Hi, I’m Dr Glenn Murray from Absolute Cosmetic. Today we’re talking about the upper eyelid lift; upper blepharoplasty, and how we mark it before surgery. Most people think of this surgery as just removing excess skin around the upper eyelid, but it’s actually more complex than that.
What is upper blepharoplasty?
Upper blepharoplasty is a surgical procedure that removes excess skin, and in most cases a strip of muscle and two small fat pads, from the upper eyelid. There’s a simpler version too, a skin-only blepharoplasty, where we just remove the heavy skin and leave the muscle and fat alone. That’s a perfectly good option if you’re a bit older and don’t mind if it’s not the most sculpted result, or if you’re younger and feel the same way. In many cosmetic cases, this involves taking out skin, a strip of muscle, and the medial and lateral fat pads.
Why does excess upper eyelid skin happen?
It happens because skin loses elasticity and the muscle and fat around the eye start to sag with age, and sometimes fat that was always there becomes more obvious as the skin around it gives way. That’s why some people end up with a heavy, hooded eyelid, and why for some patients who have had a previous eyelift the medial fat pad may pop back out a year or so post surgery. Some surgeons assess the fat pad during surgery and may choose to leave it if it isn’t visibly bulging. My preference is to address at least some of that fat pad at the time of surgery, as in my experience this can reduce the likelihood of it becoming noticeable later.
How do you spot excess upper eyelid skin?
You spot it with a simple pinch test, marking the skin while the patient is upright and pinching to see exactly how much excess skin there is. Skipping this step can make it harder to judge exactly how much skin can be removed, which is why we always mark and pinch-test before surgery. Too little and you may not have appropriately addressed the patient’s concerns. Too much and the patient may not be able to fully close their eyes afterwards which can lead todry eye which if this isn’t managed, can progress to corneal ulcers. So the marking isn’t just a formality, it’s an important step in reducing that risk. We mark it upright first, then check again with the patient recumbent, lying down as if asleep, to make sure the measurements hold up in both positions.
How can you prevent needing more extensive eyelid surgery down the track?
Getting the fat pads properly addressed at the time of surgery, rather than leaving borderline bulging fat behind, may reduce the likelihood of needing follow-up surgery later on. It’s also why the marking and pinch test matter so much before we even pick up a scalpel. Beyond that, there’s not a lot you can do to prevent the skin laxity itself, it’s a natural part of ageing around the eyes, but getting an experienced assessment early means the procedure may be less likely to need a revision in the future.
What does upper blepharoplasty treatment involve, from least to most invasive?
At the least invasive end, it’s a skin-only blepharoplasty, just removing the excess skin and leaving the underlying muscle and fat untouched. The more involved, and the more common cosmetic approach, removes a strip of skin, a strip of muscle, and a moderate amount of both the medial and lateral fat pads. We do this under sedation, with local anaesthetic that contains a small amount of adrenaline to reduce bruising and bleeding. We do this procedure in a fully licensed day surgery that’s also cosmetically credentialed. Being asleep matters, not just for the patient’s comfort, but because it is important the patient stays still while the surgeon is working close to the eye. This is one of the reasons we perform this procedure under sedation in a licensed day surgery. Once the fat and muscle are addressed, the eyelid is closed with a continuous suture.
Bruising varies significantly from person to person, some patients experience very little, while others bruise more visibly, and it’s worth knowing that going in. This is one of the more common procedures we perform, we do these every week, but like any surgery, it carries real risks, including the dry eye and corneal ulcer risk mentioned above if too much skin is removed, and you should go into it understanding those and all the other potential risks so you can make an informed decision.
If you’d like to know more about how upper and lower blepharoplasty compare, or the different eyelid surgery techniques we use, those pages go into more detail.
FAQ
What is the pinch test in upper blepharoplasty?
It’s a technique where the surgeon pinches the upper eyelid skin while marking it to work out exactly how much skin can be safely removed, done both upright and lying down.
Can too much skin be removed during an upper eyelid lift?
This is a potential risk, yes and it can leave you unable to fully close your eye, leading to dry eye and potentially corneal ulcers.
What are the medial and lateral fat pads in the upper eyelid?
They’re two small fat pockets in the upper eyelid, one closer to the nose and one further out, that are often removed or reduced during a cosmetic upper blepharoplasty to prevent bulging later on.
Is upper blepharoplasty done under general anaesthetic?
No, it’s typically done under sedation with local anaesthetic in a licensed day surgery, rather than a full general anaesthetic.
Why might bruising vary so much after upper eyelid surgery?
The local anaesthetic used contains a small amount of adrenaline which helps limit bruising and bleeding, but individual healing responses differ, so some patients have little to no bruising while others bruise more visibly.
Is a skin-only blepharoplasty an option?
Yes, for patients who mainly want the heavy skin removed without addressing the underlying muscle and fat pads, a skin-only approach is a simpler alternative to the full cosmetic procedure.
For more information on upper blepharoplasty or to book a consultation, visit absolutecosmetic.com.au.
This information is general in nature and does not constitute medical advice or establish a doctor-patient relationship. All surgical procedures carry risks, and individual results and healing vary. A consultation is required to determine suitability for any procedure.
