Upper Blepharoplasty

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney and Brisbane with over a decade of experience specialising in facial aesthetic surgery. At his clinic, Dr Turner offers upper blepharoplasty surgery for patients seeking correction of excess upper eyelid skin, whether for functional improvement, aesthetic enhancement, or both.

Upper blepharoplasty—commonly referred to as upper eyelid surgery—addresses the excess skin, muscle, and occasionally fat that accumulates in the upper eyelid region over time. This tissue redundancy can create a hooded appearance, obscure the natural eyelid crease, and, in more pronounced cases, impair peripheral vision. Through incisions concealed within the natural eyelid fold, Dr Turner removes or repositions redundant tissue to restore a more open, defined appearance to the eye region.

Understanding Upper Blepharoplasty Surgery

The upper eyelid represents one of the most delicate and visible structures of the face. Even subtle changes in this region significantly influence overall facial expression and perceived alertness. Understanding the anatomical factors contributing to upper eyelid ageing helps patients appreciate how surgical correction addresses their specific concerns.

Anatomy of the Upper Eyelid

The upper eyelid comprises multiple distinct tissue layers, each contributing to its appearance and function:

Skin Layer: The upper eyelid contains the thinnest skin found anywhere on the human body. This delicate tissue loses elasticity progressively with age, becoming redundant and developing characteristic folds.

Orbicularis Oculi Muscle: This circular muscle surrounds the eye and controls eyelid closure. Over time, this muscle can become lax, contributing to tissue descent.

Orbital Septum: A fibrous membrane separating the eyelid from deeper orbital structures. Weakening of this barrier allows underlying fat to protrude forward.

Orbital Fat Pads: Fat deposits cushioning the eye within the orbit. As supporting structures weaken, these pads may bulge forward, creating fullness in the upper eyelid.

Levator Aponeurosis: The tendinous attachment of the muscle responsible for opening the eyelid. Stretching or detachment of this structure can cause true eyelid ptosis (drooping of the eyelid margin itself).

Eyelid Crease: The natural fold formed where the levator aponeurosis attaches to the skin. The definition of this crease significantly influences eyelid aesthetics.

How Ageing Affects the Upper Eyelid

Multiple factors contribute to upper eyelid changes over time:

Dermatochalasis: The accumulation of excess, redundant eyelid skin represents the most common concern. This tissue hangs over the eyelid crease, obscuring its definition and potentially extending over the eyelash line.

Skin Elasticity Loss: Collagen and elastin degradation cause the eyelid skin to lose its ability to retract, resulting in progressive laxity.

Fat Prolapse: Weakening of the orbital septum permits underlying fat pads to protrude forward, creating fullness or puffiness in the upper eyelid.

Brow Descent: Descended eyebrows push tissue onto the upper eyelid, compounding the appearance of excess skin. This relationship proves crucial in surgical planning.

Muscle Laxity: The orbicularis muscle may become redundant, contributing to tissue fullness.

Functional Versus Aesthetic Concerns

Upper blepharoplasty addresses both functional and aesthetic indications:

Functional Impairment: When excess upper eyelid skin extends sufficiently to obstruct peripheral or superior visual fields, patients experience difficulty with activities requiring upward or lateral gaze. Reading, driving, and navigating stairs may become challenging. In these circumstances, upper blepharoplasty serves a reconstructive purpose, and Medicare rebates may apply when specific criteria are satisfied.

Aesthetic Enhancement: Many patients seek upper blepharoplasty primarily to address the tired, aged, or heavy appearance created by eyelid tissue redundancy. Restoring eyelid crease definition and removing hooding creates a more alert, refreshed appearance.

Most patients present with combined functional and aesthetic motivations, seeking both improved visual function and enhanced appearance.

The Role of Brow Position

Brow position significantly influences the appearance of the upper eyelid. A descended brow pushes tissue onto the upper eyelid, creating apparent excess that may not represent true eyelid redundancy. In such cases, brow lift surgery—rather than or in addition to blepharoplasty—may provide more appropriate correction.

Attempting to address brow descent solely through aggressive upper blepharoplasty risks several problems: inadequate improvement, an unnatural appearance, or difficulty closing the eyes. During consultation, Dr Turner evaluates brow position to determine whether an isolated upper blepharoplasty, a brow lift, or a combination of procedures will best achieve your goals.

Am I a Suitable Candidate for Upper Blepharoplasty?

Upper blepharoplasty is suitable for individuals with functional visual impairment from excess eyelid skin, aesthetic concerns about hooded or heavy-appearing eyelids, or both. Appropriate candidate selection ensures satisfying outcomes whilst maintaining realistic expectations.

Physical and Health Requirements

Suitable upper blepharoplasty candidates demonstrate:

• Good general health without conditions affecting surgical safety or healing capacity
• No active eye infections, inflammatory conditions, or uncontrolled glaucoma
• Adequate tear production (dry eye syndrome requires careful assessment and management)
• Stable refracted vision without recent significant changes
• Non-smoking status or willingness to cease all tobacco and nicotine products for a minimum of six weeks before and after surgery
• Realistic understanding of achievable outcomes
• Psychological readiness for surgical intervention (mandatory psychological assessment required per Australian regulations effective July 1, 2023)

Anatomical and Aesthetic Indicators

Upper blepharoplasty proves particularly effective for patients presenting with:

• Excess upper eyelid skin creates hooding over the natural eyelid crease
• Redundant tissue extending onto or over the eyelash line
• Obscured eyelid platform with loss of crease definition
• Puffy or full appearance due to protruding orbital fat
• Visual field obstruction from overhanging eyelid tissue
• Asymmetry between the upper eyelids
• Desire for a more alert, refreshed appearance around the eyes

Age Considerations

Whilst upper eyelid concerns most commonly present in patients aged 40 and above, younger individuals may be suitable candidates when:

• Genetic predisposition causes early eyelid tissue redundancy
• Significant asymmetry requires correction
• Ethnic eyelid characteristics warrant modification (such as creating or enhancing an eyelid crease)

Chronological age alone does not determine candidacy; tissue characteristics and functional or aesthetic concerns prove more relevant.

Medicare Eligibility for Functional Upper Blepharoplasty

When the upper eyelid excess demonstrably impairs visual function, Medicare rebates may apply. Specific criteria must be satisfied, typically including:

• Documented visual field obstruction on formal testing
• Photographic evidence of tissue redundancy
• Clinical assessment confirming functional impairment

Dr Turner can advise on potential Medicare eligibility during your consultation and arrange appropriate documentation when the criteria appear satisfied.

How is Upper Blepharoplasty Performed?

Upper blepharoplasty may be performed under local anaesthesia or general anaesthesia, depending on patient preference, medical considerations, and whether additional procedures are performed concurrently. The procedure typically takes 1 hour when performed in isolation for bilateral upper eyelid surgery. Most patients return home on the same day following appropriate recovery monitoring.

Pre-Operative Planning and Marking

Meticulous pre-operative planning proves essential for optimal upper blepharoplasty outcomes. With the patient seated upright and awake, Dr Turner carefully marks:

Eyelid Crease Position: The natural or desired crease position is identified, typically 8-10mm above the lash line in women and 7-8mm in men, though individual anatomy guides precise placement.

Skin Excision Pattern: Using a pinch technique whilst assessing eyelid closure, Dr Turner determines the maximum safe tissue excision. The inferior marking follows the desired crease; the superior marking defines the upper excision boundary.

Asymmetry Assessment: Any pre-existing asymmetry between eyelids is documented and addressed in surgical planning to achieve optimal symmetry.

Fat Pad Assessment: Areas of fat prolapse requiring reduction or repositioning are identified.

These markings are performed whilst you are seated upright, as lying flat alters tissue position and can lead to inaccurate excision planning.

Surgical Technique

Incision Creation: Using a fine surgical blade, Dr Turner creates precise incisions along the pre-marked lines. The primary incision follows the eyelid crease, ensuring the eventual scar lies within this natural fold where it becomes virtually invisible once healed.

Tissue Excision: The elliptical segment of excess skin is carefully removed. When indicated, a conservative strip of underlying orbicularis muscle may also be excised to reduce bulk and improve crease definition.

Orbital Fat Management: If assessment reveals prolapsing orbital fat contributing to eyelid fullness, Dr Turner opens the orbital septum and conservatively reduces or repositions the fat pads. Excessive fat removal is avoided, as this can create a hollow, aged appearance. The medial (nasal) and central fat compartments are addressed as needed.

Haemostasis: Meticulous attention to bleeding control minimises post-operative bruising and haematoma risk. Cautery is used sparingly and precisely to achieve haemostasis.

Wound Closure: The incision is closed in layers using fine absorbable sutures that do not require removal, or non-absorbable sutures removed approximately 1 week later. The closure technique aims to create a well-defined eyelid crease whilst minimising visible scarring.

Dressing Application: Antibiotic ointment is applied to the incision line. Dressings are typically minimal, allowing early visual recovery.

Combining Upper Blepharoplasty with Complementary Procedures

Upper blepharoplasty frequently forms part of a comprehensive facial enhancement plan:

Brow Lift: For patients with brow descent contributing to upper eyelid fullness, combining a brow lift with blepharoplasty addresses both anatomical concerns.

Lower Blepharoplasty: Addressing upper and lower eyelids simultaneously creates harmonious periorbital correction.

Facelift Procedures: Upper blepharoplasty integrates well with face and neck lift surgery for comprehensive facial aesthetics.

Skin Resurfacing: Laser treatments or chemical peels can address fine wrinkles and skin texture concerns that blepharoplasty alone does not correct.

During the consultation, Dr Turner discusses whether an isolated upper blepharoplasty or a combined procedure will best achieve your aesthetic objectives.

Recovery and Aftercare

Upper blepharoplasty recovery proceeds relatively quickly compared to more extensive facial procedures. Swelling and bruising typically peak at 48-72 hours before gradually improving, with most patients appearing socially presentable within 10-14 days. During the first week, cold compresses, head elevation, and antibiotic ointment application help manage symptoms and support healing. Sutures are removed at approximately 5-7 days if non-absorbable sutures were placed. Most patients describe mild discomfort rather than significant pain, which is easily managed with simple pain-relief medication. Temporary blurred vision, light sensitivity, and altered tear production are common initially but resolve as healing progresses.

Most patients return to office-based work within 7-14 days, though those in public-facing roles may prefer slightly longer before resuming professional activities. Light walking is encouraged from early recovery, whilst more strenuous exercise should be avoided for 3-4 weeks. Final results become fully apparent at 3-6 months as residual swelling resolves completely and incision lines mature to barely visible traces within the natural eyelid crease. Dr Turner schedules follow-up appointments at one week, one month, and three to six months to monitor healing progress and ensure optimal outcomes.

Risks and Complications

All surgical procedures carry inherent risks that must be understood before proceeding with treatment. Most patients experience expected temporary effects, including swelling, bruising, mild discomfort, temporary vision changes from ointment or swelling, and altered sensation around the eyelids—all of which typically resolve within the first few weeks. Less common but possible complications include haematoma (blood collection requiring drainage), infection, asymmetry, visible scarring, and under-correction requiring revision surgery.

More significant complications, though rare, include over-correction, causing difficulty closing the eyes completely (lagophthalmos), worsening or development of dry eye syndrome, eyelid malposition, and corneal irritation. Dr Turner minimises these risks through comprehensive pre-operative assessment, conservative surgical technique, avoiding excessive tissue removal, meticulous attention to bleeding control, and detailed post-operative care instructions. All procedures are performed in accredited facilities with appropriate emergency protocols. These potential risks will be discussed thoroughly during your consultation to ensure you can make a fully informed decision.

For comprehensive information about potential risks and how to minimise them, please read:

Risks and Complications of Blepharoplasty Surgery