Eyelid Surgery (Blepharoplasty)
If you want to remove rhytids (wrinkles) then a blepharoplasty could be the solution.
As we age our eyelid region becomes smaller and we begin to get wrinkles/rhytids and show hollowing (atrophy) or fat bags (ptotic fat). A blepharoplasty will open and remove rhtyids and re-distrubute fat in the eyelid region. Risks are involved with any procedure and these will be discussed with you at your consultation.
Youthful eyes have a seamless transition between the lower eyelid region and the cheeks. As we age the eyelids lose volume, rhtyids develop and the eyelid and cheeck become separated and more obvious. This increases the vertical eyelid cheek junction. Eyelid surgery (blepharoplasty) can address this area to remove rhtyids in the lower eyelids and remove any ptotic fat (bags/puffiness) or dark circles or loose skin (rhytids).
Video: Eyelid Surgery
Learn about the types of eyelid procedures Dr Jack Zoumaras offers and why patients commonly consider eyelid surgery to remove wrinkles and lift the eyelid region. *Level V Evidence: How you will feel after plastic surgery varies between individuals depending on psychological and physical factors, our internal research is based on how patients in our practice feel after surgery. This research is pending publication-details to follow.
EYELID SURGERY PROCEDURES:
Dr Zoumaras has over 10 years of experience in eyelid or blepharoplasty surgery.
The aim is to remove excess skin/rhtyids and redistribute the fat to blend the eyelid and cheek junction, address excess wrinkling, and correct volume atrophy so that your eyelid area blends with the cheek anatomically.
At Artiste Plastic Surgery we offer the following procedures to for your eye region.
Open Eyes (Upper Eyelid Blepharoplasty)
Our Upper Eyelid Blepharoplasty is where excess skin is removed and fat is re-positioned to open your eyes.
Office Eyelid Surgery
Our Office Upper Eyelid Pinch Blepharoplasty where excess skin is removed under local anaesthetic. Suitable in select patients only.
Eyelid Cheek Junction (Lower Eyelid Blepharoplasty)
Lower Eyelid Blepharoplasty procedure removes excess skin, re-positions fat and tightens the eye to minimise wrinkles and remove hollowness to the eyelid region. This is done through a trans-conjunctival approach.
No Touch Eye: Trans-Conjunctival Blepharoplasty
Our Trans-Conjunctival Lower Eyelid Blepharoplasty procedure involves a surgical approach behind the eyelid and not through the skin. This approach aims to volumise the eyelid (dark circles), remove fat ptotic puffiness and lift the lower eyelids.
Bilateral Upper and Lower Eyelid Blepharoplasty
A combination of Upper and Lower Eyelid Blepharoplasty to remove skin from the upper eyelids and re distribute volume and lift the lower eyelid.
Adult Content: The following patients have given consent and are representative only. Results do not guarantee that you will have the same result.
68 Year Old Upper and Lower Blepharoplasty (Eyelid Surgery)
49 Year Old Upper Blepharoplasty (Eyelid Surgery)
53 Year Old Lower Blepharoplasty (Eyelid Surgery)
What can be achieved?
Firmer Eyelid Tissues
With time, the upper eyelid skin loses elasticity. This leads to wrinkling (rhyids), dark shadows and sometimes puffiness. Dr Zoumaras will carefully assess your eyelids.
Surgery can tighten or remove the excess skin, lifting the tissues. The ligamentous support of the lower eyelid can be supported to shorten the eyelid cheek junction.
Skin With Fewer Wrinkles (Rhytids)
The loss of elasticity and shifting of fat pads around the eyes typically leads to rhytids/wrinkles around the corners of the eyes and eventual fat under the eyes. Removing excess skin and tightening the tissues can address these anatomical changes.
Volumised Lower Eyelids
The eyelids naturally have a small amount of fat in them, which is why younger eyes tend to look soft and round.
One of the first signs of ageing is fat bags (fat ptosis) under the eyes that form because the fat has become displaced from the orbit.
A lower eyelid blepharoplasty will volumise the lower eyelid region and remove any excess ptotic fat bags.
An Upper Eyelid Sulcus (Asian Eyelid Surgery)
While Caucasians and even some Asians have a lid fold or additional crease in the upper eyelid, many Asians do not. An upper eyelid surgery technique to create the upper eyelid sulcus, or “double eyelid,” in Asian eyelids that lack it can be perfromed.
PROCEdURE SNAPSHOT
1-2 hr Procedure
Day
surgery
2 weeks unsociable
Qualified facelift plastic surgeon:
- World-trained Dr Jack Zoumaras
- Qualified Anaesthetist, Accredited hospital
Results: Address excess rhtyids, skin, ptotic fat (bags)
Investment in yourself
Blepharoplasty has risks that include bleeding, asymmetry, lower eyelid malposition and more
You will feel:
BLEPHAROPLASTY TECHNIQUES
- Removal of rhytids which are signs of ageing in the upper eyelids
- An incision in the creases of the upper eyelids (to camouflage the scar) makes it possible to remove excess skin
- Removal of excess skin/rhytids in the upper eyelid
- Can correct upper eyelid impediments to fully open the eyes
- Manipulation of underlying fat helps to open the eyelid region for better function
- May also include non-surgical techniques to reduce wrinkles
- The goals of upper eyelid blepharoplasty are to open the eyes and remove rhtyids.
- Removes rhytids which are signs of ageing in the lower eyelids
- Uses the transconjunctival approach to remove fat combined with a pinch of skin to remove rhytids
- Often be accompanied by canthoplasty (canthopexy), which supports and reinforces the lower eyelids to avoid laxity during and after recovery
- May also include non-surgical techniques to reduce wrinkles
- When operating on the lower eyelids, the tone and laxity of the lower eyelids may require tightening as part of procedure.
- As a wound heals, it tends to lay down scar tissue, and scars around the eye tend to pull the lower eyelid away from the globe. A canthopexy or canthoplasty aims to support and reinforce the eyelid through the placement of accurate internal sutures in the lateral eyelid inferior retinaculum.
- Where necessary, the tarsus (fibrous tissue in the upper eyelid) can be fixated to the orbicularis muscle and skin
- This recreates or accentuates tarsal fold to show upper eyelid skin
- A incision is placed beneath the lower eyelashes
- A skin-muscle flap is raised to the orbital rim
- The orbital-malar and tear trough ligaments are released
- Fat is removed or repositioned
- Excess skin is removed
- Largely a historic procedure. In revision eye surgery, where significant skin laxity exists, and additional support is needed with a mid facelift/meloplasty
- The position of the eyebrows is paramount to the assessment of the upper eyelid region. Dr Zoumaras is a highly trained plastic surgeon in facial aesthetics and will accurately assess your brow position and its influence on your upper eyelid region.
- In some circumstances, a lower brow position is the cause of upper eyelid excess skin to the eye. In these cases, a brow lift is indicated. A brow lift can be done in conjunction with a blepharoplasty. Learn more.
- For some patients who qualify, this procedure can remove excess upper eyelid skin as the only part of the procedure
- This is performed under a local anaesthetic
- Removes skin up to 1 cm beneath the eyes
- The transconjunctival incision is made inside the eyelids to access fat
- Fat is removed or repositioned
- This approach preserves the orbicularis muscle
- Our preferred Gold standard procedure for the lower eyelids.
- May be combined with a chemical peel or laser of the lower eyelids
- Lower eyelid skin can be removed under a local anaesthetic
- Suitable for those with mild to moderate skin excess
- May be combined with a chemical peel or laser of the lower eyelid
Surgical Information
Dr Zoumaras’ preferred eyelid blepharoplasty is a transconjunctival, commissure sparing open canthoplasty with skin pinch for the lower eyelid and a upper eyelid skin and fat removal with lateral brow pexy.
Distribution of upper and lower eyelid fat and incision placements for blepharoplasty.
The eyelid region has a distinct transition from lower eyelid to cheek. This is blended with a lower eyelid blepharoplasty.
Blepharoplasty removes and blends the fat and corrects the ligamentous laxity as well as removes excess skin.
Eyelid Blepharoplasty
A Blepharoplasty shapes the eyelids as the Greek word describes. The word “blephara” is derived from the Greek word eyelid and “plasty” is to sculpt and shape.
A blepharoplasty is an anti ageing procedure to the upper face. The procedure can be performed under Local Anaesthetic in the office or with day surgery. All procedures do carry risks and these will be discussed with you.
Eyelid surgery is an option when you do not have the investment of time for a Facelift, but want a solution that is going to reverse some ageing changes. All procedures do carry risks and these will be discussed with you.
Combining upper and lower eyelid surgery is an alternative to a Facelift where patients want anti ageing treatment on the upper face only.
The Anatomy of the Ageing Eyelid
The Eyelid like the Face consists of 5 concentric layers.
- Layer 1 is Skin which is thin on the eyelids.
- Layer 2 is Fat which is negligible in the eyelids (the fatty “bags” that we see under the eyelids comes from a deeper layer (deeper even than Layer 5).
- Layer 3 is the Superficial Musculoaponeurotic System (SMAS), in the eyelids this muscle is the orbicularis oculi which opens and closes the eye.
- Layer 4 is a space that contains Ligaments. This ligament is the orbital retaining ligament of the lower eyelid (tear trough) and cheek bone and becomes a condensation for the upper eyelid. The ligament holds the skin and muscle.
- Layer 5 is bone the orbital roof, rim and cheek bone (zygoma) Directly under the lower eyelid is the Septum (continuous with Layer 5) this is suspended above the orbital bone. Behind the septum exists the eyelid fat that causes fat bags.
As we age, the skin around the eye loses elasticity, partly because of the millions of blinks per year and sun exposure. The underlying bone shrinks by 1mm per decade after the age of 30, and this combined with ligament laxity, results in; loose skin, loss in muscle tone and changes to the eyelid/cheek junction.
Deep to the ligament directly under the eyelid (above the bone) is the septum, and as this falls due to the ligament falling (see diagram below) fat bulges into the lower eyelid area to create fat bags or festoons in some patients.
Therefore the lower eyelid presents with loose skin, dark shadows, hollowness and/or fat bags.
The upper eyelid, as it ages, demonstrates loose skin called dermatochalasis that interferes with eyelid opening and fat bulges which give the appearance of heaviness.
It is almost impossible to apply eye makeup, and most patients present for an Upper eyelid blepharoplasty due to their eyelid skin touching their lashes.
In the younger patient, due to anatomical variance and genetics, some patients in their 20s and 30s have heavy eyelids that can benefit from upper eyelid surgery.
Eyelid Surgery Blepharoplasty Options
Through an incision placed in the eyelid crease or where the crease should be, excess skin and fat are carefully removed to open your eyes. The eyes will look more open and there will be increased eyelid show and many of our patients find they can apply eye makeup with easier after surgery.
Lower Eyelid blepharoplasty aims to smooth the lower eyelid by removing fat and filling dark circles. This ensures a shorter eyelid cheek junction that is anti ageing. Through a small incision inside the eyelid, the deep structures that have aged are addressed. Any excess fat is removed and re-distributed to create a smoother lower eyelid. The ligament and muscle are lifted, and excess skin removed. This results in a blended lower eyelid cheek junction and lifted eye.
An upper and lower eyelid blepharopalsty is antiageing for the entire eyelid region. The upper eyelid excess skin is removed to open the eyes and the eyelid cheek junction blended by removal of excess fat and rhtyids and volumisation in atrophied areas.
Common Concerns
Patients remain in hospital for under 24 hours and are allowed to go home with oral pain medications. Some bruising and swelling as well as blurred vision are common. Swelling should begin to decrease after the first week. You will be fit to return to work after one week to 10 days.
Taping and regular massage of the lower eyelid structures is encouraged in the immediate postoperative period, extending through the two to three weeks following your surgery. This will soften scarring and maintain the lower eyelids in the desired position. At times, the eyelids may temporarily be partially closed (tarsorrhaphy) to help with swelling and healing.
Incisions for upper and lower blepharoplasty are placed in crease lines. They may be hidden inside the eyelids, or they may be placed below the lashes or inside the natural eyelid creases. Any noticeable scarring is likely to fade over time.
The exact cost of your eyelid surgery will be determined during your consultation. Prices vary according to the extent of surgery needed and the techniques that will be applied. Combining your eyelid surgery with a facelift, brow lift, or other related procedure will also affect the cost. Other factors (location, hospital fees, surgical fees, and anaesthesia fees) are all accounted for in the final cost.
Minor discomfort can occur after eyelid surgery. Oral pain medications are used to control any associated pain during recovery. Eye drops are also used.
FAQs
Cat eye surgery is possible and involves re-creating the corner of your eye through an advanced canthoplasty. This procedure needs a lot of consideration from both the Surgeon and patient because it will permanently change the shape of the eye and has risks.
The shape of your eyes will not change, unless requested. In the early recovery phase, the canthoplasty is used to support your eye in a higher position so may appear tighter and higher. This will settle after 6 weeks.
You may return to work after one week for an upper eyelid blepharoplasty or after 2 weeks for a lower eyelid blepharoplasty.
You can apply eye make up after 10 days, once we give you clearance.
It is expected to have bruising that can last up to 7 days for the upper eye and 14 days for the lower eye.
Yes to operate on the entire eyelid region an upper and lower eyelid blepharoplasty is done. You can even combine it with a Facelift and Necklift and Brow surgery.
A canthoplasty is part of a blepharoplasty whereby the lateral ligament that supports the eyelids shape is tightened or changed. All patients undergoing a blepharoplasty have a canthoplasty. The blepharoplasty involves removal of rhtyids/wrinkles and addition and removal of fat.
A Lower eyelid blepharoplasty removes rhtyids and wrinkles to smooth the eyelid cheek junction and lifts the lower eye region.
An Upper Eyelid blepharoplasty is removes excess skin (dermatochalasis) and fat from the upper eyelid to open up the eyes.
An upper eyelid blepharoplasty can be done under Local Anaesthetic.
You can drive after one week when the sutures are removed and the bruising and swelling begin to subside.
Your eyes will be blurry for the first 1-4 days because of swelling, bruising and an ointment used in surgery, to moisten your eye. Your eyes dry out during surgery due to the surgical lighting.
You can go for walks after 5 days and then jog after 10 days. Light exercise and running can commence after 4 weeks.
Eyelid surgery recovery is two weeks in general. For the upper eyelid recovery can be expected after 7 days. For the lower eyelid this can vary between 14-21 days.
Lower Eyelid blepharoplasty is day surgery and it is expected that you have 7-14 days of downtime.
Upper Eyelid blepharoplasty is day surgery, it is expected that you have 7 days of downtime.
A Blepharoplasty, Eyelid lift or eye surgery can be performed for the upper or the lower eye. Ptosis which is where the upper eyelid droops past the iris into the pupil (coloured part of the eye) can be addressed at the same time, as can the brow. You can see with this many variables it is difficult to give you an accurate estimate of how much a blepharoplasty or eyelid surgery will cost in Sydney.
Medicare rebates may be possible if you have what is called dermatochalasis which is excess eyelid skin that affects vision.
Eyelid surgery in Sydney by Dr Jack Zoumaras will cost between $10-24K for the surgical fee alone. There are some in rooms options for select patients.
Blepharoplasty is surgery, and all surgery has the risk of short-term or long-term complications. A full list of potential complications and the response plan of action will be outlined during your consultation. Some complications include lagopthalmos, lower eyelid malposition, eyelid retraction, scleral show, scarring, asymmtery, dry eyes, blurry vision, chemosis numbness, bleeding, infection and rarely ocular injury such as corneal injury.
Many Asian upper eyelids lack a lid fold (sulcus). Part of the blepharoplasty procedure is the tarsal fixation which helps define an eyelid crease. At Artiste Plastic Surgery, we believe it is important to create this lid fold, but not to overly westernise the Asian eyelid. Dr Zoumaras can give you more information about this technique during your consultation.
With any assessment of the eyelid region, the position of the brow is important. Sometimes with brow ptosis (descent), there is more rhytids in the upper eyelid. For some patients, a simple brow elevation will correct the dermatochalasis (rhytids in the upper eyelid), and no eyelid surgery will be needed. Dr Zoumaras carefully assesses the brow and eyelid region to determine the best approach. Often the brow and upper eyelid need to be operated on.
Having had refractive or another eye surgery does not necessarily disqualify you from eyelid surgery, but you should inform Dr Zoumaras so that the appropriate precautions can be taken. With consultation with and approval from your ophthalmologist, a very conservative operation will be undertaken to your eyelid region.
You will be required to remove your contact lenses before the surgery and use eye drops to help moisturise your eyes. You will also be required to avoid wearing contact lenses for the first week after surgery.
Non-surgical treatments such as injections or laser may be used to reduce rhytids or improve hollowness around the eyes. These are sometimes combined with eyelid surgery.
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