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.

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:

• Fraxel re:pair CO2 Resurfacing Laser
• eTwo Sublative/Sublime
• Thermage
• Pellevé
• Brow Lifting
• Cheek Lifting
• Fat Transfer
• Laser Liposuction

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.

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.

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

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.

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.