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Eyelid Surgery

Your complete guide and quick links to everything you want to know! ​

How Upper & Lower Eyelids Change With Ageing

The signs of eyelid ageing most commonly appear from the early 30’s onwards but in some they can start to appear much earlier, even in the mid-20’s. Interestingly, the changes tend to run in families with similar appearances often found in siblings and in one or both parents. 

Upper Eyelid Changes 

As we age, the skin of our Upper Eyelids starts to lose its elasticity causing it to loosen and eventually sag creating an appearance of ‘heaviness’ or ‘hooding’ of the eyelids. Sometimes, muscle laxity and excess eyelid fat also contribute to the ‘heavy’ appearance.

This ‘heavy’ appearance of the upper eyelids can look even worse if there is also a degree of contributory brow ptosis (droop). Accordingly, it is very important at your Initial Consultation for your doctor to determine if there is any brow ptosis contributing to your upper lid ‘heaviness’. If there is, a Brow Lift may need to be added to the procedure.  

‘Hooding’ of the upper eyelids with loss of the crease between the eyelid margin and eyebrow produces the ‘look’ commonly described by patients as ‘tired looking’ eyes.

Early ‘Hooding’ of the Upper Eyelid
Advanced ‘Hooding’ of the Upper Eyelid

Lower Eyelid Changes 

As we age, the Lower Eyelids also age and may develop ‘bags’ with, or without, loose skin.

The ‘bags’ are actually protrusions of the normal fat tissue that cushions the eyeball within the eye socket. These fatty protrusions can appear if the tissue layers holding them in place weaken and allow the fat to fall forward. 

Typical Lower Eyelid ‘Bags’
Typical Lower Eyelid ‘Bags’

What Is Eyelid Surgery?

Eyelid Surgery, known medically as Blepharoplasty, is a surgical procedure designed to rejuvenate the appearance of the upper or lower eyelids by reversing the ageing changes described below.

In Upper Eyelid Surgery, the eyelid skin is tightened by removing the excess skin along with any excess eyelid fat to create brighter, fresher and less ‘tired’ looking eyes which in turn improves overall facial appearance.

In Lower Eyelid Surgery, the protruding fat ‘bags’ are removed, and any accompanying loose skin is tightened either by excision or Laser Resurfacing. In some cases, a portion of the herniated fat may be transposed to fill any ‘hollows’ or ‘tear troughs’ under the eyes.

Sometimes, Upper and Lower Eyelid Surgery are performed at the same time as other surgical rejuvenation procedures such as a Face Lift or Browlift.

How Is Eyelid Surgery Done?

In the best interests of patient safety and comfort, all Eyelid Surgery procedures are performed in a Licensed Day Hospital under Local Anaesthesia with Sedation, or General Anaesthesia, administered by our Specialist Anaesthetist.

Upper Eyelid Surgery takes around 1-1½ hours, while Lower Eyelid Surgery can take slightly longer.

You can go home 1-2 hours after your procedure, but you cannot go home alone. You must be accompanied by a responsible adult.

Post-operative pain is usually mild only and easily relieved with the pain-relievers your Surgeon will have prescribed.

Upper Eyelid Surgery

  • After careful pre-operative marking in a sitting position to measure exactly the amount of skin to be removed, you will be taken to Theatre.
  • When you have fallen asleep, your Surgeon will inject a local anaesthetic into the area of eyelid skin to be removed.
  • Following precisely the earlier skin markings, your Surgeon will remove the excess eyelid skin along with any excess muscle and/or excess fat.
  • The skin is then meticulously closed with ultra-fine sutures.
  • Sutures are removed 7 days later. 
  • Scars are initially pink but can be camouflaged with make-up until they fade to white over time.

Lower Eyelid Surgery

In contrast to Upper Eyelid Surgery which always involves an incision on the skin, Lower Eyelid Surgery can be performed in either of two ways: 

  1. By Scalpel Incision across the eyelid skin just under the eyelashes: This is known as the Trans-Cutaneous Technique. 
  2. By Laser or Electrosurgical Incision on the INSIDE of the lower eyelid. This approach is known as the Trans-Conjunctival Technique and its advantages over the Trans-Cutaneous Technique are:
    • It avoids any external scar on the skin.
    • No internal sutures are necessary.
    • It allows direct access to the protruding fat bag from the ‘inside’ and thereby avoids any cutting of the skin, muscle or orbital septum – the subsequent scarring of which tissue layers can sometimes cause lower lid shape deformities.

If you have only small or medium-sized ‘bags’ of fat, and your lower eyelid skin still has good elasticity without laxity or significant wrinkles, nothing more than removal of the protruding fat needs to be done.

However, if you have:

  • Large fatty ‘bags’ with eyelid skin stretched over them; or
  • Medium-sized ‘bags’ with reduced skin elasticity; or
  • Any size ‘bags’ with very loose or wrinkled skin…

… you may need the Trans-Cutaneous Technique, or add Laser Resurfacing to the Trans-Conjunctival Approach, to help tighten the loose skin.

Watch Our Eyelid Surgery Animation Videos

Upper Eyelid Surgery

Lower Eyelid Surgery

Recovery After Eyelid Surgery

  • Pain after Eyelid Surgery is usually mild only and easily controlled by the pain-relievers your Surgeon will have prescribed.
  • Rest at home during the first 24 hours. Do not exert yourself and avoid strenuous activities or exercise during the first 2 weeks after surgery.
  • Bruising and swelling after Eyelid Surgery is normal and expected. It is more pronounced the day after surgery but then proceeds to settle over the next 2 weeks.
  • Sleep on at least two pillows to keep your head elevated. This will help to reduce swelling.
  • Apply cold compresses as often as possible during the first 48 hours to reduce swelling: 10 minutes on and 10 minutes off is recommended.
  • Contact lenses can usually be worn after 14 days but only if they feel comfortable.
  • Return to the Clinic after 7 days for removal of any sutures.
  • Make-up: You can resume wearing makeup 48 hours after removal of sutures.

Final Scars After Eyelid Surgery

  • With Upper Eyelid Surgery, the scar for most of its length is hidden within the eyelid’s natural crease and is barely visible.
  • With Lower Eyelid Surgery, there is no external skin scar with the Trans-Conjunctival Technique but in the Trans-Cutaneous Technique, there will be a fine scar across the eyelid skin immediately below the eyelashes.
  • Most blepharoplasty scars eventually fade to white and are very inconspicuous. However, if you have brown or Asian skin, you may be at risk of developing pigmented scars.

Upper Eyelid Surgery 'Before & Afters'

3 Months After Upper Blepharoplasty
3 Months After Upper Blepharoplasty
3 Months After Upper Blepharoplasty
3 Months After Upper Blepharoplasty
3 Months After Upper Blepharoplasty
3 Months After Upper Blepharoplasty

Lower Eyelid Surgery 'Before & Afters'

3 Months After Transconjunctival Laser Lower Eyelid Surgery Without Any Cutting of Skin
3 Years After Transconjunctival Laser Lower Eyelid Surgery Without Any Cutting of Skin + Laser Skin Resurfacing Under Eyes To Tighten The Stretched Skin
6 Weeks After Lower Eyelid Surgery (Dr Adam Honeybrook)
6 Weeks After Lower Eyelid Surgery (Dr Adam Honeybrook)
7 Weeks After Lower Eyelid Surgery, Canthopexy & Facial Fat Grafting (Dr Adam Honeybrook)
7 Weeks After Lower Eyelid Surgery, Canthopexy & Facial Fat Grafting (Dr Adam Honeybrook)

Upper + Lower Eyelid Surgery 'Before & Afters'

3 Months After Upper & Lower Eyelid Surgery + Laser Skin Resurfacing Under Eyes To Tighten The Skin
3 Months After Upper & Lower Eyelid Surgery + Laser Resurfacing Under Eyes & Upper Lip + Chemical Peel to Rest of Face

Pros & Cons of Eyelid Surgery

The Pros:

  • Upper Eyelid Surgery can make your eyes as well as your whole face look fresher, energetic and more alert because droopy upper eyelids can make you look sleepy, tired, and even older than you really are.
  • Similarly, Lower Eyelid Surgery can remove the ‘bags’ or ‘puffiness’ under the eyes that are making you look tired or older than your true age.
  • It is a short-duration procedure without the need for a hospital stay. 
  • Recovery involves minimal pain. 
  • As the Upper Eyelid incision is made in the eyelid’s natural crease, most of the final scar is not visible when fully healed. 
  • If your Upper Eyelid ‘hooding’ can be shown to be interfering with vision, you may qualify for a partial Medicare rebate.

The Cons:

  • Although you may only need around 7-10 days of ‘downtime’, we recommend that you allow 2 weeks off work to allow more of the bruising and swelling to settle.
  • If you have brown or Asian skin, your final scars have a higher risk of being pigmented.

Potential Risks & Complications of Eyelid Surgery

Surgery and anaesthesia nowadays are considered generally safe but both have potential risks and complications which include: 

Common To Both Upper & Lower Eyelid Surgery

  • Bruising and Swelling: normal, expected and temporary.
  • Brown Staining of the Skin: Occasionally, bruising of the skin under or around the eyes can leave temporary brown staining of the skin as the bruise clears. Will eventually disappear and can be camouflaged with makeup until it does. Rarely is the staining permanent.
  • Infection
  • ‘Dry Eye’ Syndrome refers to a feeling of grittiness or dryness of the eyes and can occur after any type of eye surgery. Relievable with lubricating eye drops.
  • Blindness
  • Wide or thickened scars (hypertrophic or keloid) could occur if you are prone to them and pigmented scars are more likely in those with brown or Asian skin.

Specific to Upper Eyelid Surgery

  • Ptosis is a drooping of the upper eyelid and can occur with upper eyelid surgery if the levator muscle of the upper is inadvertently divided during surgery. Additional surgery is required to repair it.
  • Lagopthalmos refers to an inability to completely close the eye after surgery leaving a narrow slit between the upper and lower eyelids. Temporary Lagopthalmos is not uncommon in the early days after surgery due to swelling of the lids but disappears once the swelling settles. Permanent Lagopthalmos is the result of removal of too much eyelid skin which then prevents the upper eyelid meeting the lower.

Specific to Lower Eyelid Surgery

  • Ectropion (a ‘turning outwards’ of the lower eyelid margin) requires additional surgery for correction.
  • ‘Scleral Show’ refers to more sclera (eyeball white) showing under the cornea because the lid has been pulled downwards.
  • Excessive Removal of Fat produces a ‘hollow’ look under the eyes.
  • Insufficient Removal of Fat leaves a residual bulge of fat and requires repeat surgery.

General Risks

  • Allergic reaction to medications, sutures, dressings, or antiseptic solutions.
  • Deep Venous Thrombosis (DVT) and its potential to cause life-threatening Pulmonary Embolism. To reduce the risk of DVT, Calf Massagers can be applied for the entire duration of your surgery to prevent the blood in your leg veins from pooling and clotting.
  • Adverse Reactions to Anaesthesia or Medication: The safety of anaesthesia nowadays in Australia is well established. Nevertheless, potential risks exist with all anaesthesia and unexpected reactions can occur. These may include nausea, vomiting, and allergic reactions ranging from minor to severe. Respiratory failure, heart failure, heart attack and stroke are rare but documented risks of any general anaesthesia.

The Cost of Eyelid Surgery

  • Eyelid Surgery

The total cost of Eyelid Surgery is made up of the following individual costs:

  • Surgical Fee: 
  • Hospital Fee: Hospitals differ in their hourly rates for Operating Theatres. Our Surgeon will advise you of the expected Theatre Fees once it has been determined which hospital you will be attending and how long your procedure will take.
  • Anaesthetist Fee: This will basically depend on the duration of the surgery. Anaesthetic Fees are generally around $880/hour.

Can I Claim a Medicare or Private Health Insurance Rebate?

Surgical procedures for purely cosmetic reasons are not eligible for a Medicare Rebate.  

Unless your Upper Eyelid ‘hooding’ can be shown to be interfering with vision, there is no Medicare Rebate.  

If, however, the ‘hooding’ can be proven to be truly interfering with your direct vision, you may qualify for a partial Medicare Rebate, and in which case, if you also have Private Hospital Cover, you may also be able to claim a variable portion of your Hospital Fees depending on your Fund and Level of Cover. 

There is no Medicare Rebate for Lower Eyelid Surgery. 

Our Specialist Surgeons

Terms & Conditions

  • Consultations must be pre-paid at time of booking.
  • Once pre-paid, all consultations are non-refundable and non-transferable but can be moved to another date with at least 3 working days’ notice.
  • Cancellations with less than 3 working days’ notice and ‘no shows’ are not refundable or transferable and will incur a new consultation fee to re-book.
  • All payments by Credit Card & Debit Card attract a 0.3% surcharge and Amex a 1.5% surcharge.
  • The Medical Board of Australia’s new Regulations which came into effect on 1 July 2023 require that:
    • All patients seeking a consultation regarding cosmetic surgery must provide a referral and the referral must be from a GP or other specialist who does not perform cosmetic surgery or non-surgical cosmetic services themselves.
    • If a patient arrives without a referral, the Regulations recommend that the doctor should refrain from seeing the patient – in which event, any pre-paid consultation fee would be lost.

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Dr Kenneth Brito, Cosmetic Doctor

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