Eyelid Blepharoplasty

Your eyes are often the first feature people notice, but they are also one of the first areas to show signs of ageing. Dr Gounder offers a comprehensive range of eyelid surgeries tailored to your specific anatomy.

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Upper Eyelid Blepharoplasty

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Upper eyelid blepharoplasty is a procedure designed to address "hooding" of the upper lid. Over time, the skin of the upper eyelid can stretch, and muscles may weaken, causing pockets of fat to bulge or excess skin to hang over the eyelashes. This can make you look tired, sad, or older than you feel, and in severe cases, it can restrict your peripheral vision.

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Surgical Options & Anaesthesia Dr Gounder understands that every patient has different comfort levels and medical needs.

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Therefore, we offer two distinct settings for this procedure:

• In-Rooms Procedure (Local Anaesthetic): For many patients, upper blepharoplasty can be safely and comfortably performed in our procedure rooms. You remain awake but the area is completely numbed. This option is often more convenient and cost-effective, as it avoids hospital admission fees.

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• Day Surgery (IV Sedation): If you prefer to be asleep or unaware during the procedure, Dr Gounder performs the surgery in an accredited day surgery centre with the support of an anaesthetist.

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Ptosis Surgery

Correcting the "droopy" eyelid.

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It is important to distinguish between excess skin (which is treated with blepharoplasty) and a drooping eyelid caused by muscle weakness, known as Ptosis.

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Ptosis occurs when the levator muscle (the muscle responsible for lifting the eyelid) stretches or detaches. This causes the eyelid margin itself to sit too low across the pupil, creating a sleepy appearance or blocking vision. Dr Gounder performs ptosis repair to tighten or reattach this muscle, elevating the eyelid to a normal, functional position. This is often performed in conjunction with blepharoplasty to achieve the best aesthetic outcome.

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Lower Eyelid Blepharoplasty

Addressing bags and loose skin.

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Lower eyelid surgery targets under-eye bags, puffiness, and wrinkles to restore a smoother transition from the eyelid to the cheek. Dr Gounder utilises two primary techniques depending on your specific needs:

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• Transconjunctival Fat Resection (Scarless approach): Ideally suited for younger patients or those with puffiness caused solely by bulging fat pads without excess skin. Dr Gounder makes an incision inside the lower eyelid to remove or reposition the fat. There is no external visible scar with this technique.

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• Anterior Approach Skin Excision: If you have excess skin or significant wrinkles in addition to puffiness, Dr Gounder utilises an incision just below the lower lash line. This allows for the removal of excess skin and fat, as well as tightening of the muscle if necessary, resulting in a firmer, more youthful under-eye contour.

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Recovery

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Blepharoplasty is surgery, and the recovery is real. Most patients underestimate the first fortnight.

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The first 48 to 72 hours. Swelling and bruising build rather than settle during this period. Sleeping propped up and using cold compresses helps. Some oozing from the wound in the first day is normal.

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The first week. Bruising is usually at its most obvious around day three to five, and can extend onto the cheek. Skin sutures on the upper lid are generally removed at around 7-10 days. Vision can feel blurred from ointment and swelling.

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Weeks two to four. Most patients feel comfortable in public somewhere between 7-10 days, though this varies and some people take longer. Bruising can persist for two to three weeks and occasionally longer. Strenuous exercise, heavy lifting and swimming should be avoided for around two weeks.

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Months one to six. Scars pass through a firm, pink phase before softening and fading. The final appearance is not settled until three to six months, and sometimes up to a year. Judging your result at six weeks will mislead you.

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Practical points. Do not drive on the day of any procedure involving sedation. Plan time away from work realistically rather than optimistically.

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Risks and complications

All surgery carries risk. The great majority of blepharoplasty patients recover without difficulty, but complications do occur, and some are serious. You should understand these before deciding to proceed.

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Expected in most patients

Bruising, swelling, tightness and temporary blurred vision are part of normal recovery rather than complications. Numbness of the eyelid skin is common early on and usually resolves over weeks to months.

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Common

• Asymmetry. The two sides rarely heal identically. Most differences are minor and settle, but some persist and a proportion of patients need a revision procedure.

• Dry or irritable eyes. Grittiness, watering and light sensitivity are common in the early weeks. If you already have dry eye, blepharoplasty can make it worse, sometimes for months. 

• Visible or lumpy scarring. Upper eyelid incisions are placed in the natural skin crease and usually heal very well. Even so, scars can remain firm, red or raised for months, and a small number heal poorly.

• Small cysts or suture granulomas along the incision line, which usually settle or can be treated simply.

• Over-correction or under-correction. Removing too little skin leaves a result that looks unchanged. Removing too much causes problems with lid closure. Judging this is a matter of surgical experience, and neither extreme is entirely avoidable.

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Less common

• Incomplete eyelid closure (lagophthalmos). Usually temporary and related to swelling. If it persists it can expose the cornea and require lubrication, and in some cases further surgery.

• Lower eyelid malposition. Lower lid surgery specifically carries a risk of the lid sitting too low, pulling away from the eye, or showing white below the iris. Correcting this can require a second, more involved operation.

• Infection, which is uncommon around the eyelids because of the good blood supply, but does occur and may require antibiotics.

• Chemosis, a boggy swelling of the surface membrane of the eye, more common after lower lid surgery, which can take weeks to settle.

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Revision surgery

A proportion of patients need a further procedure, whether to adjust asymmetry, address residual skin, or correct lid position. This is not a sign that anything has gone wrong. It is a normal part of eyelid surgery and you should factor the possibility into your decision. 

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Results vary

Eyelid surgery does not stop the ageing process. Skin continues to change, and the appearance achieved by surgery will alter over the years. Individual results depend on your anatomy, your skin, your healing, and factors outside anyone's control. No surgeon can guarantee a specific outcome, and photographs of other patients do not predict yours.

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Making your decision

You should not feel rushed. Take the time you need, ask questions, and consider a second opinion if you want one. If you are considering eyelid surgery for appearance rather than function, Australian regulations require a cooling-off period between your consultation and your surgery, and Dr Gounder will explain how this applies to you.

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