crow's feet are actually part of
the cheek or temple. To improve this problem a brow lift or temporal
lift must be considered.
Drooping of the brow produces low flattened eyebrows with a
scowling look. This adds to heaviness in the upper eyelids and
produces furrowing in the nasal bridge line. This problem
is not improved by eyelid surgery, but is better corrected by a
foreheadplasty or brow lift.
Skin pigmentation is common in the lower eyelids and is
occasionally seen in the upper lids
as well. It is most commonly a hereditary ethnic characteristic, but
may also be sun induced. Eyelid surgery will not remove this, but
rather may make it slightly more obvious by
stretching wrinkled loose skin to an improved contour. A skin care
program incorporating a
light skin peel, either at the time of eyelid surgery or at a later
date, may help this problem. Makeup will, of course, camouflage it.
The scars from a blepharoplasty will not be as
“invisible” in this type of skin.
Facial asymmetry is normal. We all have a strong and a weak side of
our facial skeleton and hence left and right eyelids are never
identical, nor is the position of the eyebrows. This is of course
present prior to surgery, but occasionally patients notice it more
after surgery as they study their improvements closely. This asymmetry
is normal and in fact enhances beauty. It
is never the result of surgery.
Although blepharoplasty is one of the most common cosmetic surgery
procedures performed, it is frequently combined with other procedures,
either at the same time or
at a later stage, to achieve an enhanced result:
To correct the brow, bridge of nose and forehead furrows and to
reposition eyebrows which have become lower and flatter with ageing. A
new endoscopic procedure leaves minimal scarring in the hairline and
has a rapid recovery time. This option will be discussed with you
where your surgeon feels it appropriate.
Face and Neck Lift
To produce fresh facial features with improved cheek, jawline and
Lip Ancillary Procedures
To rejuvenate the lip to the youthful look. A variety of implants
and injections are available
to enhance this area.
To reshape and refine the nasal features.
Skin Care Programs
To improve skin quality. These are considered worthwhile to
maintain the tone and
appearance of the facial skin.
If you would like to know more details about how any of the above
may help you, please ask your surgeon or his staff.
Before you make a decision to undergo plastic surgery, it is
important that you be
informed of the potential risks, complications and side effects of the
surgery you are contemplating. While all care is taken to minimise or
to totally avoid these complications
and side effects, it is recognised that complications may occur
despite the best medical care. For this reason, and in order that you
may be truly informed prior to making your decision about surgery, it
is important that you carefully read and understand the risk factors.
The side effects which accompany eyelid surgery may occur on a
relatively common basis.
The complications of this surgery, although rare and unexpected, may
occur despite any surgeon's best efforts. When reading and carefully
considering this list, please understand
that many thousands of successful cosmetic procedures are performed
and the occasional occurrence of these side effects may be a part of
what is considered a successful cosmetic operation. Likewise, although
limited statistically, the complications listed herein do
occasionally occur, despite optimal care and patient co-operation.
A few medical conditions make blepharoplasty more risky. They
include thyroid problems
such as hypothyroidism and Grave's Disease, dry eye or lack of
sufficient tears, high blood pressure or other circulatory disorders.
A past history of detached retina or glaucoma are
also reasons for caution - if you have any of the above, please bring
it to the attention of
your surgeon prior to surgery so that if necessary a further
ophthalmology opinion can be obtained.
Swelling - usually is worst in the
first 72 hours and then gradually settles over one to two weeks. Some
residual swelling may be present for up to six weeks and may be
asymmetric depending on many factors such as your favourite side of
sleeping. Rarely swelling may
persist longer term and is usually intermittent and associated with
underlying allergies. This should be noted prior to surgery.
Bruising - this is maximal in the
first 72 hours and then usually resolves over the ensuing
7-10 days. If troublesome, it can be camouflaged with makeup which can
be applied within 7 days during which time dark glasses will assist.
Pigmentation - this is usually
present prior to surgery, but may be more noticeable following surgery
when the skin contour is improved by the elimination of wrinkles. It
may be improved by a skin care program, but sometimes it is hereditary
and the only effective treatment is cosmetic camouflage with makeup.
Dry Eyes and/or Tearing of Eyes, Burning
and Itching - these symptoms commonly occur following eyelid
surgery due to the changes in eyelid function. They usually settle
within a few weeks. Tearing may be related to obstruction of the
lacrimal duct-the canal responsible for draining tears from the inner
aspect of the eyelid into the nose. Occasionally this will need to be
probed to clear it.
Temporary Visual Changes -
sensitivity to light, blurring of vision and occasionally mild double
vision (diplopia) occur within the first few weeks of surgery. There
may also be
corneal irritation. These symptoms usually settle rapidly.
Occasionally it is necessary to
change your prescription for glasses or contact lenses. This change is
part of the evolution
of your optical function and is never caused by the surgery which is
only directed to your eyelids.
Inclusion Cysts -not uncommon
following eyelid surgery, small whitehead cysts are noted
in the incision lines and these are easily corrected by removal with a
fine needle in the office. They are of no consequence and are noticed
because of the excessively fine eyelid skin.
Scarring -will occur whenever skin
is incised. During healing it will pass through red, itchy, lumpy,
white and leathery stage before settling to a final state as a fine
white line. Incision
lines occasionally may be visible and tend to thicken, requiring
steroid injections and rarely additional revision surgery. Although
visible incision lines may result, fortunately the facial
skin has excellent blood supply which allows for rapid healing.
Occasionally scarring may
distort the shape of the eyelids and lead to drooping of the lower
eyelid, resulting in watering. This is called ectropion and usually
settles as the scars mature. Ectropion is minimised by incorporating a
lateral canthopery into the blepharoplasty procedure and massaging the
lower eyelids postoperatively in the prescribed manner. Occasionally a
further surgical procedure may be required to correct this.
Inability To Close Eyes -occasionally
it will be difficult to totally close your eyes whilst
asleep and hence the importance of inserting lubricating ointments
into the eye. When this occurs, it does so in the immediate
post-operative phase and usually settles when the
Infection -this is exceedingly
uncommon, but can occur following eyelid surgery. Antibiotic ointments
will usually be used in the first few weeks post surgery.
Blood Clots (Haematoma) -rarely
blood clots may develop behind the eyeball or under
the skin. These usually require evacuation.
Loss of Eyelashes -this is an
extremely rare complication following eyelid surgery.
Ptosis -this refers to drooping of
the upper eyelid due to malfunction of the upper eyelid muscle. This
is uncommon and can be corrected by a further surgical procedure.
Loss Of Eyelid Skin -this is very
rare and usually heals without the need for any further surgical
intervention. Very occasionally a small skin graft may be required to
replace the damaged area.
Alteration Of Vision -usually
temporary but very rare cases of blindness have been
reported in the medical literature. your surgeon will discuss the
mechanism of this
complication with you and the procedures he uses to prevent its
Pain temporary or permanent is extremely rare.
Two weeks prior to your operation you should avoid Asprin or
aspirin-containing medicine (Aspro, Disprin, Alka-Seltzer or any
medicine containing acetylsalicylic acid) as this can produce bleeding
or bruising. Panadol is safe.
Avoid Vitamin E two weeks prior to surgery as this may also
increase a bleeding tendency.
Vitamin B and C are safe to use.
Stop smoking to avoid the chance of post operative coughing which
increases risks of
bleeding and bruising. Smoking also decreases blood supply to the
healing tissues, increasing the risks of delayed and poor healing.
Do not drink alcohol for at least two days prior to surgery as
alcohol also increases the
chances of bleeding and bruising.
Two days before surgery start taking the ARNICA and any Vitamin C
which we have
prescribed for you. These have been shown to effectively minimise
bruising and swelling.
Avoid tea, coffee and peppermint as these products neutralise the
beneficial effects of
In the week prior to surgery, if you develop any sign of infection
such as cold, flu or pimples
on your face-please notify our office so that we can treat this
effectively. If you have a
history of facial Herpes please let us know, as Acyclovir started
before your surgery should prevent an outbreak.
Ensure you fill any prescriptions for ointment artificial tears,
analgesics and steroids which we have sent you. Remember to bring all
five vials of solumedrol if prescribed.
On the night before or the day of surgery, shampoo your hair as
usual and cleanse your face thoroughly to remove all traces of makeup.
Do not apply any moisturisers, makeup or hair products after
You should bring to hospital your normal toiletries and any regular
normal medication that
you use. Loose night clothes are recommended. Also bring a pair of
sunglasses to wear home.
If your operation is performed in hospital the nursing staff will
assist you by bathing the eyes with a saline wash and the application
of ice packs to help reduce swelling. Three
times daily, an antibiotic ointment will be applied sparingly to the
incisions, and at night it
will be inserted inside the lower eyelid. During the day, artificial
tears will lubricate and soothe the eyes.
If you choose to have your surgery at a clinic, "care of the eyes"
will be explained to you
and whoever may be assisting you at home. You may not drive yourself
or be unescorted home, as you will be under the influence of
medication. Also for the same reason, you should not conduct business,
sign any papers, or take any alcohol on the day of your operation. You
will have recovered completely by the morning after surgery.
By 48 hours after surgery, the swelling usually reaches its
maximum. The ice pack application may be discontinued unless you find
it comforting. An extra pillow is recommended whilst sleeping, and
keeping the head elevated as much as possible during the day is
Where possible elevate the head of your bed on a couple of house
bricks or telephone books.
Sunglasses will reduce the daylight glare and sun brightness,
helping to reduce eye irritability or tear formation.
In the first week following surgery it is advisable to restrict
your normal activities where possible. Avoid smoking, alcohol and
stress as these factors hinder the healing process. Detailed work such
as sewing or other handcrafts, excessive reading, writing or computer
work should be avoided as your eyes can become very tired.
Panadol or Panadeine are the desired analgesics for pain relief. No
aspirin-containing drugs should be taken as these can increase your
bruising and may
cause bleeding into the tissues. Codeine found in Panadeine or
Panadeine Forte can cause constipation. Therefore lots of fluids and a
high fibre diet should be taken. A suitable laxative
is Nulax if needed.
If you are still in hospital on the third or fourth day, the
nursing staff will remove your eyelid sutures. Alternatively you will
be given an appointment to have your sutures removed.
There may be minor bruising for up to a week and a cover makeup may
be necessary to resume work or social activities. Eye makeup may be
applied at one week, but gentle removal and cleansing is essential. A
saline wash is a very soothing finish to your nightly skin care regime
for the first few weeks.
The wounds around the eyes sometimes take on a lumpy appearance
around 10-14 days,
so a massage with vitamin E cream twice daily will help. Remember to
wash and massage
in a direction up and outwards from the nose to avoid affecting the
Often the weeks following surgery can be difficult as the patient
comes to terms with the changes achieved by surgery. It is a
transition period when some people have been known
to experience guilt and feelings of low self esteem. This is a good
time to seek the advice of
a beauty therapist and learn the art of enhancing the eyes with eye
makeup (colour, shade
and light) which you may never have been able to apply before. This
can really boost your confidence and maintain a positive state of
mind. If you would like an appointment with a trained paramedical
beauty therapist, please ask our staff and we will organise a
After six weeks, an appointment is made for you to visit your
surgeon for a check up. A photograph is often taken to compare with
your pre-op photos. At this stage you will have accepted the positive
results of your eyelid reduction and will be enjoying the "new you".
- Excessive pain or bleeding
- Abnormal swelling
- Fever during the first 24 hours or especially during the first 7
The costs of this surgery relate to:
a) surgeon and assistant surgeon
d) ancillary charge (pharmacy, etc)
your surgeon can tell you his fee and give you some indication of
the costs of the other
people involved in your care.
You must appreciate that the ultimate cost to you will depend on
where you choose to go for your procedure and what rebates you will
receive from your medical fund and Medicare. This
in turn depends on who you may be insured with and what level of
insurance you have
chosen. Please advise your surgeon if your insurance has a front end
deductible cost or "excess". With all the relevant information the
doctor's office should be able to give you a
very close approximation of what your final costs might be.
It is always preferable to arrange all your finance prior to
surgery to avoid unnecessary
stress afterwards which will detract from your enjoyment of having
achieved your goal.
Your eyes and eyelids are the most important features of facial
expression. A blepharoplasty can have a dramatic effect on your
eyelids, restoring a brighter, more rested appearance to your face.
After blepharoplasty, your eyes can express the energy and self
confidence you are truly feeling. I hope these notes have helped you.
If you have any further queries please call our office.