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Blepharoplasty: Getting a Perfect Result Every Time

“I see a lot of women, and guys as well, with upper eyelid droop. What we do is basically get rid of the droop. I make a special stitch that makes the skin fold in so when you open your eyes, the cut’s going to be right in the fold coming out to the side. After a couple weeks it fades very well and you get a really nice eyelid that’s not droopy, not interfering with your vision or sitting on your eyelashes.”Dr Beldholm

In this video and article, Dr. Beldholm goes through a range of important facts you need to know about having a blepharoplasty. You will find information on:

  • Who is suitable for an upper eyelid operation
  • Can I use my health find and what are the Medicare item numbers
  • Cost of the procedure
  • Location and options for the operation
  • Local anaesthetic vs General anaesthetic
  • Operation techniques to give you the best possible results
  • Stitch removal
  • Recovery
  • Going back to work

Who is suitable for an upper eyelid operation

blepharoplasty

This photo of one of Dr. Beldholm’s patients demonstrates the ideal patient for an upper eyelid operation. One of the most critical factors in predicting the final result is the position of the eyebrow. As seen on this patient, the eyebrow has a normal position. The postoperative photo shows the great result after the procedure!

As we age, unfortunately, everything sags. The skin on the upper eyelid becomes loose and slides down to lie on the upper eyelashes. Your forehead and your eyebrows also slide down and start to droop.

There are 2 operations that apply to this area of the face, these are very different operations:

  • Upper eyelid operation or blepharoplasty
  • Brow lift operation

The critical factor in deciding which operation is suitable for you is the position of the eyebrow. If the eyebrow lies on or above your superior orbital rim (the bone that surrounds your eye socket) then you can have a blepharoplasty and have a great result.

If the eyebrow lies below your orbital rim then you will need to look at having a brow lift.

Can I use my health fund and what are the Medicare item numbers

The item number for upper eyelid operation is: 45617

If you want a more detailed information, you can find this in the Medicare Health website.

This is what is written in the description for this item number:

“Upper eyelid, reduction of, for skin redundancy obscuring vision (as evidenced by upper eyelid skin resting on lashes on straight ahead gaze), herniation of orbital fat in exophthalmos, facial nerve palsy or posttraumatic scarring, or the restoration of symmetry of contralateral upper eyelid in respect of 1 of these conditions.”

The MBS rebates and the Health fund rebates can get quite confusing as well.

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This photo shows one of Dr. Beldholm’s patients. The arrow points to where the eyelid skin is sitting in relation to her upper eyelashes. As can be seen here, she clearly qualifies for the medicare item number.

Navigating medicare and the private health funds can be quite confusing and complicated. That is why Dr Beldholm has a skilled patient coordinator that helps you through your surgical journey and helps you with things like medicare item numbers and health fund issues.

The guiding principle for medicare is that all health conditions and operations need to be for medical conditions and health related problems.

Local Anaesthetic versus General Anaesthetic for Blepharoplasty Surgery

There are two ways of doing this operation. We can do it under local anesthetic or sedation or we can do it under general anesthetic. If we do the operation in the private hospital than we usually do it under a general anaesthetic, if we do it in our day facility in broadmeadow than we would usually do it under sedation and local. The final result that you get is the same whatever method you have it done by.

General Anaesthetic for Upper Eyelid Surgery

General anaesthetic means that you are completely asleep. An anaesthetist is monitoring your breathing and you will not remember anything from the operation. This method is done in the private hospital either in Maitland Private hospital or Hunter Valley Private Hopital. It is done as a day stay operation meaning that you spend a couple of hours in the hospital and then go home. You will need to pay for anaesthetist, hospital and surgeon’s fees.

Local Anaesthetic and Sedation for Blepharoplasty

This is what’s done when you have your operation with us at our day facility in Broadmeadow. We give you sedation which means that you are half asleep but not fully asleep. We also put in local anaesthetic in the upper eyelids to numb the area. The local stings a bit but once it takes effect, it is pain free.

Upper Eyelid Surgery Costs

There are 3 costs that need to be taken into account for this operation:

  • Hospital costs
  • Anaesthetist costs
  • Surgeon costs

Hospital costs for upper eyelid surgery

One of the main benefits of having a health fund is having the hospital paid for. You will only have the hospital paid for if you qualify for an item number. It is also important to remember that each health fund is different and it also depends on your level of cover. Some health funds have an excess that you need to pay for as well.

If you do not have a health fund then you will not be able to claim any of the costs of a private hospital back. This is why we offer this operation at our day facility in Broadmeadow, to be able to offer you the operation at a reduced price.

Anaesthetic costs for upper eyelid surgery

If you are having your operation in the Private hospital under a general anaesthetic, then you will need to pay these charges. You will get a small amount back from medicare and if you have a health fund you will get a bit more back.

Surgeons fee for upper eyelid surgery

If you have a health fund then you will get some money back for your surgeon’s fee.

Total fee for blepharoplasty or upper eyelid operation

As you can see, if you have a health fund and get an item number then the final out of pocket fee is quite difficult to tell you upfront as it has so many variables. However once you have received your quote from the hospital, anaesthetist and Dr. Beldholm then you will be able to call your health fund and find out exactly what rebates you get back once you have had the operation.

What happens if you do not have health fund cover?

If you are not covered by your health fund and you are happy to have the operation under sedation and local anaesthetic in our Broadmeadow theaters, then we have developed a package price for you.

If you do not have Health cover then our all inclusive package price is (if you qualify for an item number than you will get some money back from medicare): $6990.

What is included in this price?

  • Pre and post op care by our nurses and Dr Beldholm. Once you have had your initial consultation with Dr. Beldholm then all subsequent visits are free of charge.
  • Operation takes around 1.5 hours, if it goes longer you do not pay more.
  • Hospital charges
  • Anaesthetist charges
  • Surgeons fees
  • 6 LED light treatments with (Healite II LED). This helps any bruising or swelling after your procedure to get you back to your normal activities faster.
  • Access to 24/7 emergency number after your procedure if you have any concerns.
  • Our diamond service commitment

What happens when you are having your upper eyelid operation

Every step of the operation is critical for your result. From marking out where the cuts are going to be, to how your skin is sutured and how we take care of you after your operation.

The importance of precision and getting marked out in the anaesthetic room

blepharoplasty-marking-out-surgical-site

This photo shows one of Dr Beldholms’ patient’s after he has marked out her upper eyelids. The little arrow on the her left forehead points to a small Xanthelasma on her upper eyelid that will also be removed during her operation.

blepharoplasty

In this photo I’m testing the looseness of the upper eyelid skin to make sure that we are not going to make the upper eyelids too tight. – Dr. Beldholm

First of all, Dr Beldholm marks you out in your anesthetic bay. He always sees you just before the operation.

“I’ll do all my markings and we’ll have a chat about your expectations and what you can expect afterwards.” –Dr Beldholm

It is critically important to get these marking right. In an eyelid operation, being off by just a few millimeters makes a big difference in the final result. That is why Dr Beldholm spends a lot of time doing these markings with you before the operation starts.

The difficulty with upper eyelid surgery is that we put in local anaesthetic in the upper eyelids which distorts everything making it impossible without the markings to do the operation.

blepharoplasty

This photo is taken in our Newcastle theater showing the patient with local anaesthetic injected by Dr Beldholm. The upper eyelids are bulging out and are quite distorted. If the markings had not been done prior to the operation then it would have been impossible to tell how much skin or where to remove the skin from.

Removing the skin from the upper eyelids

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This photos shows Dr. Beldholm starting the incision for the left upper eyelid. The local anaesthetic that we used to inject the upper eyelid with has adrenaline in it. Adrenaline helps constrict the blood vessels and normally we do not get much bleeding during the operation. Dr. Beldholm uses magnifying loops to see all the small blood vessels to be able seal these.

There is a number of ways to remove the skin. They range from cutting the skin with a laser, using a diathermy to cut the skin or using a scalpel to cut the skin.

Laser Blepharoplasty versus Traditional Blepharoplasty

Dr Beldholm has used all the different methods of doing an upper eyelid surgery. The main type of lasers that can be used for upper blepharoplasty surgery is the carbon dioxide (CO2) laser.

It is important to mention that this is not new technology. In fact, the CO2 laser has been around in medicine for close to 30 years. There is no benefit to this over other methods of cutting the skin. There are also research reports stating that the laser method is associated with a lot of complications. Making the incision with a scalpel, in Dr Beldholm’s experience, is a more precise and risk free method of doing the operation.

blepharoplasty

This photo shows one of Dr. Beldholm’s patients at 6 months after her operation. Dr. Beldholm has used many methods to cut the skin but has found that a scalpel gives as good, if not better results as compared to a laser. The instruments are important but surgical skill and experience is more important.

Once we have made the incision we gently remove the skin with a pair of scissors and then trim some of the orbicularis muscle as needed.

Trimming the fat pads

As we get older the connective tissue and the fascia surrounding the eye gets loose and the fat pads that in your youth are contained within the eyes start bulging out. To get a really nice and smooth result we need to trim these. There are 2 fat pads in the upper eye area: the medial and the lateral. Before we close the skin, we explore these and trim as needed.

blepharoplasty-trimming-fat-pad

This photo shows Dr. Beldholm trimming the medial fat pad. This step needs to be done very gently as there are blood vessels deep in the eye that can be disrupted if too much tension is put on the fat pad. The instrument that Dr. Beldholm is using is called a bipolar forceps diathermy.

Plicating the upper eyelid skin to the deeper structures

One of the big issues with aging upper eyelids is that the skin slides up and down the deep structures. This is what creates some of the sagginess and also the reason why we lose the upper eyelid fold as we age. It is therefore critical that we re-create the attachments. Not doing this will create a very poor result as the upper eyelid skin will still be sagging even after the operation.

There are different methods in doing this. Some surgeons dissect out the so called tarsal plate (the upper eyelid cartilage) and stitch the upper eyelid skin to this. Dr Beldholm prefers to do a gentle running suture into the deeper tissues without dissecting out the cartilage. This works extremely well with the least amount of trauma possible. The key to success with this method is to prevent the skin from sliding down and also re-create a nice youthful upper eyelid fold.

blepharoplasty-plicating-the-upper-eyelids

This photo shows Dr Beldholm using a very thin absorbable stitch called a “6/0 Caprosyn Suture” to stitch down the upper eyelid skin to the deeper structures to re-create the upper eyelid fold.

Final Closure

As with all things in surgery there are many different methods of closing the skin. Dr Beldholm has tried most of these and at the moment, he uses a very thin permanent stitch to close the skin. The other option is to use an absorbable stitch, the benefit of this is that it will not need to be removed.

“In the end the result is what is the most important thing to me. I found that when I was using absorbable stitches the scar was not as good as with the permanent stitches. There was bunching of the incision and the scar was much thicker in the end. Although it is a bit uncomfortable to have the permanent stitches removed the result are worth it.” -Dr Beldholm

Recovery

The recovery after upper eyelid surgery is really good. You’ll find that 1 or 2 weeks is all you need. We do LED lighting in our office so that helps with the bruising and the swelling. The first week is usually the worst. You’ll have a little bit of bruising on the upper eyelid. Sometimes you get a bit of bruising down on the bottom eyelid but that’s uncommon.

I use permanent stitches. They’re very, very fine stitches. I have used absorbable stitches in the past. However, what I found with absorbable stitches is that they bunch up the skin a little bit and actually the way they dissolve is that the body needs to eat the stitch up so you get inflammation and you get a much worse scar. The little fine stitch that we need to remove gives you a much better result than doing absorbable one. Our nurses here are very skilled and they just remove that at day 7 and after that you just wait for everything to heal up. There’ll be a little fine line which after about 2 weeks you can hardly make out.

Going back to work and exercise after upper eyelid surgery transcript from video

Note: In this video Dr. Beldholm goes through what you can expect with your recovery from upper eyelid surgery.

This is Dr. Bernard Beldholm. We are talking about the recovery process after you have your upper eyelid operation. An upper eyelid operation is usually fairly straightforward. It takes about an hour to do. You spend four hours in the hospital and then you can go home. You will need someone to pick you up. There will be stitches on top of the eyelids, these will be removed at day seven. Sometimes you get a little bit of blurred vision and sometimes you get a little bit of dryness in your eyes, but other than that it’s usually very minimal discomfort.

From the recovery point of view and going back to work point of view, it all depends on what type of work you have and how much you want to show that you had something done. It usually takes about one to two weeks to get all the bruising to settle down. Usually the bruising comes down under the eyes, so that takes a little bit of time to settle. We give you LED light treatment in the office. That helps a little bit with the bruising, but still usually about two weeks it takes to completely go away.

You will also have stitches in for seven days, so that’s something you need to keep in mind. If you don’t want anyone to know or if you don’t want to wear sunnies at work, you’re probably looking at about two weeks.

Performing your work, being in front of a computer, taking phone calls, doing other things around the house, is all fine. If you have a home-type based work or if you’re not too worried about that people see you with a little bit of bruising and the stitches in, you can go back in a few days. It’s usually not a very major operation from that point of view.

What about exercise? Exercise is a little bit difficult, because when you exercise, all your blood pressure goes up and when the blood pressure goes up there’s always a chance of bleeding. We talk about reactive bleeding, which takes about ten days to happen. That’s when the clots are dissolving and you get new vessels coming through. At day ten, usually is a higher risk of re-bleeding, so you really don’t want to do any major exercise for two weeks after your operation, just to make sure you don’t get another bleed at ten days.

After two weeks, you’re pretty alright. There’s very little that can happen after that, so you can go back to exercising, doing all your normal routines, running, aerobics, that sort of thing.

The other question I get is regarding driving. Driving depends a little bit because you can get a tiny bit of blurred vision. You can get a little bit of swelling around the eyes, so it all depends on how long that takes to settle, but a few days is usually more than enough time for that to settle down.

Final conclusion

In conclusion this operation makes a big difference for many men and women. Having hanging upper eyelid skin and can be both uncomfortable, interfere with your vision and look unsightly. Modern techniques can get rid of this problem for you in around 1 hour and the recovery is usually very good.

 

*Disclaimers

General disclaimer (including google ad disclaimer)

There is no guarantee of specific results and the results can vary from patient to patient. The photos shown have not been altered, other than removing identifiable marks such as tattoos and birthmarks at the request of the patient. If any such alteration has been done then it has been done equally on both before and after photos and there is a notation under the photo stating what alteration has been done.

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AHPRA (Australian Health Practitioner Regulation Agency) disclaimer, required by Australian Law

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.