BLEPHAROPLASTY (EYELID REDUCTION)

Blepharoplasty, or eyelid reduction surgery, is a procedure offered at our Sydney practice that is designed to improve the contour and appearance of the eyes, as well as providing clearance of sight lines when the excess skin folds of the upper lids are marked enough to affect vision. Blepharoplasty can be performed on both the upper and lower lids.

Excess skin and fat around their eyes can give the appearance of tired or puffy eyes, and eyes may feel heavy towards the end of the day.  This may cause difficulty in reading or performing certain tasks.

Plastic Surgeon Dr Darrell Perkins  has over 25 years’ experience with eyelid surgery, and offers a variety of eyelid surgery techniques to patients from Sutherland Shire, Wollongong, and across New South Wales, for either vision impairment or for cosmetic reasons.

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Overview

Blepharoplasty in the upper eyelids, whether performed for vision impairment or cosmetic reasons, basically involves the same steps. In both circumstances a strip of excess skin and muscle is removed from the surface of the upper eyelid, with the incision made where the ideal fold would lie, usually about 10 millimetres above the eyelashes. This exposes the upper eyelid skin for that distance, and the new fold of the upper eyelid will be repositioned at that point of the incision. Commonly, in patients who request upper lid blepharoplasty, there is bulging of fat at the corner of the eye near the nose and this can be removed as part of the procedure.

A hallmark of lower lid aging is the progressive bulging (herniation) of fat in the lower lid giving a puffy appearance. There can also be excess skin.  Excess skin, if no fat bulging, can be trimmed on the surface. If there is fat bulging, but no excess skin (as common in younger patients who have inherited the trait of puffy eyes), the fat can be removed via an incision inside the lower eyelid so as not to be visible (called transconjunctival excision). If there is both excess skin and fat bulging this can be addressed together with removal of skin and a small window made in the muscle of the lower lid to access the fat pockets for removal.

In the lower lid surgery, always for cosmetic reasons, the potential surgery has to be tailored to correct what the patient is trying to address, and as always married with the actual physical pathology and anatomy that exists in that specific patient.

Thus, there are a variety of procedures that may be applicable in any individual, and experienced preoperative assessment and design of an operation is essential.

The scars from blepharoplasty usually heal well and difficult to perceive even with the closest inspection. The procedure is equally well tolerated by female and male patients, as the scars from surgery are rarely visible and leave no stigma of an operation.

Whether your issue is cosmetic or due to visual impairment, Dr Darrell Perkins is happy to discuss your specific circumstances. Please contact the plastic surgery practice of Dr. Darrell Perkins to schedule an initial consultation for blepharoplasty surgery.

The Surgery

Blepharoplasty is usually performed as day surgery. It has a very high safety to risk profile and upper lid blepharoplasty for visual impairment is generally well tolerated, even in the elderly. The lower lid has potentially more functional issues and caution must be exercised with patient and procedure selection. As always experience of the surgeon and careful assessment of the patient are crucial.

A general anaesthetic is required for lower lid blepharoplasty, but some upper lid blepharoplasty procedures are suitable for local anaesthetic.

Recovery

Upon completion of the surgery cool pads are placed on the patient’s eyes in recovery.

On discharge, post-operative instructions covering wound care, any medications and booked follow up appointment will be given.

It is essential that a responsible adult collect the patient and stay with them for the first 24 hours following the surgery.

In the first few days following surgery patients may experience some mild discomfort. Swelling is normal following the surgery, which may feel as a tightness of the eyes, and this will subside over the first few days to weeks.  Sleeping with the head elevated helps to reduce the swelling.  During this period there will also be some bruising, and makeup can be applied after one week or so to help disguise this.

Strenuous activity should be avoided during the early period.

It is imperative that patients do not smoke after the surgery as it affects the healing process.

Most patients would take 1 – 2 weeks off work, by which time routine activities can generally be resumed.

Any sutures are usually removed at 6 – 7 days (many are dissolvable).

Attendance at your follow up appointments is essential to allow Dr Perkins to guide you through your recovery process.

Risks

Even with the highest standards of practice, all surgical procedures carry a level of risk and the potential for complications. In addition, every individual will have a different risk profile depending on their general health, age and the complexity of the procedure.

During the consultation Dr Perkins will explain the possible complications and risks of the specific procedure to provide the necessary information to enable patients to weigh up the benefits, risks and limitations of the surgery.  The following are some of the risks associated with this procedure.

General risks involved in any surgery include post-operative infection, excessive bleeding, pain/discomfort, adverse reaction to anaesthetic.

Specific risks of surgery include swelling, bruising, numbness, removal of too much skin, asymmetry of the lids, scarring, itchiness or watering or dryness of the eyes, changes in vision, blindness (rare).

Costs

Lower blepharoplasty surgery is classified as cosmetic and as such no Medicare or private health fund rebates apply for the medical or day surgery fees.

If there is significant impairment of vision by the folds of skin of the upper lids there are MBS (Medicare Benefit Schedule) item numbers applicable, making upper lid blepharoplasty a medical procedure, not cosmetic. This has to be formally documented by a test called perimetry, performed usually by your optometrist.

If you feel you meet the criteria for upper lid blepharoplasty, we can send you a request before formal consultation to have the perimetry performed prior to your consultation at our Miranda or Kogarah rooms in Sydney.

An estimate of costs will be provided following the consultation with Dr Perkins.