What is Blepharoplasty (Eyelid Surgery)?


As we age eyelids can sag and droop and the loose skin around the eyes can result in eyes looking tired or sad. This can make your appearance older than you really are.


Fortunately, with modern treatments and advances in eyelid rejuvenation you can restore a more alert and healthy look to your eyes. Eyelid surgery has become one of the most common cosmetic procedures for both men and women because of the simplicity of the procedure and the excellent results achieved.


Eyelid surgery is a simple cosmetic surgical procedure that removes excess skin by excision. If there is excess fat, this is also removed simultaneously. In some cases patients may need the procedure on both the upper and lower eyelids. Depending on health and other factors, the benefits of eyelid surgery can last up to ten years.

Blepharoplasty at Prèface Cosmetic


Prèface Cosmetic provides the option of Blepharoplasty (Eyelid Surgery) for individuals at both our clinics in Newcastle and East Maitland.


The procedure can be performed in or out of hospital and general anaesthesia is usually not required. A mild sedative and local anaesthetic is often the preferred option. The procedure normally takes about an hour.


Blepharoplasty entails the removal of surplus tissue surrounding the eyelids. Blepharoplasty can be divided into:


  • Upper Lid Blepharoplasty
  • Lower Lid Blepharoplasty

Upper Lid Blepharoplasty


An Upper Lid Blepharoplasty refers to the removal of skin, muscle and fat from the upper eyelids.


Upper Lid Blepharoplasty may be enhanced with a Brow Lift and/or Sub-Brow Fat Sculpting. This may be performed using C02 laser, which minimises scarring, post-operative bruising and swelling.

Lower Lid Blepharoplasty

Lower Lid Blepharoplasty


Lower Lid Blepharoplasty refers to removing excess tissue of the lower eyelids. This procedure is common as the delicate under eye skin is prone to becoming lax, causing wrinkling. In addition, excess tissues prolapse underneath the lids and are sometimes referred to as ‘bags’.


The cause of under eyelid ‘bags’ is usually a combination of fat and fluid that is often very difficult to treat. Often the fat can be lysed and left to absorb by the body using a procedure called laser liposuction.


In addition to Blepharoplasty surgery, adjunctive procedures such as C02 laser resurfacing and radiofrequency resurfacing can be effective in helping to reduce scarring and reduce wrinkling and fine lines around the eyelids.

Frequently Asked Questions About Blepharoplasty


Below are some of the most frequently asked questions about Blepharoplasty (eyelid surgery). The information presented here is general in nature and your specific concerns will be discussed in detail at your consultation with Dr Hollenbach.

Why is Blepharoplasty a popular facial cosmetic surgery?

Generally speaking excess skin appears around the eyelids as we age. This is due to many factors. A major factor is the loss of collagen we experience as we age, combined with the loss of elasticity of our tissues.


The brows begin to droop. Here, fat beneath the brow, which is called ‘Sub-Brow fat’ falls down with the brows, pushing weight on the upper eyelids and the skin itself stretches.


Eyelid skin is the thinnest in the body and with time this stretching causes unwanted skin in the upper eyelid. This redundant skin is called Dermatochalasis, which often abuts on the eyelashes and pushes them down, obscuring the vision particularly superiorly and to the sides. The skin often is more lax towards the outside of the eyelids acting as a type of blinker as the skin droops down towards the outer side of the eyelids, diminishing side vision.


When upper lid Blepharoplasties are performed, skin is excised as well as some muscle and even some fat which can often prolapse, especially in the inner corner of the eyelid just outside the bridge of the nose causing a very lumpy appearance.

What are some adjunctive procedures of Blepharoplasty?

There are several surgical and non-surgical procedures that can be combined with a Blepharoplasty, depending on a patient’s concerns and desired outcomes.


These may include:

Why a Specialist Ophthalmic Surgeon is the best type of surgeon to perform a Blepharoplasty

It is important that a thorough knowledge of anatomy is undertaken and this is why a Specialist Ophthalmic Surgeon is the right surgeon to undertake this type of procedure.


The advantage of having a Specialist Ophthalmic Surgeon doing the procedure is that your eye health is checked before any procedure is undertaken. This includes checking your vision, looking at the health of your eyes and in particular testing for dry eye, which can be exacerbated after the procedure. This occurs because the blinking mechanism is interfered with during surgery and takes time to recover. If you have dry eye before the surgery, this can worsen after the surgery and this is therefore important to make sure this is assessed properly. Even if you don’t have dry eye prior to surgery you may feel some grittiness afterwards and need lubricants. Lagophathalmos or the inability to close the eyelids needs to be checked prior to surgery to avoid any postoperative disasters caused by the inability to keep the eyelids closed. This means not too much skin can be taken at the time of surgery and therefore the experience of a Specialist Ophthalmic Surgeon is advantageous.


A Specialist Ophthalmic Surgeon such as Dr Hollenbach will be go through the protocol for making sure your eyes stay comfortable after the procedure.


A Specialist Ophthalmic Surgeon is again the ideal surgeon to do a lower lid Blepharoplasty as there have been too many instances where lower lid Blepharoplasties have led to pulling out of the lower lids referred to as Ectropion due to too much skin having been removed. This is often very difficult to correct and it is very important that an experienced surgeon performs the procedure such as Dr Hollenbach, as they generally know how much skin is safe to take. Furthermore, paralysis of the lower lid eye muscles is not unknown. This unfortunate complication is again best dealt with by a Specialist Ophthalmic Surgeon. There are of course other techniques, which can lessen the amount of skin to be taken, whilst achieving a natural look.


If eye bags are the primary concern, this surgery can be performed through the eyelids without the need to remove any skin at all.

Who is an ideal candidate for Blepharoplasty?

The most important aspect of any surgery is to make sure that the proper surgery is done in the first place. There is no point in doing a Blepharoplasty on someone who has Brow Ptosis and even though this is a much more expensive procedure, often times it is in fact the Brow Ptosis which gives a heaviness of the upper lids, rather than excess skin which is called Dermatochalasis. This needs to be properly assessed at the time of the initial consultation. Often the Brow Lift is combined with a Blepharoplasty and sometimes a Brow Lift alone is more appropriate. Again a Specialist Ophthalmic Surgeon is the one with the most experience to help you make this decision.


Similarly if there is Midface Ptosis, it may be appropriate to do a Mid-Face Lift or a Cheek Lift at the time of doing a lower lid Blepharoplasty. It may also be prudent to do a fat transfer to volumise the cheeks. At the same time, Cheek Lifting can be done with absorbable threads or can be done with more formal techniques of Mid-Face Lifting. Mid-face lifting includes the use of Endotine, which is an absorbable anchoring device designed to hold the cheek up. Cheek implants may also be considered.


Many potential candidates who see me for Blepharoplasty are young or middle aged. This is driven through media, both social media and more formal advertising media. Dr Hollenbach thinks that one should be circumspect. He would not consider doing Blepharoplasties on anyone under the age of 30, unless it was absolutely necessary in terms of vision being compromised by excess skin. He actually can not remember any such case.


Dr Hollenbach believes Blepharoplasty can be done if needed after the age of 30 and of course the older one gets, the more skin is present and so there is no upper age limit for the procedure.


It should be noted that if the upper eyelid skin abuts the lashes, then the term functional Blepharoplasty is used where it becomes a medical procedure and not a cosmetic procedure. This can be partly covered under Medicare.

What are the risks involved with Blepharoplasty?

Like all surgical procedures, blepharoplasty surgery carries risks. It’s important to be aware of common risks so you are able to weigh up the benefits, risks and limitations of the surgery. Below is a list of possible complications and specific risks for blepharoplasty surgery. General risks and complications of surgery can be found here. There may be complications that are not listed here and some lifestyle factors and medical conditions can cause greater risks.


The most serious risk is visual loss due to bleeding behind the eyeball. This is called a Retrobulbar Haemorrhage and is extremely rare. If you are on blood thinners this should be stopped prior to the surgery after discussion with the surgeon and your general practitioner.


Risks of blepharoplasty surgery:

  • Lagophthalmos and inability to close the eyelids
  • Post-operative asymmetry
  • Dry Eye Syndrome
  • Transient numbness around the eyelashes
  • Upper lid ptosis
  • Infection
  • Post-operative bleeding
  • Scarring
  • Allergic reactions
  • Bleeding
  • Swelling and bruising

What is recovery from Blepharoplasty like?

As with many procedures, surgical wounds usually take 1-2 weeks to heal. Sutures are removed at that time or are often left to dissolve and absorbed by the body, which may take up to 8 weeks.


There will be some bruising and swelling, which generally subsides about 1-2 weeks after the operation. Keeping your head elevated, posturing and applying cold compress immediately after surgery are paramount in minimising pain and swelling. It may take up to 3 months for everything to settle down and swelling can persist over this period.


At Prèface Cosmetic we provide patients with tailored recovery programs to reduce post-operative bruising and swelling. This may include the use of LED lights or laser treatments to absorb blood from bruising. Silicon scar gels may also reduce scarring and platelet therapy can aid with healing and reduce persistent swelling


Swimming, physical exercise and heavy lifting is to be avoided for two weeks. Mineral makeups can commence a few days after surgery if you so desire.

What is the cost of Blepharoplasty?

The costs of Blepharoplasty vary depending on whether it is upper lid or lower lid and whether any adjunctive procedures are performed. It also depends whether the surgery is covered by your health insurer or Medicare.


These costs will be given to you at the time of your initial consultation and should be discussed further with Dr. Hollenbach.

Before and After Blepharoplasty Surgery


Below is a gallery of before and after images of patients who have undergone Blepharoplasty surgery at Prèface Cosmetic.


Results and recovery will vary patient to patient according to factors including genetics, age, diet and exercise.

Blepharoplasty Surgery at Prèface Cosmetic Newcastle & East Maitland Clinics


All options for surgery will be discussed with you at your consultation.


Like other clinics, Blepharoplasties can be performed with sedation and local anaesthesia in a small operating theatre within Dr Hollenbach’s rooms. Patients are discharged the same day. Alternatively, the procedure can be done in a private hospital with an anaesthetist.


Dr. Hollenbach also offers non-surgical alternatives to blepharoplasty using our Fraxel re:pair CO2 laser, which can be used to perform skin resurfacing around the eyelids or the full face as part of the Blepharoplasty procedure.

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