Excess upper eyelid skin can increase the perception of age, and can even lead to restricted vision by physically blocking the eye. Some people can also have an excess of fatty tissue that makes the eye seem ‘puffy’, and this is when Blepharoplasty can be performed.

Excess fat deposits and drooping skin under the eyes (‘bags’) can make a person look permanently tired and aged. When the lower lid droops significantly, the delicate ‘white’ of the eye can be exposed, causing discomfort and pain.

Both Upper and Lower Blepharoplasty remove the excess skin and/or fat deposits and help to restore firm, healthy skin around your eyes, giving you a revitalised, more youthful expression.

Blepharoplasty can be performed under local anaesthetic.

Blepharoplasty is very delicate surgery, and your commitment to following all the instructions for post-surgery care will help ensure the best result.

Blepharoplasty in Detail

Patient Journey

The Operation

  • The ‘ellipse’ of extra skin (the skin to be removed) from the upper eyelid is marked out while in a sitting position. The bottom edge of the ellipse follows the line of the natural eyelid crease, and extends from the area just above the tear duct along to the outer edge of the eyelid opening, where it then angles slightly up and outward into an existing laugh line.
  • Incisions are carefully placed so that within several months, they will hardly be visible. On the upper lids, the incision is about an inch long and lies in the fold of the eyelid. On the lower lids, the incision is made just under the lashes in the natural crease.
  • The skin above the incision is gently pinched while the eyes are closed to determine the maximum amount of skin that can safely be removed without pulling up on the upper eyelid margin or down on the brow. To avoid a ‘stark’ outcome, the actual amount of skin removed is always a little less.
  • Upper eyelid skin is removed using a scalpel, fine scissors and forceps (laser is not used, as this may result in a more obvious final scar). Very occasionally, the underlying orbicularis muscle might be overdeveloped or stretched; if this is the case, there may be some slight trimming. If there is ‘orbital’ fat bulging, a structural layer known as the orbital septum is opened. One or both fat pads will be thinned slightly (over-thinning would lead to hollowing.) The upper eyelid’s opening muscle (elevator muscle complex) is located below the fat. It is identified and then carefully avoided during Blepharoplasty surgery.
  • Lower eyelid skin and muscle fibres are removed along with the puffy, fatty tissue.
  • Bleeding is meticulously controlled. The skin incision is closed using a very fine continuous suture that runs just under the skin. If there is no fat bulging, the orbital septum is left intact and no fat is removed from the middle pocket. At Brisbane Cosmetic Clinic, ‘Tissue-sparing Blepharoplasty‘ has become the rule rather than the exception as we aim for the most natural and pleasing result possible.

Post-Operation

  • This is an outpatient procedure, which means you go home on the same day. You must organise for someone to drive you home and to stay with you for the first 24 hours after eyelid surgery. You will not be discharged from the hospital unless there is someone to pick you up, and you should not take public transport.
  • You should expect mild pain, which can be controlled with prescription oral pain medication. After about three days, you will probably no longer require prescription pain medication.
  • Swelling and bruising improve within 7 – 14 days, depending on the extent of the Blepharoplasty surgery. The bruising first moves down into the cheek and even the neck before fading. Light camouflage creams containing ‘green’ colour help to hide bruising on the cheeks, but you should not apply this to the eye area for the first 10 – 14 days. Bandages are not used.
  • Glasses may be worn immediately, but you should wait 7 – 14 days to wear contact lenses. You must wait 10 – 14 days before using eye makeup.
  • You must avoid homeopathic remedies and medicines, which promote fast healing, as these could actually leave you with more obvious scarring.
  • You will be presentable in public in 7 – 14 days, depending on the extent of the eyelid surgery. You may feel capable of returning to work in 7 days, but your appearance may be a limiting factor. You may resume exercise in two weeks. You must wear sun protection for at least six months, although we encourage you to use it permanently (SPF 30+).
  • You should see your final result in 3 – 6 weeks, and the scars should fade significantly within six months.

Reducing Swelling and Bruising:

  • If you leave the operating theatre without an eye pad, begin ice pack treatment as soon as possible after you get home.
  • If you leave the operating theatre with an eye pad, leave it intact until instructed to remove it by the Doctor. Once the eye pad has been removed, start ice pack treatment as soon as possible.
  • Sit upright as much as possible during the day and sleep propped up to about 45 degrees for the first few days after surgery. This improves circulation, reduces swelling and aids lymphatic drainage.

Ice Pack Treatment:

  • Specially designed masks are available from chemists. You need to purchase several so there is always one cooled and ready for use. Alternatively, a small bag of frozen peas or similar product wrapped in a clean cotton cloth will make a good ice pack. If ice cubes are used, they need to be in a non-leaking clear plastic bag.
  • While sitting upright, put some clean gauze over the eyelids, then apply the ice pack. This can feel very cold, and you need to hold a cloth in your hand, or wrapped around your head in order to secure the pack
  • Try to keep the ice pack applied to your eye for 45 minutes of every hour during waking hours if possible. If you cannot manage this, anything longer than 15 minutes every hour is satisfactory.
  • Continue the ice pack applications for three days after Blepharoplasty surgery.

Reducing Swelling and Bruising:

  • If you leave the operating theatre without an eye pad, begin icepack treatment as soon as possible after you get home.
  • If you leave the operating theatre with an eye pad, leave it intact until instructed to remove it by the Doctor. Once the eye pad has been removed, start icepack treatment as soon as possible.

Warm Compresses

  • On the fourth day after eyelid surgery, switch to warm flannel applications for 15 minutes every hour until the swelling and bruising has settled. Use boiled water, cooled to comfortable hand temperature, applied on a clean flannel or sterile gauze swabs.
  • Continue for four days, or until the bruising has subsided.

Eyelid Cleaning:

  • Always wash your hands first!
  • The first eyelid clean is done when the eye pad is removed (the first dressing), or approximately 12 hours after Blepharoplasty surgery.
  • Use sterile gauze squares and saline solution. Either purchase sachets of saline or make up a simple solution with one teaspoon of salt in a litre of water that has been boiled. Leave to cool before use and make up a new batch for each use.
  • Soak the gauze swabs in the saline and place on the eyelids to remove superficial debris.
  • Dab the eyelids, moving the gauze horizontally across the eyelid and avoiding the eye. Go from the nose end (medial) to the outside corner (lateral). Clean the eyelashes from their base to tips.
  • After the first clean, continue twice daily cleans for one week, then once daily for the second week.

Sutures (Stitches)

  • The sutures used are quite secure, but still be gentle!
  • If ‘absorbable sutures’ have been used, these may not require removing.
  • Sometimes, even when ‘absorbable’ sutures have been used, Dr Konrat may decide to remove them between 4 and 21 days after eyelid surgery.
  • If ‘permanent’ or ‘non-absorbable’ sutures are used, Dr Konrat will remove them between 4 and 21 days after surgery.
  • If a stitch breaks and the wound opens, or your vision blurs, or there is bleeding, discharge or excessive pain, you must contact Dr Konrat immediately.

Possible Risks & Complications

RISKS SPECIFIC TO BLEPHAROPLASTY SURGERY

Blindness

This is rare: it occurs in fewer than 1 in 10,000 people who undergo blepheroplasty. This small risk only applies if you are having fat removed.

Blurred Vision

This is also a very rare problem. It can be caused by irritation, swelling or damage to any of the muscles that surround the eyeball and coordinate its movement. Even if these symptoms occur, they are usually temporary.

Dry Eye Syndrome

A variety of circumstances could cause dry eye syndrome, but it is most often related to lack of lower eyelid support following eyelid surgery, leading to a lower than optimal lower eyelid. This can often be avoided by a special suture that supports the lower eyelid through the healing process (canthopexy).

Inability to Close the Eyes

At times, the removal of too much upper eyelid skin can cause dry eye syndrome. In severe cases, skin grafting may be necessary to correct this problem. Dr Konrat prefers to take less skin than measured, to help avoid this possibility.

Corneal Abrasion

This can occur during any operation, whether it is on the eyes, or any part of the body, because the eyes may sometimes open during Blepharoplasty surgery, rendering them susceptible to being scratched by a member of the operating team. Treatment involves taping the eye shut while it heals.

Hollow (Sunken) Eyes

To help you visualise this condition, find a picture of Mary Tyler Moore. She appears to have had too much fat removed from her eyelids, leaving her with a sunken, hollow appearance. This can usually be prevented by the conservative approach advocated by Dr Konrat.

GENERAL RISKS OF SURGERY

  • This surgery is carried out under local anesthetic, the lowest level of risk.
    • Rarely, a person may have an allergic reaction to the local anesthetic, or experience a rapid heartbeat due to the adrenaline that is used to reduce bleeding.
    • There may be some minor discomfort intermittently throughout the procedure with a local anesthetic.

Mental Health disorders and Elective Surgery

  • It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection.
  • Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and can be stressful.
  • Please discuss openly with Dr Konrat in your consultation prior to surgery, any history of emotional depression or mental health disorders. If you are unsure whether a matter is relevant, please mention it anyway. Although many individuals may benefit psychologically from the results of elective cosmetic surgery, the effects on mental health can never be predicted and could possibly have a negative influence on emotional stability.