Blepharoplasty (eyelid surgery)

Blepharoplasty is surgery on the upper or lower eyelids, or both. It removes or repositions excess skin and fat and, where appropriate, supports the structures around the eyelid.

Also called cosmetic eye surgery, eyelid surgery, or upper and lower blepharoplasty. Me Clinic offers blepharoplasty in Melbourne and Tasmania, performed by Specialist Plastic Surgeons.

Upper and lower are different operations

Upper blepharoplasty

Removes excess skin and refines small fat pads through an incision placed in the natural eyelid crease. It addresses hooding of the upper lid and restores a visible lid platform while keeping the natural eye shape. See upper blepharoplasty.

Lower blepharoplasty

Addresses under-eye bags and the lid-cheek transition. Lower eyelid fat is often repositioned rather than simply removed, to reduce bulging while filling the hollow below it and softening shadowing. See lower blepharoplasty.

Many patients treat both in a single procedure - one anaesthetic, one recovery, and generally a lower total cost than two separate operations. Others need only one, depending on their anatomy.

The distinction that determines whether surgery will help

Heaviness around the eyes has more than one cause, and eyelid surgery only addresses some of them:

Excess eyelid skin and prominent fat pads - what blepharoplasty addresses.
Descended brows - if the brow has dropped, the upper lid looks crowded even where eyelid skin is normal. Operating on the lid alone in that situation can make the brow look heavier. This is a brow lift problem.
Ptosis - drooping of the eyelid itself due to weakness of the muscle that lifts it. This is a different operation to removing skin, and doing the wrong one leaves the eye still drooping.
Under-eye hollowing or pigmentation - dark circles caused by shadow or pigment rather than by fat bulging. Surgery may not change these.

A proper assessment separates these. Where several are present, more than one procedure may be needed.

Why eyelid changes develop

Ageing and genetics reduce skin elasticity and shift the fat around the eyes. Sun exposure, allergies, fluid retention and brow descent all contribute. Eyelid anatomy varies widely between individuals - some notice changes in their thirties, others much later.

What the procedure involves

Blepharoplasty is generally performed under local anaesthesia with sedation, or under general anaesthesia where appropriate. It is a day procedure - most people go home the same day, accompanied by a support person. Surgery takes approximately one to three hours depending on whether the upper lids, lower lids or both are treated. Me Clinic performs these procedures at Glenferrie or Masada.

On the day, measurements and crease markings are confirmed while you are sitting upright, so the plan reflects how your lids sit in a natural position.

Upper eyelids - the incision sits in the natural crease, where the resulting scar is concealed.
Lower eyelids - access is either from inside the lid (transconjunctival, leaving no external scar) where skin quality is good, or just beneath the lashes (a fine subciliary or skin-pinch incision) where skin also needs tightening.

Excess skin is trimmed and fat pockets conservatively removed or repositioned. Fine sutures close the incisions, and ointment and cool packs are applied before discharge.

Recovery

First 48 hours - cool compresses, head elevation, and frequent lubricating drops or ointment as directed.
Bruising and swelling - typically peak at two to three days and improve over one to two weeks. The area around the eyes may be bruised and swollen for 7 to 14 days.
Sutures - removed at around day five to seven, or dissolve.
First check-up - the day after the procedure at the clinic.
Work - many people return to desk-based work in 7 to 10 days. Allow longer for physical or public-facing work.
Exercise - avoid strenuous activity for around two weeks.
Vision - temporary blurring from ointment and swelling is common. Protect eyes from wind and sun.
Makeup and contact lenses - typically after review, often around one to two weeks for makeup, and contacts once comfortable and approved.
Swimming - avoid until healing is complete, because of infection risk.

Skin generally heals within two to three weeks. Healing times vary; follow your written post-operative plan and attend all reviews. An after-hours contact number is provided.

Costs

Upper blepharoplasty - $8,000 to $12,000
Lower blepharoplasty - $9,000 to $13,000
Upper and lower together - $15,000 to $18,000

The quoted price includes fees for the surgeon, assistant if required, hospital, anaesthesia, recovery care and follow-up. A personalised quote is provided at consultation.

As at September 2024 and including GST, a consultation with a Specialist Plastic Surgeon is $350. You need a referral from your GP to see one of our plastic surgeons - a requirement for all cosmetic surgery since 1 July 2023 - and appointments are generally available within 7 to 14 days. Payment for major surgery is due four weeks before the procedure.

Medicare

Purely cosmetic eyelid surgery is not covered by Medicare. Where overhanging upper eyelid skin is documented to impair the upper visual field, MBS item 45618 may apply and a partial rebate may be available. Strict criteria apply and formal visual field assessment is required. Your surgeon determines eligibility at consultation; a valid referral is required.

Me Clinic is not a no-gap provider, so out-of-pocket costs apply even where a rebate is available. See does Medicare cover my surgery.

Non-surgical alternatives

Anti-wrinkle injections around the eye area can relax the muscles that pull the brow downward, allowing the forehead muscles to lift the brow slightly. The change is usually a few millimetres, takes about 10 minutes to perform, appears over 10 to 14 days and typically lasts three to six months.

This is a modest and temporary change. It does not remove excess skin or fat, and it is not equivalent to surgery. Where hooding is significant, it will not achieve the same thing - and knowing that before you start a course of treatment saves money.

Dermal fillers can soften an under-eye hollow, but the under-eye is a technically demanding area with a higher rate of visible complications and its own vascular risk.

Risks

All surgical procedures carry risks and potential complications. For blepharoplasty these include:

Infection
Bleeding and haematoma
Scarring - visible or thickened scars
Dry eye, grittiness and irritation, which can be persistent
Difficulty closing the eyes fully (lagophthalmos), which can lead to corneal exposure and damage
Ectropion or lid retraction - the lower lid pulling away from or down from the eye, a recognised complication of lower blepharoplasty that may need further surgery
Asymmetry between the two sides
Over-correction, producing a hollowed or startled appearance, or under-correction
Changes in sensation of the eyelid
Double or blurred vision
Loss of vision - rare, generally caused by bleeding behind the eye, and a surgical emergency
Anaesthesia complications
An unsatisfactory result and the possible need for revision surgery

Seek urgent medical attention after eyelid surgery for severe or increasing pain, rapidly increasing swelling or bruising, or any loss or change of vision.

Please read our information on the risks and complications of cosmetic surgery before proceeding.

Experience and choosing a surgeon

Me Clinic has over 35 years of experience in cosmetic surgery and has performed over 5,000 cosmetic eye procedures since the 1980s.

Specialist Plastic Surgeon is a protected title in Australia, held by doctors who have completed accredited surgical training and are Fellows of the Royal Australasian College of Surgeons. You can check any practitioner's registration free of charge on the AHPRA public register.

Me Clinic also offers upper eyelid ptosis correction, brow lift, facelift, thread lift, dermal fillers and laser skin resurfacing.

Booking

Contact Me Clinic via the contact form or phone 1300 852 050. Me Clinic is at 4 Burke Road, Malvern East VIC 3145, five minutes' walk from Caulfield station.

See upper blepharoplasty, lower blepharoplasty, before and after, brow lift, or all face procedures.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.