Reconstructive eye surgery (Oculoplastics) FAQS

Common types of reconstructive eye surgery include:

• Eyelid lesion and tumour surgery
• Drooping eyelid (ptosis) surgery
• Blocked tear duct surgery
• Eyelid lift (blepharoplasty) surgery.

Blepharoplasty can be performed on the upper and lower lid, depending on your individual needs.

Ophthalmologists who have completed further training in oculoplastics perform reconstructive surgery of the structures around the eye – e.g. the eye socket (orbital surgery), around the eyeball (periocular surgery), the tear drainage system (lacrimal surgery) and the eyelid (blepharoplasty). They can also be called ophthalmologists who perform oculoplastic surgery.

Reconstructive eye surgery can take varying amounts of time depending on the type of surgery you receive. Many reconstructive eye surgeries, such as blepharoplasty, are performed as day procedures, and you can expect to be discharged from hospital on the same day as your surgery.

If you’re ready to consider your reconstructive eye surgery options, book an appointment with one of our specialists.

Blepharoplasty, or ‘eyelid lift’ surgery, is a surgical procedure that involves the removal or repositioning of excess skin, fat and muscle around the eyelids. It can be performed on the upper eyelids, lower eyelids, or both.

Blepharoplasty is commonly performed for medical and cosmetic reasons. Aesthetically, blepharoplasty can help reduce the signs of ageing, such as droopy eyelids or bags under the eyes, and create a more youthful, refreshed appearance. Medically, it can be offered to improve your vision if sagging eyelids are obstructing your field of vision.

If you would like to learn more about blepharoplasty, you can read our eyeMatters factsheet here.

The best age for blepharoplasty depends on individual factors, including current medical conditions, the presence of eyelid drooping or bags, visual field obstructions, and the desired outcome.

Ultimately, the ideal time for blepharoplasty will depend on your specific needs and circumstances. An ophthalmologist who performs oculoplastic surgery will check your eyes and advise if blepharoplasty is an option for you.

Excessive watering (also called epiphora) of the eyes can lead to eye irritation and recurrent eye infections. This condition can be surgically treated by opening the tear drainage system in the inner corner of the eye (also called the punctum). Treatments include:

• Punctum dilation – a procedure where the punctum is widened using a probe to improve tear drainage
• 3-snip punctoplasty – a procedure where three small incisions are made to the punctum to create a larger opening for tear drainage from the eye
• Dacryocystorhinostomy – a surgical procedure that creates a new drainage pathway between the eye and nose, bypassing the blocked tear duct.

Ptosis surgery is a procedure designed to correct drooping of the upper eyelid. Drooping eyelids, or ptosis, may be present at birth (congenital ptosis) or develop later in life (involutional ptosis) – and it can potentially obstruct your field of vision, sometimes even completely. Ptosis surgery can improve the cosmetic appearance of the eye and return lost vision.

Eyelid lesion surgery is a surgical procedure that removes growths or abnormalities (these are often referred to as lesions) on the eyelids. These lesions can be benign (non-cancerous) or malignant (cancerous). After the lesion is removed, the surgeon will use skin flaps and grafts to preserve the appearance and function of the eyelid.

Reconstructive eye surgery is generally not very painful, due to the use of anaesthesia during the procedure. Your surgeon will inject a local numbing medication around the eye (typically around the eyelid and surrounding areas), so you won’t feel pain during the procedure. However, you might be aware of a sensation of pressure or movement during the procedure – this is normal.

Sometimes, patients are also given light sedation in addition to the local anaesthesia to help them feel more relaxed or drowsy. This can help to ease any anxiety or nervousness during the surgery.

For more complex or lengthy procedures, general anaesthesia may be used. This is less common in reconstructive eye surgery but could be an option if multiple procedures are being performed, or if you and your surgeon decide it’s necessary for your comfort and safety.

After reconstructive eye surgery, your surgeon will provide you with post-surgical care instructions and will prescribe pain relief medications to support your recovery.

For most cases of reconstructive eye surgery, you will be awake during your surgery – however, the area around your eye will be numbed using local anaesthesia so that you won’t feel any pain. The use of local anaesthesia allows your surgeon to work on the delicate structures around your eye while you remain conscious and able to follow instructions if needed.

Immediately after reconstructive eye surgery, your surgeon will place a dressing over the eye (or eyes) to protect it and minimise post-operative swelling and bruising. You may feel some mild discomfort, pressure or tightness around the eye after your surgery – this is normal and will settle as the eye heals. Your surgeon will also prescribe pain relief and eye drops/ointment, which should be used as instructed. Additionally, as reconstructive eye surgery is often performed as a day procedure, you will likely be able to leave the hospital on the same day as your surgery.

It is common for the eyelids to bruise and swell post-operatively. Swelling typically lasts around two weeks, although this can vary depending on the type of surgery. You may also notice that swelling increases after dressing removal; this is expected, and it will gradually resolve. To minimise post-operative swelling, you can:

• Sleep at a 45-degree angle
• Apply ice packs for a few minutes at a time, 4 times a day, for the first 4 days after your surgery.

If swelling persists beyond 4 days, you can continue to use ice packs until the swelling resolves. If you prefer, you can purchase specific cooling eye pads from your chemist. A packet of frozen peas (or equivalent) wrapped in a tea towel is also a good alternative.

Reconstructive eye surgery, like any surgical procedure, carries some risks. While these surgeries are typically safe and effective, potential risks include:

• Infection – there is potential for infection with any operation; however, meticulous cleaning of the surgical area, intravenous antibiotics during the surgery, sterile surgical technique and following your post-operative care instructions can all minimise this risk
• Scarring – any surgical scars usually heal very well and fade to a thin line with time; rarely, a prominent scarring response may require further management
• Additional surgery – on occasion, further surgery may be required to achieve the ideal results
• Bleeding – minor nose bleeding is common after dacryocystorhinostomy; occasionally more significant nose bleeding may occur, which could require a nose pack or further treatment.

Before having reconstructive eye surgery, your surgeon will discuss the risks with you and how they can be minimised.

The cost of reconstructive surgery will depend on the surgery you receive. A Medicare rebate may apply if the surgery is for functional reasons. Cosmetic eyelid lifts do not attract a Medicare rebate. Your surgeon will discuss the costs with you before surgery. If you have private health insurance, please contact your insurer to find out what level of cover you have and whether they will cover any costs.