Eyelid Surgery (Blepharoplasty)

Eyelid surgery can rejuvenate the area surrounding your eyes, and improve the appearance of the eyelids (both upper and lower lids). It may be performed for aesthetic reasons or to address functional impairment, such as obstruction of vision caused by excess upper eyelid skin.

Conditions that may be considered for surgical treatment include:

- Excess or lax upper eyelid skin that alters the eyelid contour and, in some cases, obstructs vision
- Prominent fat deposits that contribute to eyelid puffiness
- Under-eye bags
- Lower eyelid laxity or malposition that exposes the white of the eye below the iris
- Excess lower eyelid skin and fine wrinkles

The appropriate treatment depends on the underlying anatomical cause. Some conditions may require procedures other than, or in addition to, blepharoplasty.

Patient selection and anatomical assessment

Suitability for eyelid surgery is determined through an individual assessment of general health, ocular health, eyelid anatomy and treatment expectations. Relevant considerations include medical conditions that may impair healing, smoking, existing eye conditions and the extent to which the anticipated outcome corresponds to the patient’s goals.

Upper eyelid drooping may result from excess eyelid skin, descent of the forehead and eyebrow, or dysfunction of the structures responsible for elevating the eyelid. Drooping of the eyelid margin, known as eyelid ptosis, requires a distinct assessment and may require a different surgical approach.

The surgeon evaluates the eyelids in relation to the surrounding facial structures before recommending treatment.

Consultation with your plastic surgeon

The consultation includes a discussion of:

- The patient’s concerns, treatment goals and expectations
- Medical conditions, allergies and previous treatments, particularly those involving the eyes
- Current medications, vitamins and herbal supplements
- Alcohol consumption, smoking and other substance use
- Previous surgical procedures

The surgeon also assesses general health and relevant risk factors, documents the eyelid anatomy, and may obtain clinical photographs. Available treatment options, anticipated outcomes, limitations, potential complications and the proposed form of anaesthesia are discussed.

Patients should have an opportunity to ask questions and raise concerns, including anxiety about surgery or recovery. The decision to proceed should follow an informed discussion of the expected benefits, limitations and risks.

Risks and potential complications

Blepharoplasty carries risks associated with surgery and anaesthesia. Potential adverse effects and complications include:

- Anaesthesia-related complications
- Bleeding from the incisions
- Altered skin sensation or numbness around the eyelashes
- Difficulty closing the eyes
- Dry eyes
- Ectropion, in which the lower eyelid turns outwards
- Infection
- Lower eyelid retraction or abnormal positioning, which may be temporary or persistent
- Persistent pain
- Sensitivity to sunlight or other bright light
- Swelling and bruising
- Unfavourable scarring
- Temporary or permanent changes in vision, including, very rarely, loss of vision
- The need for revision surgery

The relevance of these risks varies according to the patient’s health, anatomy and planned procedure. Before surgery, the surgeon should explain the material risks and potential complications, address the patient’s questions and obtain informed consent.