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Upper Blepharoplasty (Upper Eyelid Surgery)
Upper blepharoplasty, or upper eyelid surgery, is tailored to your specific needs, whether that involves removing excess skin, muscle or fat. The procedure aims to restore the contour of the upper eyelids and improve your field of vision where heavy skin has begun to block it. It is important to also check for eyelid ptosis, which is different from excess eyelid skin and needs a different operation.
Excess upper lid skin develops as skin loses elasticity and the tissue holding fat within the orbit weakens. The result can be a fold resting on the lashes, a lost eyelid crease and a heavy sensation late in the day. Where upper eyelid skin demonstrably affects the field of vision, a Medicare item number may apply subject to clinical criteria, sometimes including a visual field test.
Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, performs eyelid surgery in Sydney and assesses brow position, eyelid muscle function and tear film before advising how much skin can be removed.
Who it may suit
- Upper eyelid skin that folds onto your lashes or narrows your upper field of vision
- A heavy, tired feeling in the lids when reading or during screen work
- An upper lid crease that has disappeared beneath a fold of skin
- Uneven upper lids, where one side carries more skin than the other
- Adults in stable general and eye health, not smoking, with realistic expectations of what surgery changes
What upper blepharoplasty involves
Upper blepharoplasty is usually day surgery under local anaesthetic with sedation, or general anaesthetic, at an accredited facility such as St Luke’s Hospital in Potts Point, East Sydney Private Hospital, Sydney Day Hospital, The Skin Hospital in Darlinghurst or Double Bay Day Hospital.
- Markings are drawn while you sit upright, so the crease position and the amount of skin to be removed are judged with your brow at rest.
- Anaesthetic is given as agreed beforehand.
- An incision is made within the natural upper lid crease, a measured amount of skin is removed, and a strip of muscle or a small amount of fat is taken only where it contributes to the fullness.
- Both sides are compared during the operation and adjusted for symmetry.
- The incision is closed with fine sutures, then ointment and cold compresses are applied.
Recovery
Most people go home within hours and manage discomfort with simple analgesia. The timeframes below are typical rather than fixed.
- Bruising and oedema usually peak in the first two to three days and settle over roughly two weeks
- Sutures are generally removed at about five to seven days
- Many patients return to desk work within about a week, and to exercise after two to four weeks once cleared
- Vision can be blurry for the first few days from ointment and swelling, so avoid driving until it clears
- Scars sit within the crease and usually fade over several months, continuing to settle for a year or more
Risks and considerations
Risks include bleeding and haematoma, infection, dry or gritty eyes, watering, temporary blurred vision, small suture cysts or milia along the incision, visible or thickened scarring, asymmetry and reaction to anaesthetic. Removing too much skin can leave difficulty closing the eyes fully, and removing too little can leave a residual fold. Rare and serious complications include injury to the eye and loss of vision.
Skin removal does not lift a low lid margin. If ptosis is present and untreated, the eye may still look tired afterwards. Ageing continues, so laxity can return over the years and a further procedure is sometimes needed.
Your consultation with Dr Maryam
A referral from a registered medical practitioner is required before your consultation, and a GP referral is preferred. Dr Maryam examines your lids and brows, measures eyelid muscle function, arranges a visual field test where vision appears affected, and takes preoperative photographs.
Before you decide, the risks, possible complications and alternatives are discussed, including brow surgery, ptosis repair, or choosing not to operate. A cooling-off period of at least seven days applies between consultation and booking surgery. Patients under 18 have a cooling-off period of at least three months and also require assessment by an appropriate registered health practitioner. Enquiries can be made on 1300 067 668.
What actually happens
Your Journey, Step by Step
Before your consultation
Common questions, answered plainly.
What does upper blepharoplasty involve?
Upper blepharoplasty removes excess upper eyelid skin, and where needed a small amount of orbicularis muscle or fat. Measurements are taken with you sitting upright, the incision is planned to sit in the natural lid crease, and fine sutures are used. It is usually performed as day surgery under local anaesthetic with or without sedation, and you go home the same day. Brow position and eyelid function are assessed first, as these affect the plan.
Can upper eyelid surgery improve my field of vision, and would Medicare cover it?
Heavy upper lid skin can hang over the lashes and reduce the upper part of your field of vision. Where there is a documented functional problem, a Medicare item number may apply, and a health fund may contribute if you have appropriate cover. Eligibility depends on clinical criteria, sometimes including a visual field test, so it cannot be assumed. A GP referral is required before your consultation, and the fee structure is explained in writing beforehand.
How long does recovery from upper eyelid surgery take?
Most people are comfortable with simple pain relief and use cool compresses for the first few days. Bruising and oedema are usual and typically settle over one to two weeks, though some people take longer. Sutures are generally removed about five to seven days after upper eyelid surgery. Many people return to desk work within a week and avoid heavy lifting, straining and eye rubbing for a few weeks. Scars usually soften and fade over several months.
What are the risks of upper eyelid surgery, and is ptosis treated at the same time?
Risks include bleeding or haematoma, infection, asymmetry between the two sides, visible or slow-healing scars, dry eyes or irritation, temporary blurred vision, difficulty closing the eye, over-correction or under-correction of skin, and rarely serious complications affecting vision. Ptosis, where the lid margin itself sits low because of levator muscle weakness, is assessed separately and needs a different repair. Skin removal alone will not lift a ptotic lid. Your risks and options are discussed at consultation.
