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Eyelid surgery

Blepharoplasty is eyelid surgery to address ageing of the eyelids, which can improve vision and give you a fresher, brighter and more youthful appearance.

The signs of ageing around the eye are anatomically complex, but show dramatic and impressive improvement with surgery.

Blepharoplasty can help you if you have

  • Loose, wrinkled, crepe like skin on your eyelids
  • Low, drooping eyelids making you appear aged, tired or sad
  • Unsightly bulging of your lower eyelids
  • Heavy upper eyelids obstructing your vision

The thin skin of the eyelids is prone to show the signs of ageing earlier than the rest of the face. Fine wrinkles at the corner and under the eyes are accompanied by shadows and puffiness of the lower eyelid. With time, the supportive structures of the eyeball weaken. This causes the youthful almond shape of the eye to become rounder. In addition, the fat that cushions the eyeball pushes through its increasingly lax supportive tissues causing the eyelids to bulge. The skin can become loose and crepe like, sometimes so severely that it rests on the eyelashes and obstructs vision.

The structures that surround the eye also contribute to the appearances of ageing. The descent of the eyebrows accentuates eyelid heaviness, especially at the outer corner of the eyes. A brow lift may help in some cases, either through surgery or injections. Some people develop a deep trough at the junction between the lower eyelid and the cheek. This occurs as the cheek fat descends in the face unmasking the connective tissue attachments between skin and bone. This trough can be addressed with non-surgical fillers or with eyelid surgery.

What to expect at your first consultation

The consultation will address your concerns about the appearance of your eyes and eyelids, and your goals for treatment. The consultation will be performed with sensitivity to your opinions and thoughtfulness to your concerns. It is important to determine if you have any medical conditions that could interfere with safe eyelid surgery. Your surgeon will perform a general eye examination and then assess the bone structure, connective tissue support, fat and skin of your eyes. Clinical photographs will be taken, and analysed with you.

We will then discuss the best course of action to address your concerns. Written information will be provided to you, so that you can consider your options. If eyelid surgery is appropriate the benefits and risks of surgery will be discussed in detail. You should consider eyelid surgery carefully, and you will have the opportunity to see your surgeon in another consultation should new questions arise after your first visit.

What the procedure involves

It is possible to have surgery on either or both the upper and lower eyelids. The goal is to achieve a symmetrical result that makes your eyes appear brighter and more youthful. The surgery is performed as a day surgery procedure if only the upper lids are attended to, or often as an overnight stay if surgery is performed on the lower eyelids.

The incisions to remove drooping skin is placed at the natural upper and lower eyelid crease lines, and become virtually invisible with time. Bulging fat bags are removed or resited to fill hollow areas. In patients with heavy bags under their eyes but no excess skin, the fat in the bags can be improved through an incision in the conjunctiva (inside the eyelid), leaving no skin scars. Lower eyelid surgery is also combined with a canthopexy procedure. A canthopexy is a subtle elevation of the outer corner of the eye, giving a sharper, more youthful appearance to the lid.

The skin incisions are closed with very fine sutures, and a gentle ice pack is applied to your eyes to limit bruising.

After the surgery

An icepack is kept on your face in the recovery room. Ointment is applied to the eyes (this may make your vision blurry) and to your wounds. Your eyes and upper face will be bruised and somewhat swollen for two weeks after the surgery. It is reasonable to expect that this may limit some of your activities and social interactions.

Your stitches are removed five to seven days after the surgery, and the scars settle over the next six weeks, and mature over the next six months. You will be provided with advice on the best way to treat your scars so you have the best chance at thin, subtle lines that are hard to see.

Eyelid surgery is not simple, and patients can experience persistent swelling of the lids and even the conjunctiva for four to six weeks. There are steps your surgeon can take to improve the situation if this arises, so you should be sure to be able to come for office visits until everything has settled. We are always available to support our patients through every step in their post operative recovery.

Can private health insurance be used?

Eyelid surgery that is performed primarily for aesthetic reasons cannot be claimed against your private health insurance. You can usually use your private health insurance for upper eyelid surgery if your vision is obstructed and loose skin rests on your upper eyelid. Lower eyelid reduction may be covered in limited situations after conditions such as trauma or nerve damage. Your insurance can pay for all your operating theatre and hospital costs, including the post operative stay. Medicare and your private insurance also contribute to the doctors’ bills. Call your health fund and see if you are covered. The Medicare Benefits Schedule codes that are likely to be used are 45617 for the upper eyelid and 45620 for the lower.

Who should perform eyelid surgery

Eyelid surgery is sometimes described as simple, but it is real surgery, and even in the most straightforward cases should be performed with sophisticated surgical technique for the safest and best results. It carries real risks, and as such should be considered carefully.

We recommend that the procedure is only ever performed in an accredited hospital. We also recommend that you carefully consider your choice of surgeon. Unfortunately doctors without surgical qualifications beyond their medical degree are allowed to perform surgery. Your surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons (FRACS) or Ophthalmology, which means that they have specialist surgical training. FRACS is the standard qualification required in Australia to perform surgery in private and public hospitals. Members of the Australian Society of Plastic Surgeons have a FRACS and specialised training in Plastic and Reconstructive Surgery, including eyelid and facial rejuvenation surgery.

Our surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Plastic Surgeons. They have both received Honours degrees in their Sydney medical schools. They both have FRACS qualifications as Specialist Surgeons in Plastic and Reconstructive Surgery, and are members of the Australian Society of Plastic Surgeons. They both have extensive experience and training in blepharoplasty, including the most advanced and up to date techniques. They are committed to giving their patients the safest and best treatment available.

Where to get more information

A consultation with a qualified Plastic Surgeon is the best place to get more advice. More information and a video presentation on blepharoplasty are available online at the Australian Society of Plastic Surgeons website.