Dr Naveen Somia
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In 1818, Dr Von Graefe a German Surgeon coined the term ‘Blepharoplasty’ to describe surgical techniques used to repair eyelid deformities following eyelid cancers. But in 2018 in Sydney and in rest of the world, Blepharoplasty refers to cosmetic eyelid surgery or eyelift.

The surgery will rejuvenate your eyelids and give you a fresh and rested look. It reverses the ageing changes by getting rid of loose and excess eyelid skin, correcting droopy or weak upper eyelids and removing eyebags and wrinkles around the upper and lower eyelids to get rid of the tired look.

The surgery can be combined with an eyebrow lift, midface or cheek lift or fat grafting to area around the eyelids and the face for total facial rejuvenation.

A brow lift and an eye lift are two different operations. An eyelift typically refers to upper eyelid surgery or blepharoplasty whereas a brow lift refers to surgery to stabilise and lift the eyebrow. In some patients it may be necessary to perform both these operations to improve vision and appearance.

Doing your own research on the internet is advisable. You can discuss the surgery with your GP and they may be able to recommend a good Plastic Surgeon. You can come and ask me directly any questions you have about this surgery or any other cosmetic treatment at my practices in either Bondi Junction or Bella Vista in an intimate setting.

Most plastic surgeons will have basic information about the surgery on their websites. The Australian Society of Plastic Surgeons (www.plasticsurgery.org.au) and the Australian Society of Aesthetic Plastic Surgeons (www.asaps.org.au) also have some helpful information.

My favourite site is www.realself.com which is like the trip advisor of cosmetic surgery complete with patient stories, experiences and enough information that can help your decision making process. You can view my profile on there too.

The surgery may attract Medicare benefits and private health fund cover if it satisfies certain stringent criteria and is classified as medical, not cosmetic. If your vision is impaired due to malposition of the upper lids, excess skin resting on your eyelashes or a droopy eyelid (Eyelid Ptosis) Medicare and private funds may cover part of the costs. If the surgery is performed to reconstruct cancer defects, improve accidental injuries, birth deformities and eyelid malpositions such as entropion and ectropion it is considered medical and will attract a Medicare benefit and private health cover. In these cases you will be given a Medicare item number after your consultation.

You should check with your private health fund if your plan covers you for the procedure. Health funds have varying levels of cover and if the surgery is for cosmetic purposes, it's not covered.

If you have skin only blepharoplasty then it is unlikely that your wrinkles will disappear. However, if you have a blepharoplasty combined with ptosis correction, some of your forehead wrinkles will soften and may disappear after the surgery. If you combine corrugator muscle resection with the surgery, you can get rid of the frown lines. Crows feet wrinkles can be reduced after the surgery but may not be abolished totally.

Yes they can be done at the same time.This way you have one operation, one recovery period and one anaesthetic but the operation will take longer.

I recommend that you take at least two weeks off work if you are having upper eyelid surgery and three weeks if you are having lower eyelid surgery.

You may choose to go home the same day, provided there is an adult at home who can care for you. However, If it dosen’t cost you extra, I recommend you stay overnight and leave in the morning rested. This will allow you to rest and relax for the crucial 12 hours after the operation.

The trained nurses can provide focused eye care, monitor your vision, ensure that you get eye drops, eye ointment and ice packs and you remain pain free.

There are three types:

1. Skin only Blepharoplasty
2. Comprehensive Blepharoplasty and
3. Comprehensive Blepharoplasty and Ptosis (droopy eyelid) Correction

Skin only - Only the excess upper eyelid skin is removed, usually done under local anaesthesia and takes about 1 hour. Seen in people over 50 years old.

Comprehensive - Treats excess skin and simultaneously addresses deeper tissues such as fat, muscle and connective tissue. Excess skin is one aspect of eyelid ageing but the other aspects such a as excess fat, increased muscle activity and bulk, loose connective tissue, weak tendons and droopy eyebrows are equally important and all need to be addressed for the best results. This can take up to 90 minutes.

Ptosis (droopy eyelid) correction - In this condition, the muscle that opens the upper eyelid becomes overstretched and loses its ability to open the upper eyelid. This is similar to an overstretched rubber band that has lost its elasticity. Surgical tightening of this loose muscle restores the function of this muscle and fixes a droopy eyelid. Since a droopy upper eyelid co exists with multiple ageing changes of the upper eyelid, both these operations can be combined to restore the function and aesthetic of the most important part of your face. This combined operation can take upto two hours.

Ageing changes in your upper eyelids are noticeable in your late 30s or 40s. The 10 most common ageing changes in the upper eyelid are:

1. The eyelid droops with age causing eyelid ptosis
2. The eyelid can move up (eyelid retraction)
3. The eyelid edge can be turned in due to muscle over-activity (entropion)
4. The eyelid edge can be turned out due to muscle weakness (ectropion)
5. The eyelid muscle may be weak or scarred and eyelid closure may be incomplete risking damage to the eye
6. Excessive upper eyelid fullness due to bulging fat
7. Excessive upper eyelids hollow and sunken eyelids due to loss of fat
8. Absent or a very high eyelid crease
9. Asymmetric eyelid crease
10. Uneven eyelid margins

The eyebrows are just like any other structure in the face and are affected by ageing in one of three ways:

1. The eyebrows can raise too high
2. The eyebrows may droop
3. They can become uneven and asymmetric

A very high arched eyebrow is caused by the pull of an overactive forehead or frontalis muscle in response to a droopy eyelid. The treatment is to correct the droopy eyelid.

If the eyebrows are low and droopy then a brow lift done at the time of eyelid surgery is effective. A brow lift can be done either endoscopically, or by an external or internal approach.

If your only problem is excess skin and every other supporting structure of the eyelid is in excellent condition, then a skin-only Blepharoplasty is appropriate. Unfortunately, this only occurs in a small group of patients who are young, when the remaining eyelid tissues are capable of maintaining robust and strong support to the eyelid.

1. Excess thin and crepey skin
2. The lower eyelid can be pulled down (eyelid retraction)
3. The lower eyelid edge can be turned in due to muscle over-activity (entropion)
4. The lower eyelid edge can be turned out due to muscle weakness or scarring from previous eyelid surgery (ectropion)
5. Excessive lower eyelid fullness due to bulging fat causing eyebags
6. Excessive hollowing due to soft tissue volume loss and bony loss
7. Droopy corners of eyelids giving the eyelids a sad look

The surgery removes excess thin and crepey skin from the lower eyelid, removes the eyebags and redistributes bulging fat. It also tightens the supporting ligaments that have weakened with age.

After the operation you will be in the post op recovery area before you go back to the day stay area or your ward. The nurse looking after you will ensure that you are comfortable, pain free and not nauseous, if you aren't feeling well then appropriate medications will be administered. The nurse will check your vision and make sure you can see.

You will be monitored for excessive bruising, bleeding or swelling. Soothing eyedrops will be placed in your eyes, antibiotic eye ointment will be applied to your suture lines and an icepack placed over both your eyes will be replaced as necessary to reduce the swelling and bruising. It is normal to have blurry vision after the operation.

If you have upper eyelid surgery the bruising lasts for one week and noticeable swelling for two weeks. If you have both upper and lower, bruising may last two weeks and noticeable swelling for three weeks. One in ten patients who have the surgery experience bruising around the lower eyelid.

These time frames are relevant only if you are having the surgery the first time. Bruising and swelling in revisional surgery are unpredictable and usually last longer. Although swelling is less noticeable after two weeks, post operative eyelid swelling can linger for 6-12 weeks. It is recommended to wait for 12 weeks to see the final result.

It is important to be healthy in the weeks leading up to your surgery and also after the operation. This will ensure your eyelid tissues heal well. During recovery post surgery eating healthy and drinking plenty of water is essential. A balanced and nutritious diet rich in proteins, vitamins and minerals is critical. In addition, oral medications such as Arnica and Bromelain taken before the operation can help reduce bruising and swelling. Both these can be purchased at your local pharmacy.

Patients describe it as discomfort and tightness rather than pain. Stinging sensation in the suture line and mild pain may be present but this is easily controlled by simple pain medications. It is unlikely that you will have severe pain as less than one in twenty patients require strong pain medications.

No, you will be able to open your eyes, look around as normal and use lubricating and soothing eye drops, antibiotic eye ointment and ice packs for most of the first week following surgery.

It may be blurry due to the swelling in the surface of the eye and the use of lubricating eye drops. Your eyelids will feel heavy and tired after being open for a while. This is due to the heavy and swollen upper eyelids. Fortunately this is transient and usually settles over the next few days.

Maximum swelling is seen on day three, this can be sudden and quite dramatic after minimal swelling for the first two days. Patients frequently interpret this as a worsening of their condition and are concerned. Fortunately this is a normal occurrence and usually resolves over the next few days with rest and regular use of icepacks.

The eyelids will be numb for about 12 -24 hours due to the local anaesthetic used before the operation. Once the effect of the local anaesthesia wears off, normal sensation will return in most areas. The skin between the eyelash and the surgical incision will remain numb and the sensation will gradually return over 12 months. The reduced sensation in that strip of skin can cause an unfamiliar sensation when applying makeup, mascara or eyeshadow..

Most of the sutures are dissolving ones and hence do not need removal however, there are a few sutures that need to be removed at the 7-10 day mark. If dissolving sutures are used in the deep tissues, they take about three months to dissolve.

The first post op visit is 5-7 days after surgery. The second visit is at two weeks and then at six weeks. However if there is a concern or a need, you may be seen earlier or more frequently.

The scar is minimal and well hidden in the natural crease/fold of the upper eyelid. In the lower eyelid the scar is well concealed as it lies 2 mm below the eyelid margin and at the level of the corner of the eye, it is hidden in a natural crease.

Eyelid scars remain raised and slightly red for about 3 –4 months after surgery and then begin to fade and continue to improve for up to 12 months. By 4-6 months the scars are barely visible.

Silicone gel is a good option. However you have to use the right amount so that it does not trickle into the eye and irritate the eye. If you choose silicone gel for the scar, you should use it twice a day for 3-4 months starting three weeks following surgery. If you chose not to use silicone gel, a regular moisturising cream would suffice.

You can use makeup 2-3 weeks after the surgery. Ideally you should avoid using makeup over the suture line as it can irritate it and cause a scar.

The surface of your cornea (the platform on which your contact lens sits on) is swollen following eyelid surgery. It can remain swollen for up to 4-6 weeks, I recommend not using contacts for this time and encourage you to wear a pair of spectacles. If your spectacle frame is rectangular in shape, it can strategically camouflage the eyelid incision and upper eyelid swelling, which is an added benefit.

It is not advisable to engage in strenuous physical activities for at least four weeks after surgery. The only activity permitted during this time is walking. Activities that raise your blood pressure and heart rate increase the risk of swelling in the eyelid and can open up the wound, increase risk of infection and scarring. If you have a history of slow healing or if it is revisional surgery then waiting for six weeks may be advisable.

It is not advisable to swim for at least six weeks following eyelid surgery. Prolonged contact with water in the pool or the ocean can potentially irritate the eye surface, affect the thin eyelid skin and may influence scarring. Swimming goggles can tightly compress the area around the eye and increase the swelling and slow down the healing.