During The Operation : Double Eyelid Surgery

1.What are the types of Upper Blepharoplasty or Upper Eyelid Surgery?

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.

2. How does ageing affect my upper eyelids?

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

3. How does ageing affect my eyebrows?

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.

4. Will a skin only upper blepharoplasty or skin only upper eyelid surgery be enough?

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.

5. How does ageing affect my lower eyelids?

  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

6. What is involved in a lower blepharoplasty or lower eyelid surgery?

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.