The starting point for patients who are considering eyelid surgery is often the cosmetic appearance of their eyelids. However, as a specialist plastic surgeon, Dr Ellis Choy knows that there is much more to consider, including a patient’s eyelid position, eye health, general health and their overall goals for surgery. He looks at all of these factors before recommending surgery.
With the information below, you can begin to self-assess whether you may be a good candidate for eyelid surgery. For a professional assessment, request an in-person consultation with Dr Choy.
Why Candidacy Depends On More Than Eyelid Appearance
Two patients with eyelids that are similar in appearance may receive different recommendations. There are many surrounding structures that affect the appearance of the eyes. Loose skin, shifting fat pads, stretched eyelid muscles and a descended brow can all create heaviness in the eye area, and each of these is addressed differently.
Blepharoplasty, or eyelid surgery, is used to remove excess skin from the eyelid itself. If your heaviness is coming from somewhere else, such as forehead laxity and a descended brow, this surgery may not be right.
It is also important to consider whether you are likely to have a good outcome based on your health and expectations. Dr Choy will not recommend a procedure if he does not believe it will be safe for you or likely to address the concerns you describe to him.
Physical Signs You May Be a Candidate for Eyelid Surgery
Heavy Upper Eyelids
Your upper eyelids may feel weighed down or puffy, even when you are fully rested. Some people who opt for eyelid surgery feel like they have to work to keep their eyes open by the end of the day. This can come from skin laxity or from muscle changes.
Lids Descending Towards the Lash Line
Excess upper eyelid skin can fold down over your natural crease. In some cases, it can even reach the lashes and rest on them. Eye makeup may smudge onto the fold or disappear when your eye is open, and be more difficult to apply.
Puffy Under Eye Bags
Fat below the lower lid protrudes forward, and the skin on the lower lid loosens and creates a bulge that doesn’t go away with sleep. Lower eyelid surgery can smooth this lower lid puffiness, but note that it will not address fine lines around the eyes (crow’s feet) or dark circles.
Functional Signs That You May Be a Candidate for Eyelid Surgery
Narrowing Peripheral Vision
If you have to tilt your head back or lift your brows to see clearly, you may have excess upper eyelid tissue that is reducing your visual field. This is typically confirmed through a visual field test performed by an ophthalmologist or optometrist, and Dr Choy can assess whether blepharoplasty will improve these vision concerns.
Dry or Irritated Eyes
If the lid is drooping, it can sometimes cause delicate inner surfaces to be exposed. Skin rubbing against skin in the upper lid fold may also cause irritation. Dry eyes should be assessed before surgery to be sure of the cause, as blepharoplasty can worsen some causes of pre-existing dryness.
Difficulty Reading or Driving
Sometimes excess eyelid skin can cause you to miss road signs that are above eye level or make you lose your place on a page. You may feel your eyes tire more quickly when doing close work because of a reduced upper visual field.
Headaches or Brow Pain
If your lids are obstructing your vision, your forehead muscles have to compensate by holding the brows up. You may do this without even realising what is happening, but you may notice chronic pain and tension in the muscles of your forehead, or you may have a headache at the end of the day.
Why the Distinction Between Cosmetic and Functional Eyelid Surgery Matters for Insurance Coverage
Eyelid surgery performed for appearance alone is not covered by Medicare, and you pay the full cost. If excess skin is obstructing your vision, the surgery may qualify for a Medicare item number, which can also open access to private health insurance benefits. You will need to have a visual field test and take preoperative photographs to provide your insurance with proof of functional issues.
Health Factors That Influence Your Candidacy for Eyelid Surgery
General Health and Smoking Status
Dr Choy considers candidates who are in reasonably good health. One of the most important factors is whether or not you smoke. Nicotine constricts blood vessels and reduces oxygen delivery to healing tissue. There is an association between smoking and wound healing complications in facial surgery, including wound separation after upper blepharoplasty. If you do smoke, you can still have the surgery, but you will need to stop smoking well in advance of your appointment.
Existing Eye Conditions and Dry Eye
If you have glaucoma, thyroid eye disease, previous eye surgery or dry eye syndrome, this will influence whether your eye surgery should move forward and what techniques will be used if you are a candidate for the surgery. Some conditions will need to be treated first.
Skin Type, Ethnic Background and Tissue Quality
Eyelid anatomy varies from person to person, and patients of Asian heritage may have a low crease or no visible crease. Surgical planning is personalized to accommodate these unique factors and ensure the results match the patient’s individual facial structure. Dr Choy performs Asian blepharoplasty as well as ptosis repair, where a stretched eyelid muscle is causing drooping instead of excess skin.
Is Age a Deciding Factor?
Age-related eyelid change is common in those who are forty or over, but hereditary heaviness can be present even in an individual’s twenties or thirties. The appropriate timing for your surgery will depend much more on your health and the condition of your eyelids rather than your age.
Other Considerations for Eyelid Surgery
If your brow has descended and reduced the space between the brow and the lash line, removing upper eyelid skin may pull the brow lower instead of addressing the concern. A brow lift may be a better option in this case. Blepharoplasty will not treat crow’s feet or other fine wrinkles, and it cannot stop ageing from continuing.
Recovery usually involves some swelling and bruising for around two weeks, and about a week of resting at home. The results of a blepharoplasty can last for many years, but eyelid tissue can loosen again, and results will vary between patients.
What Your Candidacy Consultation With Dr Choy Involves
Dr Ellis Choy is a specialist plastic surgeon who trained at the University of Sydney and holds two FRACS fellowships in general surgery and in plastic and reconstructive surgery. During your consultation with Dr Choy, you will go over your muscle tone and lid position and review your eye health history, general medical history and medications. He will explain what is causing your eyelid changes and how surgery will affect these changes. He will also discuss all of the risks and complications involved in eyelid surgery so you are fully informed before making a decision.
Request an Eyelid Surgery Consultation With Dr Ellis Choy in Sydney
If you think you may be a good candidate for eyelid surgery, we would love to talk to you more about blepharoplasty with Dr Ellis Choy. Contact us online or call us on (02) 8962 9388 to arrange an in-person assessment with Dr Choy.
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