What Does Upper Blepharoplasty Address?
Upper blepharoplasty addresses the soft tissue changes affecting the upper eyelid. Specifically:
- Dermatochalasis, the accumulation of excess upper eyelid skin that hoods over the natural eyelid crease
- Fat prominence from prolapse of the medial or central fat compartments
- Asymmetry between the two upper eyelids
- Functional visual field obstruction where the weight of excess skin pushes the eyelid margin downward into the line of sight
The incision is placed precisely within the natural upper eyelid crease, so the scar is concealed when the eyes are open and becomes progressively less visible over three to six months. In most patients, the scar is not visible in normal social settings once fully healed.
In more significant cases, the weight of excess skin can physically restrict the upper visual field. Where this is documented through formal visual field testing, the procedure may qualify for a Medicare rebate. The cosmetic versus functional distinction is discussed in detail below.
Is It a Brow Problem or an Eyelid Problem?
This is the most important question at consultation, and the answer often changes which procedure is actually appropriate.
The brow and the upper eyelid work together as one anatomical unit. When the brow descends with age, it pushes skin downward toward and over the eyelid crease, creating what looks like excess upper eyelid skin. If the brow has dropped significantly, a brow lift may address more of the concern than blepharoplasty alone. Attempting to compensate for brow descent by removing upper eyelid skin can anchor the brow in a lower position and worsen the overall appearance over time.
A simple self-assessment: stand in front of a mirror and gently lift the outer third of each eyebrow with a fingertip. If most of the apparent hooding resolves, brow descent is likely the primary concern. If the hooding remains, true upper eyelid skin excess is the dominant issue. Many patients have both, in which case combining upper blepharoplasty with a brow lift in a single operation is the appropriate approach.
Dr Turner assesses brow position carefully at every upper blepharoplasty consultation. The decision between blepharoplasty alone, brow lift alone, or a combination is based on examination findings, not on what the patient initially assumes their problem to be.
Upper Blepharoplasty vs Ptosis Surgery
A separate but commonly confused condition is true eyelid ptosis, where the upper eyelid margin itself sits too low because the levator muscle responsible for opening the eye is weakened or stretched. Patients with ptosis often describe the same heavy or tired appearance as patients with excess skin, but the underlying anatomy is different and the surgical correction is different.
Upper blepharoplasty addresses excess skin, muscle, and fat above the eyelid margin. Ptosis surgery, by contrast, tightens or advances the levator muscle to lift the eyelid margin itself. Performing blepharoplasty alone in a patient whose primary problem is ptosis will produce a limited result. Performing ptosis surgery in a patient whose problem is skin excess will likewise miss the actual concern.
Distinguishing the two requires examination of the upper eyelid margin position relative to the pupil (the margin-reflex distance, or MRD-1), assessment of levator function, and observation of the eyelid crease position. Dr Turner assesses both at consultation. Patients with both conditions, which is common, may need a combined procedure.
The Procedure
Upper blepharoplasty is performed under local anaesthesia with sedation or general anaesthesia, depending on patient preference and whether other procedures are being combined. It is generally a day procedure with no overnight hospital stay required in most cases. Where the procedure is combined with a brow lift, lower blepharoplasty, or facelift, an overnight admission may be appropriate.
Operating time for upper blepharoplasty alone is typically 45 to 60 minutes. Combined procedures take longer in proportion to the additional work.
The surgical steps are:
Marking. With the patient upright, Dr Turner precisely marks the skin to be removed. This is one of the most important steps in the entire procedure. Removing too little leaves the concern unaddressed. Removing too much can prevent the eyelids from closing fully and cause chronic dry eye or, in severe cases, lagophthalmos. Markings are carefully calibrated to each patient’s anatomy and to the planned closing margin.
Incision. The incision follows the marked pattern, placed within the natural upper eyelid crease. Internal and external limits respect the medial canthus and the lateral orbital rim.
Tissue removal. Excess skin is removed. The orbital fat compartments are assessed and, where contributing to the appearance, fat is conservatively removed or repositioned. A strip of orbicularis oculi muscle may be removed in selected cases where additional definition of the eyelid crease is appropriate.
Closure. Fine sutures close the incision. The sutured line sits within the natural crease and is typically not visible when the eyes are open.
Cosmetic and Functional Upper Blepharoplasty
The distinction between cosmetic and functional upper blepharoplasty determines both the regulatory pathway and the Medicare eligibility.
Cosmetic upper blepharoplasty addresses the appearance of the upper eyelids, hooding, heaviness, excess skin, without a documented functional component. This is the most common presentation. It is not covered by Medicare or private health insurance.
Functional upper blepharoplasty is performed where excess upper eyelid skin causes a documented and measurable obstruction of the upper visual field. This requires formal visual field testing performed by an optometrist or ophthalmologist confirming the functional impairment. Where the criteria are met, Medicare rebates may apply to the surgical fee component.
Many patients have both cosmetic and functional concerns at the same time. Where functional criteria are also met in a patient primarily seeking cosmetic improvement, Medicare eligibility should be properly assessed before surgery rather than discovered afterwards.
Medicare Eligibility and Item 45617
The relevant Medicare Benefits Schedule item for functional upper blepharoplasty is Item 45617. A rebate under this item may apply where:
- Excess upper eyelid skin causes a documented visual field obstruction
- Visual field testing from an optometrist or ophthalmologist confirms the impairment with photographic and visual field documentation
- A GP referral documenting the functional concern has been obtained before consultation
- The surgical technique addresses the functional component
The Medicare rebate covers the surgical fee component only. Anaesthesia and hospital fees remain out of pocket regardless of Medicare eligibility. Where private health insurance criteria are also met, an insurer may contribute to the hospital admission cost.
Purely cosmetic upper blepharoplasty without a documented functional component is not covered by Medicare or private health insurance. Dr Turner will assess eligibility at consultation and advise on the documentation required for a Medicare claim.
Am I a Suitable Candidate for Upper Blepharoplasty?
Upper blepharoplasty may be appropriate where:
- Excess upper eyelid skin is causing a hooded appearance or contributing to visual field obstruction
- Brow position is appropriate (or a combined brow lift is planned)
- General health is good with no conditions that significantly increase surgical risk
- Eye health is stable. Dry eye, previous ophthalmic surgery, or other conditions affecting the ocular surface need to be assessed before proceeding
- The patient is a non-smoker, or can cease all nicotine products for at least six weeks before and after surgery
- A psychological evaluation confirming suitability has been completed, as required under current AHPRA regulations
- The patient has had a minimum of two consultations and observed the mandatory cooling-off period before consent
- Expectations about what the procedure can and cannot achieve are realistic
Patients with significant brow descent may need a brow lift alongside, or instead of, upper blepharoplasty. Patients with true eyelid ptosis may need ptosis surgery rather than blepharoplasty. Dr Turner will advise which approach is most appropriate at consultation.
Recovery After Upper Blepharoplasty
Recovery from upper blepharoplasty is generally manageable compared with larger facial procedures, though individual recovery timelines vary based on technique, combined procedures, age, skin type, and personal factors.
Days 1 to 3. Swelling and bruising around the eyes peaks in the first few days. Cold compresses applied to the cheeks and forehead (not directly on the eyelids) may help manage swelling. Some patients experience mild discomfort and a degree of dry eye sensation as the eyes adjust. Prescribed eye drops and ointment are used as directed. Head elevation while sleeping is recommended for the first two weeks.
Days 5 to 7. Sutures are removed at the post-operative appointment. By this point bruising is often yellow-green and beginning to resolve. Many patients feel comfortable in public settings with sunglasses by the end of the first week.
Week 2. Most visible bruising has resolved. The majority of patients return to desk-based work and social settings within one to two weeks. Eye makeup can typically resume from two weeks once the incision line is fully sealed.
Weeks 3 to 6. Residual swelling continues to resolve and the incision line begins to fade from pink to less visible.
Months 3 to 6. The final result becomes apparent as all swelling resolves and the incision line matures fully. Before-and-after comparisons taken at this point reflect the settled outcome rather than the early post-operative appearance.
For a detailed recovery guide, see Recovery After Blepharoplasty.
Risks and Complications of Upper Blepharoplasty
All surgery carries risk. Upper blepharoplasty has a generally favourable safety profile in appropriately selected patients, but every patient should understand the potential complications before consent is given.
Potential complications may include:
- Bleeding or haematoma, including the rare but serious complication of retrobulbar haematoma
- Infection
- Asymmetry between the two upper eyelids
- Over-resection of skin leading to difficulty closing the eyes (lagophthalmos), which can cause exposure keratopathy
- Under-correction requiring revision surgery
- Dry eye, either temporary or persistent
- Altered eyelid sensation
- Visible scarring or scar widening
- Eyelid malposition
- Suture-related complications including milia formation
- Recurrence of excess skin over time
- Anaesthetic-related complications
The likelihood of each complication varies with the technique selected, patient health factors, ocular surface status, surgeon experience, and adherence to postoperative instructions. Specific risks are discussed in detail at consultation, and a written consent document outlining all known risks is provided before surgery.
Combining Upper Blepharoplasty with Other Procedures
Upper blepharoplasty is frequently combined with other procedures to address the upper face more comprehensively. Combining procedures means one anaesthetic, one recovery period, and a more balanced overall result than treating concerns in isolation.
Brow lift. Where brow descent is contributing to upper eyelid hooding, combining brow lift and upper blepharoplasty in a single operation addresses both concerns simultaneously and avoids the risk of treating the eyelid while leaving the underlying brow problem unaddressed.
Lower blepharoplasty. Where concerns extend to the lower eyelids, under-eye bags, fat prominence, excess lower eyelid skin, or tear trough deformity, both upper and lower blepharoplasty can be performed in the same operation.
Male blepharoplasty. Male upper blepharoplasty is approached with specific anatomical considerations. The male upper eyelid sits with less crease definition and a more masculine brow position, and the technique is adapted to preserve those features rather than producing a feminised appearance.
Facelift surgery and deep plane facelift. Where broader facial ageing changes accompany upper eyelid concerns, upper blepharoplasty may be combined with a facelift in a single operation.
Upper Blepharoplasty Cost in Sydney
Cosmetic upper blepharoplasty in Sydney with Dr Turner starts from $6,000 all-inclusive. The consultation fee is $450.
The all-inclusive surgical fee covers:
- Surgeon’s fee
- Hospital admission and theatre fees
- Specialist anaesthetist fee
- All postoperative follow-up appointments
A surgical deposit of $1,000 is payable only after the second consultation, not at the first consultation. A formal itemised quote is provided after the second consultation and reflects the specific technique selected and any combined procedures planned.
Where Medicare item 45617 criteria are met for a functional component, a Medicare rebate may reduce the out-of-pocket cost on the surgical fee. Hospital and anaesthetic fees remain payable. Where private health insurance criteria are met, the insurer may contribute to the hospital admission.
Combining upper blepharoplasty with lower blepharoplasty, a brow lift, or a facelift in a single operation may be more cost-effective than performing each procedure separately, as the hospital and anaesthetic costs are shared across procedures.
Consultation Pathway and AHPRA Requirements
Under Medical Board and AHPRA requirements effective 1 July 2023, the following pathway applies before cosmetic upper blepharoplasty can be booked:
- A referral from your GP or a specialist physician is required before the first consultation
- A minimum of two in-person consultations with Dr Turner before surgery is booked
- A psychological evaluation to confirm suitability for the planned procedure
- A mandatory cooling-off period of at least seven days before formal consent is given
- A surgical deposit of $1,000 is payable only after the second consultation
Where upper blepharoplasty is performed for documented functional visual field obstruction under Medicare Item 45617, a different regulatory pathway applies. Dr Turner’s team will confirm which pathway applies to your specific situation at consultation.
Frequently Asked Questions About Upper Eyelid Surgery
What is upper blepharoplasty?
Upper blepharoplasty is surgery to remove excess skin, and where appropriate fat and a strip of muscle, from the upper eyelids. It addresses hooding of the upper eyelid caused by excess skin descending over the eyelid crease (dermatochalasis), which can affect both the appearance of the eyes and, in more significant cases, the upper visual field. Incisions are placed within the natural eyelid crease and are typically not visible once healed. The procedure is performed under local anaesthesia with sedation, or under general anaesthesia, as a day procedure typically lasting 45 to 60 minutes.
Does Medicare cover upper blepharoplasty?
Medicare may cover upper blepharoplasty under Item 45617 where the procedure addresses a documented functional visual field obstruction caused by excess upper eyelid skin. The functional impairment must be confirmed by formal visual field testing from an optometrist or ophthalmologist, and a GP referral documenting the functional concern is required. The rebate covers the surgical fee component only. Hospital and anaesthetic fees remain out of pocket. Purely cosmetic upper blepharoplasty is not covered by Medicare. Dr Turner will assess eligibility at consultation.
How long does upper blepharoplasty recovery take?
Sutures are removed at five to seven days. Most visible bruising and swelling resolves within two to three weeks. Most patients return to desk work and social settings within one to two weeks. The incision line continues to mature and fade over three to six months. Final results, with all swelling resolved and the scar line fully settled, are typically seen at three to six months. Individual healing timelines vary based on age, skin type, and personal factors.
What is the difference between blepharoplasty and a brow lift?
Upper blepharoplasty removes excess skin, and where appropriate fat and a strip of muscle, from the upper eyelid itself. A brow lift elevates the position of the eyebrows and addresses descent of the forehead and brow tissue. When the brow has dropped significantly, it pushes skin toward the eyelid crease and creates apparent upper eyelid hooding. In these cases, a brow lift may address more of the concern than blepharoplasty alone, or both may need to be combined. Dr Turner will assess brow position and eyelid anatomy at consultation to advise which approach is most appropriate.
What is the difference between upper blepharoplasty and ptosis surgery?
Upper blepharoplasty addresses excess skin, fat, and where appropriate muscle, above the eyelid margin. Ptosis surgery addresses a different condition: weakness or stretching of the levator muscle that opens the upper eyelid, which causes the eyelid margin itself to sit too low over the pupil. Both can produce a heavy or tired appearance, but the anatomy and the surgical correction are different. Performing blepharoplasty in a patient whose primary problem is ptosis produces a limited result, and vice versa. Examination of the margin-reflex distance, levator function, and eyelid crease position is used to determine which procedure is appropriate, or whether both are needed.
Will upper blepharoplasty fix hooded eyes?
Upper blepharoplasty addresses hooding caused by excess upper eyelid skin (dermatochalasis). Where the hooding is primarily caused by descent of the brow rather than by excess eyelid skin, a brow lift may address more of the concern than blepharoplasty alone. Where both contribute, combining brow lift with upper blepharoplasty in a single operation is the appropriate approach. The mirror self-test described earlier in this page is a useful first step in identifying which anatomy is driving the hooded appearance, but a definitive assessment requires in-person examination at consultation.
Will upper blepharoplasty leave visible scars?
Incisions are placed within the natural upper eyelid crease, which conceals them when the eyes are open. The incision line matures and fades progressively over three to six months. For most patients, the scar is not visible in normal social settings once healed. Individual scarring varies depending on skin type, healing factors, and sun protection. Sun exposure to the incision line in the first three months can cause pigmentation changes, and sun protection is recommended during this period.
How much does upper blepharoplasty cost in Sydney?
Cosmetic upper blepharoplasty in Sydney with Dr Turner starts from $6,000 all-inclusive. This covers the surgeon’s fee, hospital and theatre fees, specialist anaesthetist fee, and all postoperative follow-up appointments. The consultation fee is $450. A surgical deposit of $1,000 is payable only after the second consultation. Where Medicare Item 45617 criteria are met for a functional component, a Medicare rebate may reduce the out-of-pocket cost on the surgical fee. A formal itemised quote is provided based on the specific technique selected and any combined procedures planned.
Related Procedures and Resources
Related procedures:
- Brow Lift Sydney
- Lower Blepharoplasty Sydney
- Male Blepharoplasty
- Forehead Lowering Surgery
- Facelift Surgery Sydney
- Deep Plane Facelift
Helpful guides:
Consult with Dr Scott J Turner
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS, AHPRA MED0001654827). He consults for upper blepharoplasty in Sydney at:
- Bondi Junction, 39 Grosvenor Street
- Manly, Suite 504, Level 5, 39 East Esplanade
Surgery is performed at Bondi Junction Private Hospital and Delmar Private Hospital in Dee Why.
Contact the practice on 1300 437 758 or [email protected] to arrange a consultation. Read more about Dr Turner’s background and training.
