Blepharoplasty – Upper Eyelids

1. What is Upper Eyelid Blepharoplasty?

Our eyes are one of the first places to show signs of ageing. For some of us, excess skin and fat on our upper eyelids can create a heavy-looking aged appearance and puffiness, and in some cases even block our vision. Blepharoplasty Sydney expert Dr. Angelo Tsirbas can reverse these changes and restore a more youthful and rested appearance.

Upper Eyelid Blepharoplasty is known as cosmetic eyelid surgery. The word Blepharoplasty comes from the Ancient Greek language: blepheron meaning ‘eyelid’ and plassein meaning ‘to mold or give form’. It is one of the most common cosmetic procedures performed in facial plastic surgery today.

2. Why should I see an Oculoplastic Surgeon?

Oculoplastic Surgery is also known as Ophthalmic Plastic and Reconstructive, Oculofacial or Eye Plastic Surgery. It is a surgical sub-specialty of Ophthalmology that deals with the medical and surgical management of deformities and abnormalities of the eyelids, lacrimal (tear) system, orbit (bony socket) and the adjacent face.

Oculoplastic Surgeons who specialise in Blepharoplasty have taken their area of expertise one step further, devoting their skills purely to cosmetic eyelid surgery. Because such advanced training and experience is required in the areas of Opthalmology, cosmetic and corrective eyelid surgery, these specialists are rare and provide patients with the comfort they are dealing with an absolute expert in the field of cosmetic and functional eyelid surgery.

3. What are the advantages of having blepharoplasty performed by an Oculoplastic specialist?

Many plastic surgeons perform the Blepharoplasty procedure in the same manner for all patients. This is like visiting a hairstylist who can only cut your hair in one way. The Art of Blepharoplasty needs to be refined and customised for each patient individually. As recent as 10 years ago and even today, excessive orbital fatty tissue was removed as part of the blepharoplasty procedure, resulting in periorbital hollowness and an ill appearance. Today we know that youthful eyes are open and full. This is why I, as an Oculoplastic surgeon, customise the treatment plan for each of my patients individually to achieve a youthful harmonious outcome.

4. I can’t put my eye makeup on like I used to, will cosmetic eyelid surgery help?

Absolutely. This is one of the most common complaints that we hear in our practice. As mentioned previously the redundant skin that develops as we age usually causes the makeup to smear. After surgery most of our patients are not only ecstatic about how they look, but are also thrilled that they don’t have to worry about this problem anymore.

5. Will there be a scar on my eyelids?

The incision on the upper eyelids is made on the eyelid crease, so not only is it hidden, but it also heals very nicely. Scars happen when the surgeon operating on the eyelids is not familiar or does not have much experience with operating on this area. Because of my specialisation in Oculoplastic surgery, you can rest assured that you will have an expert working on your eyes.

Blepharoplasty Dr Angelo attending to patients

Blepharoplasty – Lower Eyelid Bags and Dark Circles

Lower eyelid “bags” and “dark circles” are two of the most common reasons patients see me for a consultation. Each patient will have a different story and presentation, although most patients have the same common complaint, “over the past few years I’ve noticed these dark circles and bags, which I didn’t have before, and they make me look and feel tired”. Another common complaint is that “I’m tired of people telling me I look tired”. As you will see in this section, there are multiple reasons for the development of dark circles and lower eyelid bags. Any rejuvenation plan needs to consider all the variables and design an individualised plan for each patient. Unfortunately, general plastic surgeons performing surgeries on multiple areas of the body will not be dedicated to surgery in the delicate orbital area, and will therefore be unable to tailor this surgery to each patients individual needs. As you will see, not everyone will need surgery, and not everyone can be helped with non-invasive means of treatment either. In our practice there are more than 30 ways to rejuvenate the lower eyelids alone, and the best treatment for you will be different than your best friend’s or neighbour’s.

1. What are the different variables associated with lower eyelids and ageing?

Genetics: The blue print of life is handed down from our parents. Thus, it is very common that most patients will say that “I have my dad’s, mom’s, or some other relative’s eyes”. Although we don’t have any choice in this matter, it is an important part of our initial consult with you.

Anatomical differences: Variations in our anatomy such as the position of the upper and lower eyelids, angle of the corner of the eyes, position of the brow, cheek and forehead, and prominence of the eyes are very important things to consider. For example some people have very prominent eyes, and will need a different treatment than someone who has deep set eyes. The ageing process will be significantly different depending on the anatomical differences between each individual. During your initial consultation as part of the exam, these specific differences will be noted to create an individualised plan for you.

Skin changes: As part of the ageing process our skin atrophies (becomes thin) and loses its strength. Also, because of frequent eye rubbing, the skin stretches and thus we develop excess skin on both the upper and lower eyelids.

Herniation of orbital fat: There is a structure called the septum in the eyelids that helps prevent the content in the eye socket from moving forward. Part of the reason we get lower eyelid bags is that this structure gets weak with time and the fat that should normally be in the eye socket moves forward.

Loss of volume: As part of the ageing process we continue to lose volume in the face. In some people this is a major part of why they get “bags” underneath their eyes. During the initial evaluation we need to determine this important variable.

Descent of the mid-face or cheeks: Because of the effects of gravity as we age, the tissue around the face drops. This contributes to making the “lower eyelid bags” even more prominent.

Lack of sleep: The process of sleeping is not only important for our body and mind to rest but it is essential in getting rid of waste build up and in the rehydration of facial tissue. It is recommended that everyone sleep at least 7 hours per night. Studies have shown that diuretics such as coffee and alcohol, combined with lack of sleep, will lead to significant accelerated ageing.

Sun exposure: It is never too late to start using good sunscreen. Sun exposure not only can lead to skin cancer but it can significantly accelerate the ageing process. We recommend SPF of 25 + for everyone every day. You also want to make sure the product you use has both UV-A and UV-B protection.

Diet: “Green vegetables can essentially cure everything”. This is true in a sense that green vegetables have tons of antioxidants and other nutrients that slow down the process of ageing. A balanced diet is essential.

Allergens: If at times your eyelids swell, itch or turn red, it is possible that you may be allergic to something. This process can lead to worsening of the lower lid bags and dark circles.

2. Why do I have lower eyelid bags?

Make sure you read the previous question. Lower eyelid bags happen because of herniation of eye socket fat, loss of volume in the face, gravity effects, tissue dehydration and stretching of the skin.

3. Are there creams that can help with the dark circles?

There are a multiple reasons people get dark circles underneath their eyes, including genetics, lower eyelid position, lower eyelid bags, allergens, sun exposure, previous trauma, and loss of volume in the cheeks. Identifying the underlying cause is the most important and effective way to treat them. During the initial consultation I will identify the cause and will identify your required treatment. If a specific eye cream is needed I will recommend it for you.

Surgery

1. I’m young and I don’t think I am ready for surgery. Is there anything less invasive?

Yes, in fact about 50% of the patients that see us for eye rejuvenation will not need surgery and they will benefit from minimally invasive procedures such as volume restoration (dermal fillers), anti-wrinkle injections, peels and eye creams.

2. What are the surgical options for lower eyelid surgery?

Transconjunctival Lower lid Blepharoplasty involves making the incision behind the eyelid. This is the most ideal procedure for younger patients or those with very little redundant skin on the lower eyelid. The incision is then used to access the prolapsed orbital fat for repositioning or removal. If the patient has redundant skin, a pinch of skin could be removed, or the patient may need lasers or chemical peels to address this variable.
Transcutaneous Lower Lid Blepharoplasty: The incision is made about 1 to 2 mm below the eyelashes on the lower eyelid. This procedure is best performed on older patients or those that may have significant redundant skin.

3. What other procedures can be combined with blepharoplasty?

Because of their close proximity to the eyelids, the eyebrows and cheeks play an important role in the final aesthetic outcome of the procedure. During the initial evaluation, depending on your needs, a brow-lift/forehead lift or a mid-facelift procedure might be recommended in combination with the blepharoplasty.

4. How long does the surgery take?

A typical primary eyelid surgery takes between one to two hours.

5. What type of anaesthesia is used?

Blepharoplasty can be performed under local anaesthesia with sedation rather than general anaesthesia. This type of anaesthesia is performed by an anaesthetist, and its main advantages are: (1) it does not require inserting a breathing tube in the throat, (2) it does not require a breathing machine, (3) the recovery is much faster, and (4) there is less nausea after surgery. All of these elements translate into greater comfort and safety.

During the anaesthesia, an intravenous needle is placed into one of the veins of the arm or hand. Relaxing medication is given to make the patient fall asleep. The amount of medication is adjusted as needed. After the patient is asleep, numbing medicine is placed in the skin of the area that is being operated on. During the procedure, the patient is unaware of anything going on and cannot hear anything, yet he or she is breathing normally. We always use a specialist anaesthetist to monitor our patients during surgery.

Recovery

1. What is recovery like?

After the procedure you will likely experience some discomfort and the upper eyelid/s may feel ‘tight’. This sensation should resolve within a few days. The elevation of the eyelid will often be immediately noticeable, though in some cases the bruising and swelling associated with the surgery will obscure this finding. The bruising and swelling will usually resolve in 2-3 weeks. Ice packs are recommended for the first 5 days to decrease swelling and most patients can return to work after 12 to 14 days.

What other costs will I have to pay?

1. How much does Blepharoplasty Surgery with Dr Angelo Tsirbas cost?

There is no set fee for cosmetic blepharoplasty. The cost is determined case by case according to the degree of difficulty. A range for an upper lid cosmetic blepharoplasty is $5000 – $7000. Lower lid blepharoplasty can range from $6000 to $8000.

2. Are there other costs that I am responsible for?

The patient is also responsible for paying the Anaesthetist and hospital. These fees are separate to the surgical fee.

All fees are paid two weeks prior to surgery.

3. Does insurance cover this?

Your health insurance may cover the cost of upper eyelid surgery if it is causing problems with your vision. After your initial consultation, I will be able to tell you if you may be eligible and if further tests are necessary to determine eligibility. Any cosmetic procedure is not covered by private health cover.