Blepharoplasty (eyelid surgery)

What is an upper blepharoplasty?

Upper blepharoplasty is an operation of the upper eyelid, also known as an eyelift. The aim is to rejuvenate, giving the eyes an open or uplifted look. It involves removing part of the excess skin and sometimes fat. The hooding on the outside of the eyes can also be removed at the same time. A Medicare item number may be applicable if the upper eyelid skin is touching the eyelashes causing obstruction of vision.

The operation results in a greater “eyeshadow surface area.” At the Swan Clinic, we aim for natural results, which give a refreshing look, without the tell-tale signs of surgery. In addition, our technique gives long term natural results

How to ensure a natural result?

In the 1980s, the approach was a very reductive one. Lots of skin was excised with over resection of the fat pads around the eyelid. This over-skeletonisation of tissues paradoxically led to an aged hollow look. We now restore the tissues to their rightful place rather than over resecting them. Our improved knowledge of anatomy and long-term study of patients had led to improved outcomes for our patients through modern surgical techniques.

How to get the best outcomes?

The key to a successful outcome is to exclude eyebrow ptosis (which is recognised by overactive frontalis muscle keeping the eyebrows up), eyelid ptosis (which needs a separate operation to repair overstretched levator muscle), and any eyelid asymmetry (which can be corrected for in surgery).

What is a browpexy?

A browpexy is used to help suspend the brow internally through an upper eyelid skin cut. This can be combined with an upper eyelid lift. Recovery takes longer as the sutures are anchored to the bone. It takes longer than a standard upper blepharoplasty as additional sutures are used to define the upper eyelid crease.

How do I know if I need upper eyelid surgery or a brow lift? Do I need a browpexy?

Everyone is different. The shape of our eye, our eyelid type, the shape of the eye socket and where the brow sits. What about the eyebrows?

We often notice hooded eyelids when our makeup sticks.

To find out if you have excess eyelid skin or upper blepharoplasty, pinch the skin and close one eye. This tells you how much skin you need to remove.

You can then check if you have hooding. This is excess skin on the outside of the eye. This too can be removed at the same time.

To find out if you might need a brow lift, look at where your eyebrows sit. Then lift them up. If lifting the eyebrows puts them in a good position, then you might need a brow lift.

Brow lift

A brow lift is done through a cut in the hairline (which is an endoscopic brow lift) or a direct brow lift which involves hiding the scar in the eyebrow line. But this may need feathering on top or covering with a brow pencil.

The operation in between is a browpexy. This is when we put deep sutures to suspend the brow up through an upper eyelid cut.

Finally, you can find out if you have fat around the eye that needs to be removed. You can do this by pushing on the eye and looking for bulging. In the 80’s, we took a very reductive approach and we removed a lot of fat. Now a days, we try not to remove fat as it can result in a hollow or aged look with time. If you need fat removed, this must be done under general anaesthetic at hospital.

At the Swan Clinic, we tailor the operation to you.

Where can upper blepharoplasty procedure be performed?

This procedure may be done in the rooms or in theatre as day surgery depending on the extent of the treatment required. In selected cases, excess skin and a strip of muscle can be excised. With appropriate repair, haemostasis and skin closure. This scar is usually very faint and heals well. The procedure takes about 2 hours and can be done in the rooms. Patients may be eligible for a Medicare rebate if the upper eyelid skin touches the eyelashes as this can interfere with front forward vision and reading.

When there are bulging fat pockets, this procedure is done in theatre under a general anaesthetic. In these cases, the eye lid structures are protected, and these bulging fat pads are redraped with minimal removal. This allows sculpting of the tissues around the eyes while adding definition.

Sometimes this operation is combined with a browpexy, lower eyelid surgery, a browlift or fat grafting to the cheeks. Occasionally, anti-wrinkle injections can complement the result.

Lower eyelid lift (lower blepharoplasty)

This procedure is best to treat excess skin or excess fat deposits. It is the most powerful manoeuvre.  It can be combined with one or more of the above treatments. It involves redraping or removing excess fat and reducing excess skin. This allows sculpting of the tissues around the eyes while adding definition. The lower blepharoplasty usually involves a lateral canthopexy or canthoplasty to anchor the corner of the eye and gives the procedure longevity.

What can I do for bags under my eyes?

This can be a difficult area to treat. The first step to finding what you need, is to look at the lower eyelids area. Is the problem excess skin? Fatty deposits under the eyes? Or is loss of tissue caused by bone loss or fat descent of the cheek fat pads. Look at the corner of the eye, is the tissue here too lax, needing tightening of the tissues or a canthopexy. There are a number of options to treat this area.

Filler

This can be an easy way to treat lower eyelid hollowing or tear trough. A small amount can be injected along the. This can fill the concavity, allowing the light to retract, and improves the appearance of dark circles under the eyes. At the swan clinic, we always use a TSK cannula with very light pressure to ensure your safety during this procedure. We also use a very soft filler of the best quality in this location to prevent fluid absorption by the filler which can paradoxically increase the heaviness in this area.

Fat grafting

If you have cheek bone loss or fat pad descent, then you might benefit from fat grafting along the orbital rim and along the cheek bones. This can improve the fine lines around the eye and improve the hollowing along the lower eyelid. The advantage of fat grafting is that 50-80% lasts forever and it uses your own tissues.

Anti-wrinkle injections

If wrinkling on the outside of the lower eyelid is the problem, then you might benefit from anti-wrinkle injections. It helps weaken the muscle that can contract excessively and cause these lines. The dose and location can be tailored to your needs.

Medical grade creams and peels.

Prevention is the key to successful treatment. Medical grade topical treatments are best for treating fine lines. Creams that hydrate the skin and include retinol and c-esta can do a lot to reverse thin crepey lower eyelid skin. This can be combined with a peel after proper skin preparation.

Double eyelid surgery

Patients who have this procedure do not wish to have a Caucasian eye. What they seek is an eyelid crease. This procedure is performed very carefully. After identification of any asymmetry, measurements are performed and an operation is tailored depending on your wants and what you need.

In addition to the reaction of a crease, your operation may include

1. Elimination of any additional creases that may be present
2. Removal or suspension of excess fat
3. Treatment of any excess muscle
4. Treatment of any excess skin
5. Treatment of ptosis or eyelid malposition

This procedure can be performed under local anaesthetic in the rooms or under sedation in hospital. It takes around 1-2 hours and is performed as day stay. The sutures are removed after one week. Recovery takes 1 week and return to exercise in 2 weeks.