Eyelid surgery

Blepharoplasty is eyelid surgery to address ageing of the eyelids, which can improve vision and possibly achieve a more well defined upper eyelid appearance

The signs of ageing around the eye are anatomically complex, but can 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
  • Lower lid bags
  • Heavy upper eyelids obstructing your vision

The thin skin of the eyelids is prone to showing 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 (eyelid bags). The skin can become loose and crepe like, sometimes so severely that it rests on the eyelashes and obstructs vision. We are more prone in Sydney’s south to show early signs of ageing around the eye as we spend a lot of time in the sun, squinting our eyes and exposing our skin to damage from UV radiation.

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 muscle relaxing 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 30 minute 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 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 patient’s through every step in their post operative recovery.

How long will I stay in hospital after an eyelid operation?

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.

Is an eyelid reduction a painful operation?

Surprisingly, most Sydney blepharoplasty patients describe the surgery as uncomfortable but not painful. Your eyelids will feel tight and swollen and sometimes a mild burning pain for the first day after surgery. A lot of patients get good comfort out of applying make up removal pads dipped in cold water to their eyes. The swelling peaks at 48 hours after the surgery, and the starts to subside. There is great improvement in your sensation of tightness as the swelling subsides and with the suture removal.

How long before I can drive after upper or lower eyelid reduction?

Our Sydney patients are able to drive approximately one week after eyelid surgery. Usually, at one week following surgery, our Southern Aesthetic Plastic Surgery patients will be off sedating pain relief and will be able to comfortably turn their head to check their blind spots.

How long will it be before I can return to work and exercise after facial plastic surgery?

Most people having blepharoplasty surgery can return to work after one week and can gently exercise after one week. You can perform stronger exercises eg heavy lifting, pilates after 4 weeks.

Which hospitals do Dr Sanki and Dr Kotronakis operate in?

Dr Sanki and Dr Kotronakis are Kogarah and Shire eyelid rejuvenation specialists, and perform surgery at major hospital facilities including St George, Hurstville, Bondi Junction and St Luke’s private hospitals. They select their hospitals based on their high standards of peri-operative care and their outstanding surgical equipment.

Is it possible to have an all female surgical team?

Dr Sanki has an all female surgical team available weekly. Surgery can be a vulnerable time for women, and having the security of an all female plastic surgery team can be comforting and reassuring. Dr Sanki’s team are not picked upon their gender, but are picked for their experience, dedication and skill.

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. You can 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 blepharoplasty operations?

A blepharoplasty may sound simple but it is real surgery, and should be performed with sophisticated surgical technique for the safest and best results. It carries real risks, and as such should be considered carefully. Fortunately, eyelid surgery in Sydney is safely performed by our highly experienced surgeons.

We recommend that you carefully consider your choice of surgeon. Unfortunately doctors without surgical qualifications beyond their medical degree are allowed to perform surgery. Your plastic surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons in Plastic surgery (FRACS plast), which means that they have specialist plastic 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 surgery.

Our Sydney blepharoplasty surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Specialist Plastic Surgeons. They are Australian University trained, and received honours from their medical schools. They are members of the Australian Society of Plastic Surgeons and Dr Sanki holds the Chair for Education for the Australasian Society of Aesthetic Plastic Surgeons. They have extensive experience and training in eyelid surgery, 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 the right advice. More information on blepharoplasty is available online at the Australian Society of Plastic Surgeons and Australasian Society of Aesthetic Plastic Surgeons websites. You can view a video of the procedure there.

Plastic surgery, like any other surgical procedure, carries certain risks and potential complications. It is important for individuals considering plastic surgery to be aware of these risks before making a decision. Your plastic surgeon will explain the specific risks of your procedure and your risk profile in the context of your general health and the complexity of your procedure. Here are some of the common risks associated with plastic surgery:

1. Infection: Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur.

2. Scarring: Scarring is an inherent risk of plastic surgery. While surgeons strive to minimise visible scarring, some procedures may result in more noticeable or keloid scars.

3. Pain and discomfort: Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. The level of pain varies depending on the procedure and the individual’s pain tolerance.

4. Hematoma and seroma: Hematomas are collections of blood that can form under the skin after surgery, while seromas are collections of fluid. These fluid collections may require drainage.

5. Nerve damage: Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, or loss of sensation in the affected area. Nerve damage can also cause muscle weakness or paralysis.

6. Blood clots: Surgical procedures carry a risk of blood clot formation, particularly in the legs. Blood clots can be serious if they travel to other parts of the body, causing complications like pulmonary embolism.

7. Anesthesia risks: Plastic surgery usually requires the use of anesthesia, which carries its own set of risks. These include adverse reactions to anesthesia, breathing difficulties, and, in rare cases, life-threatening complications.

8. Unsatisfactory results: Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes.

9. Revision surgery: In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes. This can increase the financial and emotional burden on the patient.

10. Psychological and emotional effects: Plastic surgery can have psychological and emotional impacts, both positive and negative. While many people experience improved self-esteem and body image after surgery, others may struggle with unrealistic expectations, body dysmorphia, or dissatisfaction with the results.

11. Blindness. There are rare reports of blindness (0.00625%) due to bleeding causing compression of the optic nerve.

It’s crucial for individuals considering plastic surgery to consult with a qualified and experienced plastic surgeon who can thoroughly explain the risks and benefits specific to their desired procedure. Understanding and carefully weighing these risks against the potential benefits can help individuals make informed decisions about whether to proceed with plastic surgery.