Blepharoplasty in Canberra: Upper and Lower Eyelid Surgery Guide

Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney

For Canberra patients considering eyelid surgery, the first thing worth understanding is that “blepharoplasty” isn’t one decision. It’s three potential conversations. Upper eyelid surgery for hooded eyelid skin. Lower eyelid surgery for under-eye bags or fat prolapse. Brow position assessment, because the upper eyelid sometimes looks heavy when the actual issue is brow descent rather than eyelid skin alone.

This guide walks through what each procedure addresses, when a brow lift may need to enter the discussion, the Medicare eligibility pathway for upper blepharoplasty in selected cases, and what recovery typically looks like for Canberra patients travelling to Sydney for surgery. Eyelid surgery isn’t one procedure for every patient. The right plan depends on what’s actually happening anatomically.

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at the Campbell clinic in Canberra and at Sydney clinics in Bondi Junction and Manly. The breakdown below is how the eyelid surgery conversation typically goes during consultation.

Considering eyelid surgery in Canberra? The Brow Lift and Blepharoplasty Canberra page is the right starting point for individual assessment. It covers upper blepharoplasty, lower blepharoplasty, endoscopic brow lift, and combined brow-lid planning. Two consultations apply at the Campbell clinic before any surgical decision is made.

What this Canberra blepharoplasty guide covers

• Upper blepharoplasty
• Lower blepharoplasty
• Brow position and eyelid heaviness
• Blepharoplasty, brow lift, or ptosis repair?
• What’s commonly assessed at consultation
• Medicare eligibility for upper eyelid surgery
• Blepharoplasty recovery for Canberra patients
• Risks of eyelid surgery

What’s commonly assessed at consultation {#whats-assessed}

Before the procedure-specific detail, here’s the most common patient concern matched to the likely clinical assessment:

The point of starting with this is straightforward. What looks similar in the mirror often has different anatomical causes. Upper eyelid heaviness can reflect dermatochalasis (excess skin). Brow ptosis (a low-sitting brow). Eyelid ptosis (the eyelid margin sits low). Or a combination. Blepharoplasty alone may not fully address heaviness when brow position or the eyelid mechanism is the main contributor.

A peer-reviewed study found postoperative brow depression in 34.2 per cent of patients after upper blepharoplasty and noted that brow position should be discussed before surgery, particularly in older and male patients. That’s why these distinctions are worth making at consultation, not in retrospect.

Upper blepharoplasty {#upper-blepharoplasty}

Upper blepharoplasty addresses excess upper eyelid skin and, in some patients, prolapsed fat or thickened orbicularis muscle. The result aims to restore a clearer eyelid crease and reduce upper eyelid hooding.

It suits patients with dermatochalasis (true excess upper eyelid skin) where the eyelid skin is the main contributor to heaviness. Not brow descent. Not eyelid ptosis. Assessment includes how much skin is present, where the natural eyelid crease sits, what the brow position is doing, and whether the eyelid margin itself sits at the correct height.

The surgery is typically performed under local anaesthetic with sedation, or under general anaesthetic depending on patient preference and combined-procedure planning. Scars sit within the natural upper eyelid crease and generally settle well over weeks to months.

For a Canberra-specific overview of upper eyelid surgery and how it’s assessed alongside brow position, see the Brow Lift and Blepharoplasty Canberra page.

Lower blepharoplasty {#lower-blepharoplasty}

Lower blepharoplasty addresses under-eye bags. Fat prolapse. Skin laxity. Lower eyelid support. The technical approach varies based on what’s actually causing the concern.

Transconjunctival lower blepharoplasty, where the incision is made inside the lower eyelid, is suitable for patients with fat prolapse but minimal skin excess. No external scar. Faster recovery.

Skin-pinch or skin-flap lower blepharoplasty is suitable when skin laxity is part of the picture. The incision sits just below the lash line and generally heals into a fine line.

Fat repositioning may be discussed where lower eyelid bags coincide with a deep tear trough. Rather than removing all the prolapsed fat, the technique repositions it to soften the under-eye contour.

Lower eyelid support is part of the planning conversation. Patients with lax lower eyelid tone may need a tightening procedure (canthopexy or canthoplasty) at the same operation to reduce the risk of post-operative lower eyelid malposition.

For lower eyelid bags, puffiness, and fat repositioning considerations, see the Canberra brow and eyelid surgery page.

Brow position: why eyelid heaviness isn’t always eyelid skin {#brow-position}

This is the most underappreciated part of an eyelid consultation.

Some patients describe their concern as “heavy eyelids,” but the cause may not be eyelid skin alone. A descended brow can push soft tissue downward onto the upper eyelid, creating hooding that looks like an eyelid problem from the patient’s perspective. In other patients, the main issue is genuine excess upper eyelid skin. In others again, true eyelid ptosis, where the eyelid margin sits low because of the levator mechanism. Many patients have a combination.

This matters for two practical reasons.

First, treating the eyelid without recognising brow descent may leave persistent heaviness after surgery. The eyelid skin gets reduced. The brow continues to push tissue down. The patient sees less change than expected.

Second, removing too much eyelid skin can pull the brow down further. Published evidence describes postoperative brow depression after upper blepharoplasty as a recognised concern, particularly when brow position wasn’t addressed in the surgical plan.

Where brow descent is a significant contributor, an endoscopic brow lift and blepharoplasty plan for Canberra patients may be discussed. Combined planning addresses both the brow position and the eyelid skin in one operation. One recovery period.

Not every patient needs a brow lift alongside blepharoplasty. But assessing brow position before recommending eyelid surgery is essential, not optional.

Blepharoplasty, brow lift, or ptosis repair? {#brow-lift-or-ptosis}

Three terms patients often use interchangeably. Three different things clinically.

Blepharoplasty removes or repositions eyelid skin and fat. Addresses dermatochalasis (excess skin) and fat prolapse.

Brow lift addresses brow position. The brow gets repositioned upward, which may also reduce upper eyelid hooding when brow descent is contributing.

Ptosis repair addresses a low-sitting eyelid margin caused by the levator muscle (the muscle that lifts the upper eyelid). Different anatomy. Different surgery.

These can overlap in the same patient. A consultation assesses all three. Eyelid skin. Brow position. Eyelid height. If the eyelid margin itself sits low, blepharoplasty alone won’t correct the concern. Published guidance suggests that blepharoplasty should not be performed for patients presenting with diagnosed ptosis without addressing the ptosis correction where appropriate.

In practice, where ptosis is suspected, further ophthalmic or oculoplastic assessment may be recommended before any surgical decision. The eyelid margin position, levator function, and Marginal Reflex Distance (MRD1) are all measurable findings that determine whether ptosis repair, blepharoplasty, or both are appropriate.

Medicare eligibility for upper eyelid surgery {#medicare}

Upper blepharoplasty may attract a Medicare rebate in selected cases. Specifically, Medicare item 45617 may apply when excess upper eyelid skin causes documented visual field obstruction and the relevant criteria are met.

Formal visual field testing is usually required. The testing documents whether the upper eyelid skin is mechanically interfering with the patient’s visual field. That’s the clinical threshold for Medicare eligibility under this item number.

Cosmetic upper blepharoplasty (where excess skin is present but visual field isn’t affected) doesn’t attract the same Medicare pathway. Lower blepharoplasty and brow lift performed for appearance alone are also outside the Medicare functional pathway.

Eligibility isn’t assumed before testing. The consultation determines whether visual field testing is appropriate. The testing determines whether the Medicare item number applies.

Blepharoplasty recovery for Canberra patients {#recovery}

Eyelid surgery recovery is generally well-tolerated, but it does need planning. Particularly for patients travelling between Canberra and Sydney for the procedure.

Typical recovery elements:

• Bruising and swelling: most prominent in the first 5 to 7 days, gradually resolving over 2 to 3 weeks
• Sutures: external sutures are typically removed at 5 to 7 days post-op
• Activity restrictions: avoid heavy lifting, vigorous exercise, and bending forward for 1 to 2 weeks
• Eye care: lubricating drops, ointment, and ice packs are commonly recommended in the first week
• Return to work: many patients return to non-physical work after 1 to 2 weeks, depending on the social tolerance for visible bruising
• Final result: settles over weeks to months as residual swelling resolves

For Canberra and ACT patients, the typical recommendation is to plan 5 to 7 days in Sydney after surgery before returning home, particularly if suture removal is required at the post-op review. Recovery planning differs depending on whether surgery is upper eyelid only, lower eyelid only, combined upper and lower blepharoplasty, or blepharoplasty combined with brow lift. Combined procedures generally extend the recovery window.

For travel and accommodation guidance, see Travelling from Canberra for Plastic Surgery.

Risks of eyelid surgery {#risks}

All surgery carries risk. Eyelid surgery has its own specific risk profile worth understanding before deciding to proceed.

Common, generally minor:

• Bruising and swelling
• Temporary blurred vision from ointment use
• Mild scar visibility (usually settles over months)
• Asymmetry in early healing (often resolves with settling)

Less common, but recognised:

• Lagophthalmos (incomplete eye closure), usually temporary
• Dry eye symptoms or worsening of pre-existing dry eye
• Ectropion (lower eyelid pulling away from the eye), particularly with poor pre-existing lower eyelid support
• Hypertrophic scarring
• Need for revision surgery

Rare but serious:

• Postoperative ptosis (the eyelid sits lower than before surgery)
• Visual loss from intraorbital haemorrhage. Very rare. Mentioned because it’s a recognised risk and shouldn’t be omitted from informed consent.

Two risk areas deserve specific attention at consultation.

Dry eye symptoms should be assessed before upper blepharoplasty. Patients with pre-existing dry eye may experience worsening symptoms after eyelid surgery. Tear film testing or referral to an ophthalmologist may be appropriate where dry eye is suspected.

Lower eyelid support and laxity affect lower blepharoplasty risk. Patients with lax lower eyelid tone may need a tightening procedure at the same operation to reduce the risk of post-operative ectropion or lower eyelid malposition.

Published peer-reviewed literature describes the full risk spectrum for upper and lower blepharoplasty. The conversation with your surgeon should cover the specific risks relevant to your anatomy and goals, not a generic risk list.

Consultation pathway under AHPRA cosmetic surgery guidelines

The Medical Board and AHPRA cosmetic surgery guidelines that came into effect in July 2023 apply to cosmetic eyelid surgery.

The requirements: a GP referral before the cosmetic surgery consultation. At least two pre-operative consultations with the operating surgeon. Psychological screening for body dysmorphic disorder and other relevant factors. Informed consent obtained by the surgeon performing the procedure. A cooling-off period of at least seven days after the second consultation and informed consent, before surgery can be booked or a deposit paid.

Patients aren’t asked to sign consent forms at the first consultation. Consent is finalised at the second consultation, after the cooling-off period has elapsed.

Functional upper blepharoplasty for documented visual field obstruction follows a similar consultation pathway, although the Medicare item-number eligibility pathway runs alongside it.

Where to go from here

For an overview of brow lift and blepharoplasty options for Canberra patients, including upper eyelid surgery, lower eyelid surgery, endoscopic brow lift, and combined planning, visit the Brow Lift and Blepharoplasty Canberra page.

For travel and accommodation guidance for Canberra patients having surgery in Sydney, see Travelling from Canberra for Plastic Surgery.

To arrange a consultation, contact the practice online or call 1300 437 758. A GP referral is required before any cosmetic surgery consultation. Consultations at the Campbell clinic are held on Fridays by appointment.

Canberra Clinic: G24/6 Provan Street, Campbell ACT 2612 Email: [email protected] Consultations: Fridays by appointment

Frequently asked questions

Is eyelid heaviness always treated with blepharoplasty?

No. Eyelid heaviness may be caused by excess upper eyelid skin (dermatochalasis), brow descent (brow ptosis), eyelid ptosis (low eyelid margin), or a combination. A blepharoplasty consultation should assess the eyelid skin, brow position, and eyelid height before deciding whether upper blepharoplasty, brow lift, ptosis assessment, or combined treatment is appropriate. Treating the wrong anatomy can leave the original concern unaddressed.

What is the difference between upper blepharoplasty and lower blepharoplasty?

Upper blepharoplasty addresses excess upper eyelid skin and sometimes prolapsed upper eyelid fat. Lower blepharoplasty addresses under-eye bags, fat prolapse, skin laxity, and lower eyelid support. The procedures involve different anatomy, different surgical access, and different recovery and risk profiles. Some patients have surgery on both at the same time. Others have one or the other depending on their concerns and clinical findings.

When is a brow lift considered with blepharoplasty?

A brow lift may be considered when brow descent contributes to upper eyelid hooding or upper-face heaviness. If the brow is pushing tissue downward onto the upper eyelid, eyelid surgery alone may not fully address the concern. In these cases, combined endoscopic brow lift and blepharoplasty planning may be discussed, addressing both the brow position and the eyelid skin in one operation. Whether combined surgery suits an individual patient depends on brow position assessment, eyelid skin volume, and patient goals.

Can upper blepharoplasty be covered by Medicare?

Upper blepharoplasty may be eligible for a Medicare rebate (item 45617) when excess upper eyelid skin causes documented visual field obstruction and the relevant Medicare criteria are met. Formal visual field testing is usually required to document the obstruction. Cosmetic upper blepharoplasty, lower blepharoplasty, and brow lift performed for appearance alone are different pathways and don’t attract the same Medicare item number. Eligibility isn’t assumed before testing.

Will blepharoplasty fix dark circles?

Not always. Lower blepharoplasty may improve shadowing caused by fat prolapse or under-eye bags casting visible shadows, but it doesn’t reliably treat pigmentation, vascular colour, thin skin, or hollowing that isn’t caused by lower eyelid fat position. For patients whose dark circles are mainly pigmentary or vascular, surgery generally isn’t the right first option, and other approaches may be more appropriate.