Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Canberra patients often ask about “eyelid surgery” as if it’s one procedure. In practice, upper blepharoplasty and lower blepharoplasty address different concerns, use different techniques, and have different recovery and Medicare considerations. The right starting point is identifying whether the concern is upper eyelid hooding, under-eye bags, brow descent, eyelid ptosis, or a combination.
This guide walks through what each procedure addresses, how they differ, when both can be combined, and when the issue is actually brow position or true eyelid ptosis rather than eyelid skin or fat. The goal: help you understand what to ask at consultation, not self-diagnose from a guide.
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 upper-versus-lower conversation typically goes during consultation.
Considering eyelid surgery in Canberra? The Brow Lift & Blepharoplasty Canberra page is the right starting point if you haven’t yet had individual assessment. The combined location page covers upper blepharoplasty, lower blepharoplasty, and brow lift, all of which are assessed together because eyelid concerns rarely sit in isolation.
Quick comparison: upper vs lower
Side-by-side overview:
| Question | Upper blepharoplasty | Lower blepharoplasty |
|---|---|---|
| Main concern | Hooded or heavy upper eyelid skin | Under-eye bags, puffiness, or lower eyelid laxity |
| Main anatomy | Upper eyelid skin, crease, fat, sometimes muscle | Lower eyelid fat pads, skin, support, and lid-cheek junction |
| Common patient wording | “My eyelids feel heavy” or “my upper lids are hooded” | “I look tired even when I sleep” or “I have under-eye bags” |
| Medicare relevance | May apply only when MBS criteria and documentation requirements are met | Usually cosmetic for under-eye bags. MBS item 45620 applies only in limited medical circumstances |
| Brow relevance | Brow descent may contribute to upper eyelid heaviness | Less central, but overall facial balance still matters |
| Common combination | Upper blepharoplasty with brow lift | Lower blepharoplasty with upper blepharoplasty or other facial procedures |
What upper blepharoplasty addresses
Upper blepharoplasty addresses excess or overhanging upper eyelid skin. In some patients, conservative fat or soft-tissue adjustment is part of the operation. Incisions are usually placed in the natural upper eyelid crease so scars settle into the eyelid fold over weeks to months.
What upper blepharoplasty can address:
- Heavy or hooded upper lids caused by excess upper eyelid skin (dermatochalasis)
- Disrupted upper eyelid crease where skin is folding over the natural fold
- Functional cases related to documented visual field obstruction, where MBS item 45617 may apply
- Upper eyelid puffiness caused by mild fat prolapse, where conservative fat management is appropriate
What upper blepharoplasty doesn’t address:
- Brow descent. If the brow is the main contributor to upper face heaviness, brow lift assessment is the conversation
- True eyelid ptosis. A low-sitting eyelid margin caused by the levator muscle isn’t corrected by removing skin
- Forehead lines or compensatory frontalis activity. These may improve indirectly but aren’t the surgical target
For Canberra-specific assessment combining upper eyelid surgery with brow position, see the Brow Lift & Blepharoplasty Canberra page.
What lower blepharoplasty addresses
Lower blepharoplasty addresses under-eye bags, puffiness, fat prolapse, skin laxity, and the transition between the lower eyelid and the cheek. It’s more technically dependent on eyelid support, skin quality, and fat management than upper blepharoplasty. Several different surgical approaches are available.
Modern lower blepharoplasty often focuses on fat preservation or repositioning rather than aggressive fat removal. Removing too much fat can leave a hollowed appearance over time. Repositioning fat can soften the tear trough and lid-cheek junction in selected patients.
What lower blepharoplasty can address:
- Under-eye bags caused by fat prolapse
- Lower eyelid puffiness where fat is the main contributor
- Skin laxity in the lower eyelid where skin-pinch or skin-flap technique is appropriate
- Tear trough hollowing where fat repositioning is suitable
What lower blepharoplasty doesn’t always address:
- Pigmentation-related dark circles. Surgery doesn’t change skin colour
- Vascular dark circles caused by visible blood vessels under thin skin
- Cheek or midface descent. Festoons (cheek-area swelling below the lower lid) may need different intervention
- Severe lower eyelid laxity without lid support procedures (canthopexy or canthoplasty) added at the same operation
Lower eyelid laxity and dry-eye history are assessed before surgery because both affect the suitable technique and the post-operative risk profile.
Brow lift vs upper blepharoplasty
Upper eyelid hooding may be caused by excess eyelid skin, brow descent, eyelid ptosis, or a combination. The most common patient assumption is that hooded eyelids equal excess skin. In some patients, the brow position is doing most of the work.
Brow descent pushes tissue downward onto the upper eyelid. The upper eyelid skin may not be excessive at all. It’s just being pushed into a hooded position by the descended brow above. Removing eyelid skin in this scenario may leave residual heaviness, because the brow continues to push tissue down after surgery.
Decision frame:
| If the main issue is… | The consultation may focus on… |
|---|---|
| Skin folding over the upper eyelid crease | Upper blepharoplasty |
| Outer brow sitting low and pushing tissue onto the eyelid | Brow lift assessment |
| Brow descent plus eyelid skin excess | Combined brow lift and upper blepharoplasty |
| Eyelid margin itself sitting low | Ptosis assessment |
| Lower eyelid bags | Lower blepharoplasty |
Published research on brow and eyelid position shows that mechanical brow elevation can change eyelid measurements differently in normal eyelids, dermatochalasis, and ptosis, supporting the need to assess brow and eyelid position together rather than relying on appearance alone.
For more detail on the brow lift technique itself, see the Endoscopic Brow Lift in Canberra guide. For combined brow and eyelid surgery planning, see the Brow Lift & Blepharoplasty Canberra page.
Blepharoplasty vs ptosis repair
Three terms patients often use interchangeably. Three different things clinically.
Blepharoplasty addresses eyelid skin and fat. Upper or lower, depending on what’s being addressed.
Brow lift repositions the brow. It doesn’t remove eyelid skin.
Ptosis repair addresses a low-sitting upper eyelid margin caused by the levator muscle (the muscle that lifts the upper eyelid). Different anatomy. Different surgical procedure.
These can co-exist in the same patient. Acquired blepharoptosis literature notes that patients with both ptosis and dermatochalasis may need a combination of ptosis repair and upper lid blepharoplasty. The surgical plan addresses both findings, not just the more obvious one.
If the eyelid margin itself sits low at consultation, blepharoplasty alone may not correct the concern. Further ophthalmic or oculoplastic assessment may be recommended before any surgical decision.
Can upper and lower blepharoplasty be combined?
Yes, when both upper-lid and lower-lid concerns are present. Combined surgery means one anaesthetic. One facility booking. One recovery period. For Canberra patients travelling to Sydney, the logistics generally favour combining where the clinical case supports it.
The trade-offs of combined surgery:
- More swelling and bruising than isolated upper or lower blepharoplasty
- Higher dry-eye risk in the early recovery period
- Recovery window typically extended compared with isolated procedures
- Suitability depends on eye health, tear film, eyelid support, and recovery capacity
A peer-reviewed review of cosmetic blepharoplasty and dry eye reported postoperative dry eye incidence ranging from 0 to 26.5 per cent, with higher rates after simultaneous upper and lower blepharoplasty than after isolated upper or lower blepharoplasty in one retrospective study. Pre-operative dry-eye assessment matters more for combined surgery than for either procedure alone.
Medicare and private health insurance
Medicare doesn’t fund non-therapeutic cosmetic services.
For upper blepharoplasty, MBS item 45617 may apply where the relevant clinical criteria are met. The current item descriptor refers to a history of demonstrated visual impairment and other listed medical indications, with photographic and/or diagnostic imaging evidence in the patient notes. The 2022 MBS amendment removed the previous explicit requirement that visual field testing be confirmed by an optometrist or ophthalmologist. Visual field testing may still be clinically useful, but the item descriptor no longer makes it the only pathway.
For lower blepharoplasty, cosmetic surgery for under-eye bags is generally not Medicare-rebatable. MBS item 45620 applies only to specific medical indications such as exophthalmos-related orbital fat herniation, facial nerve palsy, post-traumatic scarring, or relevant symmetry restoration, with clinical need documented. Most patients seeking lower blepharoplasty for cosmetic reasons fall outside both pathways.
Private health insurance may contribute where an MBS item applies and the patient’s hospital cover is suitable. Where the procedure is cosmetic only, private health insurance generally doesn’t contribute. The fund can give you a definitive answer based on your specific policy.
For full pricing detail, see the Eyelid Surgery Cost in Canberra 2026 guide.
Recovery differences
Recovery patterns differ between upper, lower, and combined surgery.
Upper blepharoplasty. Bruising and swelling concentrate in the upper eyelid region. External sutures are typically removed at 5 to 7 days. Many patients return to non-physical work after 1 to 2 weeks, depending on tolerance for visible bruising. Temporary tightness, irritation, or dryness can occur.
Lower blepharoplasty. Bruising and swelling may extend into the lower lids and upper cheeks. Lower eyelid support and skin laxity influence recovery and risk profile. Temporary watering, dryness, or irritation may occur. Recovery may be longer or more visible than isolated upper eyelid surgery.
Combined upper and lower. More swelling and bruising than isolated surgery. Longer recovery window. Canberra patients should allow time in Sydney before returning home, with follow-up timing planned before travel.
For travel and accommodation guidance, see Travelling from Canberra for Plastic Surgery.
Risks and limitations
All surgery carries risk. Eyelid surgery has its own specific profile worth understanding before deciding to proceed.
Upper blepharoplasty:
- Bruising, swelling, infection, scarring
- Dry eye or irritation
- Asymmetry between sides
- Under-correction or over-correction
- Need for revision surgery
- Doesn’t correct brow descent or true eyelid ptosis unless separately addressed
Lower blepharoplasty:
- Bruising, swelling, irritation
- Lower eyelid malposition, retraction, or ectropion (lower eyelid pulling away from the eye)
- Hollowing if fat is over-resected
- Persistent dark circles where pigmentation or vascular factors are the cause
- Need for revision surgery
Combined surgery: all risks of both, plus higher dry-eye risk in the early recovery period.
A peer-reviewed review on cosmetic blepharoplasty and dry eye lists mechanisms including changes to eyelid closure, blink force, tear film distribution, and lower lid position. Pre-operative tear film assessment may be appropriate for patients with pre-existing dry-eye symptoms.
Where to go from here
Decision summary by main concern:
| If you’re concerned about… | Start by reading… |
|---|---|
| Upper eyelid hooding | Brow Lift & Blepharoplasty Canberra |
| Under-eye bags | Brow Lift & Blepharoplasty Canberra |
| Brow heaviness | Endoscopic Brow Lift in Canberra |
| Cost or Medicare | Eyelid Surgery Cost in Canberra 2026 |
| General eyelid procedure detail | Blepharoplasty in Canberra |
If you’re unsure whether your concern is upper eyelid skin, lower eyelid bags, brow descent, or eyelid ptosis, the next step is individual assessment. Start with the Brow Lift & Blepharoplasty Canberra page, then contact the practice to arrange a Canberra consultation.
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.
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
The practice doesn’t endorse, partner with, or recommend any specific loan providers or BNPL services.
Frequently asked questions
What is the difference between upper and lower blepharoplasty?
Upper blepharoplasty addresses upper eyelid skin, hooding, and sometimes upper eyelid fat. Lower blepharoplasty addresses under-eye bags, lower eyelid fat, skin laxity, and the lower lid-cheek transition. The procedures involve different anatomy, different surgical access, and different recovery and risk profiles.
How do I know if I need upper blepharoplasty or a brow lift?
If the brow has descended and is pushing tissue down over the upper eyelid, brow lift may need to be considered. If the main issue is excess upper eyelid skin without significant brow descent, upper blepharoplasty may be more relevant. Many patients need both assessed together because brow position and eyelid skin can both contribute to the same visual concern.
Can upper and lower blepharoplasty be done together?
They can be considered together when both upper and lower eyelid concerns are present. Combined surgery may involve more swelling, bruising, and dry-eye consideration than isolated upper or lower eyelid surgery. Whether combined surgery is suitable depends on eye health, tear film, eyelid support, and recovery capacity. For Canberra patients travelling to Sydney, combined surgery generally favours efficiency where the clinical case supports it.
Is blepharoplasty covered by Medicare?
Upper blepharoplasty may attract a Medicare rebate (MBS item 45617) only when relevant clinical criteria are met and clinical need is documented, including a history of demonstrated visual impairment with photographic and/or diagnostic imaging evidence. The 2022 MBS amendment removed the previous explicit visual field testing requirement. Lower blepharoplasty for cosmetic under-eye bags is generally not Medicare-rebatable; MBS item 45620 applies only to limited medical indications. Medicare benefits aren’t payable for non-therapeutic cosmetic services.
What if my eyelid itself is drooping?
A low eyelid margin may represent eyelid ptosis rather than excess upper eyelid skin or brow descent. Ptosis affects the eyelid lifting mechanism (the levator muscle) and is corrected by a different surgical procedure. Blepharoplasty alone may not correct true eyelid ptosis. Where ptosis is suspected at consultation, further ophthalmic or oculoplastic assessment may be recommended.
