Oculoplastics

Blepharoplasty is eyelid reduction surgery on the upper or lower eyelids to remove excessive and redundant skin and reposition pockets of fat. The surgery is generally done for either or both of the following reasons:

/ Functional purposes: to restore peripheral vision loss and improve symptoms of eyelid fatigue.

/ Cosmetic purposes: to improve the appearance of eyelid changes associated with the effects of facial and skin ageing.

The major causes are:

/ ageing

/ sunlight exposure

/ genetics (i.e. your inherited eyelid shape from your parents).

Eyelid skin is delicate and thinner than the rest of the body and ageing effects are often seen here first. Sun damage and ageing combine to cause skin to lose elasticity resulting in ‘bagginess’ and loose, surplus skin that droops due to gravity. The extent of eyelid drooping and sagging occurs due to multiple factors, including the genes you inherited from your parents and the amount of sun exposure you’ve had throughout your life.

Other age-related changes include a weakening of the tissue around the eye, allowing fat to bulge forward. This is often prominent in the inner corner of the upper eyelid or along the lower eyelids. Smoking is a well-recognised cause of skin damage, which accelerates an ageing facial appearance. Sometimes chronic allergies, which cause repeated swelling of the eyelids, result in loose skin being stretched that does not return to its original shape.

It is important to have expert and individualised pre-operative advice on realistic expectations when considering blepharoplasty surgery. Pre-operative consultation is the key to understanding the risks and benefits of the surgery.

/ The final appearance will depend on the pre-existing eyelid and eyebrow shape. Surgery cannot restore the youthful appearance or quality of one’s skin.

/ Preserving healthy vision and eyes is the number one priority.

/ There are important limits on the amount of skin that can be removed from the upper eyelid. A freely moving and closing upper eyelid must stay that way.

/ The second priority is to maintain a natural appearance, such that it may not be obvious that eyelid surgery has been done but rather that a refreshed and vibrant facial appearance has been restored.

/ Being able to trust and have confidence in your surgeon is the foundation for a positive experience. A patient with a great result is generally happy and confident before surgery was undertaken.

Surgery involves careful measurement and excision of redundant skin of the upper eyelid.

/ The surgery is done as a day case procedure with a twilight anaesthetic (intravenous sedation) and local anaesthetic, making the procedure painless.

/ The skin incision is hidden in the fold of the upper eyelid.

/ Most procedures take 60 minutes.

/ Often dissolving sutures are used but some sutures may be removed one week after the surgery.

/ Eye pads with ice are placed over the eyes for 30 minutes after the surgery and are removed before the patient is discharged.

/ Bruising of the eyelid will be very obvious for the first week.

/ Patients can resume driving 24 hours after the surgery (if they are no longer wearing an eye pad) and have returned to their usual routine after several days.

/ A period of 5 to 7 days off work is recommended after the surgery.

/ There is not much pain after surgery and usually only paracetamol is required for mild discomfort.

/ It may be 7-10 days before active exercise (swimming, lifting weights) is resumed, but light exercise (e.g. walking) is encouraged from the first day.

/ Post-operative visits are usually at 1 and 4 weeks after surgery.

Lower eyelid surgery focuses on removing the bulges and bags that appear underneath the eyelid. This is done by a fat reposition technique that is effective in restoring the lower eyelid appearance. This surgery differs from upper eyelid blepharoplasty surgery because:

/ The surgery is more complex and takes longer, up to 2 hours.

/ A general anaesthetic is used and the patient is completely asleep for the surgery.

/ The incision is made on the inside of the lower eyelid and dissolving sutures are used.

/ Sometimes a skin incision is made to remove redundant skin. This is done just below the eyelashes.

/ Recovery is similar to upper eyelid blepharoplasty surgery and obvious swelling is present for one to two weeks. However it sometimes takes several months for the lower eyelids to feel completely back to normal.

/ Upper and lower eyelid blepharoplasty are often combined in the same procedure.

/ Surgery can still be done as a day case procedure in most cases, but does require up to 3 hours under a general anaesthetic.

Most people only ever need one blepharoplasty procedure in their lifetime. As ageing is a continuing process surgery won’t prevent further changes but it would be unusual to consider surgery within 10 to 15 years after a successful procedure.

The procedure has a high satisfaction rate and a low complication rate if done with a focus on the health of the eyes and with realistic expectations about the outcomes. However, one must understand there are risks when considering blepharoplasty surgery:

/ Common issues in the early post-operative period include uneven bruising, prolonged swelling, an itchy eyelid, wound redness and the eyelid feeling tight. These issues are part of the healing process and almost certainly improve with time.

/ Much less common are issues such as sudden post-operative bleeding or a blood clot, infection, dry eye problems, nerve damage or pain.

/ It would be rare to have wound scarring, significant post-operative unevenness or an unsatisfactory outcome. Sometimes revision surgery can be needed or considered. There may be additional costs depending on the circumstances.

/ Very rare complications include vision disturbance (loss of vision or double vision) or serious health problems from the anaesthetic (for example, allergic reactions).

There are strict eligibility definitions for upper eyelid blepharoplasty surgery under Medicare.

/ These eligibility criteria can only be assessed individually by consultation and examination.

/ The surgeon undertaking the surgery makes the final decision.

/ If the Medicare criteria for functional surgery are not met, then Medicare or private health funds consider surgery and associated costs cosmetic and therefore not refundable.

/ Lower eyelid blepharoplasty surgery is always considered cosmetic surgery.

If surgery is recommended for you, you will be provided with an estimated cost as part of the consent process.

/ The complexity of surgery required will vary from patient to patient and a detailed assessment of your eyelids will inform the final quote.

/ Costs of surgery will include surgeon’s fees, surgical facility costs and anaesthetist fees.