Eyelid Surgery (Blepharoplasty) in Cape Town

A More Open Appearance – and, in Some Cases, Improved Visual Function

The delicate skin around your eyes changes as you age. Over time, the eyelid skin may lose elasticity. In addition, the supporting tissues can weaken and fat around the eyes may become more prominent.

As a result, you may develop heavy upper eyelids, excess skin, puffiness or bags beneath the eyes.

For some people, these changes mainly affect appearance. However, excess upper eyelid skin can sometimes become severe enough to obstruct the visual field. In these cases, eyelid surgery may have a functional as well as cosmetic benefit.

Blepharoplasty, commonly known as eyelid surgery, removes or repositions excess skin and fat around the eyelids. The procedure can create a fresher, more open appearance. Furthermore, in appropriately selected patients, upper eyelid surgery may improve peripheral vision when excess skin obstructs the visual field.

At Eye & Laser Clinic, we assess your eyes, eyelids and visual function before recommending treatment.

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Could Your Eyelid Surgery Qualify for Medical Aid?

In certain cases, eyelid surgery may qualify for medical aid benefits when there is a medical or functional indication rather than a purely cosmetic reason.

For example, severe excess upper eyelid skin may obstruct the visual field or interfere with normal visual function. Therefore, an ophthalmologist must first examine your eyelids and determine the severity of the condition.

Where clinically appropriate, your eye specialist can provide a medical motivation to your medical aid for consideration.

However, medical aid approval is not guaranteed. Cover depends on your specific medical aid, benefit option, clinical findings, authorisation requirements and the fund’s own criteria.

Therefore, if heavy or drooping upper eyelids are affecting your vision, the first step is an ophthalmic assessment. We can determine whether the problem is functional, cosmetic or a combination of both. Where appropriate, we can then provide the necessary clinical motivation for consideration by your medical aid.

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What Is Blepharoplasty?

Blepharoplasty is surgery of the upper eyelids, lower eyelids, or both.

During the procedure, the surgeon removes or repositions excess skin, fat and, when necessary, other supporting tissue.

However, blepharoplasty is not simply about changing your appearance. Your eyelids play an important role in protecting your eyes and maintaining a healthy ocular surface. Therefore, careful assessment and surgical planning are essential.

The aim is to address the specific eyelid concern while maintaining normal eyelid function and achieving a natural result.

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Why Do Our Eyelids Change With Age?

The skin around your eyes is particularly thin. Therefore, age-related changes often become noticeable around the eyes.

As you get older, your skin gradually loses elasticity. At the same time, the tissues that support your eyelids may weaken. Fat around the eye can also become more prominent.

Consequently, you may notice:

• Loose or excess upper eyelid skin

• Heavy-looking upper eyelids

• Skin that folds over the natural eyelid crease

• Puffiness around the eyes

• Bags beneath the eyes

• Excess lower eyelid skin

• Reduced peripheral vision caused by severe excess upper eyelid skin

However, not every heavy or drooping eyelid has the same cause.

For example, ptosis occurs when the upper eyelid itself sits lower than normal. In other patients, a low brow position may contribute to the heavy appearance.

Therefore, a specialist assessment is important. Your ophthalmologist can identify the underlying cause and recommend the appropriate treatment.

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What Can Eyelid Surgery Improve?

Blepharoplasty can address several concerns around the eyes.

Depending on your individual anatomy, eyelid surgery may help with:

• Excess upper eyelid skin

• Heavy upper eyelids caused by redundant skin

• Upper eyelid skin that interferes with peripheral vision

• Prominent eyelid fat

• Puffiness around the eyelids

• Bags beneath the eyes

• Excess lower eyelid skin

As a result, the eyes may appear more open and refreshed.

However, blepharoplasty cannot correct every concern around the eyes. For example, standard eyelid surgery does not remove all facial wrinkles or crow’s feet. It also may not correct dark circles beneath the eyes.

Therefore, your specialist will first determine what is causing your concern before recommending surgery.

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Upper Eyelid Blepharoplasty

Upper eyelid surgery focuses on excess skin and other tissues of the upper eyelid.

First, the surgeon carefully plans how much tissue to remove. The surgeon usually places the incision within the natural upper eyelid crease. Consequently, the scar can blend into the normal eyelid fold as healing progresses.

Next, the surgeon removes the planned amount of excess skin. When necessary, the surgeon may also remove or reposition excess fat.

Finally, the surgeon closes the incision carefully.

For some patients, upper blepharoplasty mainly improves appearance. However, other patients have significant excess skin that interferes with their peripheral vision. In these cases, surgery may provide a functional benefit.

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Lower Eyelid Blepharoplasty

Lower eyelid surgery primarily addresses bags, excess skin and prominent fat beneath the eyes.

Depending on your individual needs, the surgeon may make an incision just below the lower eyelashes. Alternatively, the surgeon may work through an incision on the inside of the lower eyelid.

The surgeon can then reposition or remove excess fat. In addition, the surgeon can address excess skin when necessary.

Because every patient’s eyelid anatomy differs, there is no single technique that suits everyone. Therefore, your surgeon will choose the approach that best suits your eyelid structure and treatment goals.

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Who Is a Good Candidate for Blepharoplasty?

Many healthy adults with excess upper or lower eyelid tissue may be suitable for surgery. However, age alone does not determine whether you qualify.

Instead, your specialist will examine your eyes and eyelids carefully. Your doctor will also consider your general health and medical history.

It is particularly important to tell your ophthalmologist if you have:

• Dry eye disease

• Glaucoma

• Thyroid disease or thyroid eye disease

• Diabetes

• High blood pressure

• Cardiovascular or circulatory conditions

• Previous retinal problems

• Previous eye or eyelid surgery

• Other significant eye conditions

• Medicines or supplements that may increase bleeding

In addition, your surgeon will discuss your expectations. This conversation is important because the aim should always be realistic and appropriate for your individual facial anatomy.

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What Happens During Your Eyelid Assessment?

Your consultation is one of the most important parts of the process.

First, your ophthalmologist examines your eyelids and surrounding structures. In addition, the doctor evaluates your eye surface and overall eye health.

The assessment also helps distinguish excess eyelid skin from conditions such as ptosis or brow descent.

If your eyelids appear to interfere with your vision, your specialist may assess the functional effect. Depending on the findings and medical-aid requirements, additional documentation or testing may also be necessary.

Your specialist will then explain whether surgery is appropriate and what you can realistically expect.

Furthermore, your medical history may affect how your surgeon plans the procedure. Therefore, always tell your doctor about medicines, supplements and existing medical conditions.

Importantly, do not stop prescribed blood-thinning medication or other medicines on your own. Instead, discuss them with your surgeon and the doctor who prescribed them.

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What Happens During Blepharoplasty?

The exact procedure depends on whether you need upper eyelid surgery, lower eyelid surgery, or both.

For upper blepharoplasty, the surgeon usually works through the natural eyelid crease. The surgeon carefully removes or repositions the planned tissue and then closes the incision.

For lower blepharoplasty, the surgeon may work through an incision beneath the eyelashes or from inside the lower eyelid. The surgeon can then address excess skin or prominent fat according to your needs.

Because every procedure is individualised, the length of surgery varies.

Your surgeon will explain the planned technique and anaesthesia before your procedure.

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What Is Recovery Like After Eyelid Surgery?

Swelling and bruising commonly occur after blepharoplasty. However, these symptoms gradually improve as your eyelids heal.

Your surgeon will provide specific aftercare instructions. For example, these may include guidance on:

• Wound and eyelid care

• Prescribed medication

• Eye drops or ointment when appropriate

• Physical activity

• Sleeping position

• Follow-up appointments

• When you can return to work and normal activities

Many patients feel comfortable returning to normal social activities once the initial swelling and bruising settle.

However, everyone heals differently. Therefore, you should not compare your recovery with someone else’s.

Although much of the initial swelling improves relatively quickly, your eyelids may continue to settle for several weeks or months.

Most importantly, follow your surgeon’s instructions throughout the healing process.

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Are There Risks With Blepharoplasty?

Blepharoplasty is a well-established surgical procedure. Nevertheless, all surgery carries potential risks.

Serious complications that affect vision are rare. However, they can occur.

Therefore, a thorough pre-operative examination is essential. Your surgeon will discuss your individual risk factors, expected benefits and possible complications before surgery.

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Can Blepharoplasty Improve Your Vision?

Yes, but only in certain patients.

If excess upper eyelid skin hangs over the eye and obstructs part of your peripheral visual field, removing that excess tissue may improve visual function.

However, blepharoplasty does not improve the eye’s focusing ability.

For example, eyelid surgery does not correct:

• Short-sightedness

• Farsightedness

• Astigmatism

• Presbyopia

• Cataracts

Therefore, an ophthalmic assessment is important when eyelid problems appear to affect vision.

Your ophthalmologist can determine whether the problem comes from excess eyelid skin, another eyelid condition or the eye itself.

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Cosmetic vs Functional Eyelid Surgery

Understanding the difference between cosmetic and functional blepharoplasty is particularly important.

Cosmetic blepharoplasty aims primarily to improve the appearance of the eyelids.

In contrast, functional eyelid surgery addresses an eyelid problem that interferes with normal function. For example, severe upper eyelid skin may obstruct the visual field.

Sometimes, however, a patient has both functional and cosmetic concerns.

This distinction is also important when considering medical aid. A medical aid may consider funding in certain cases when clinical evidence demonstrates a functional problem.

However, each medical aid applies its own rules and authorisation criteria. Therefore, your specialist must assess your individual case before determining whether a medical motivation is appropriate.

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How Long Do Blepharoplasty Results Last?

Blepharoplasty can provide long-lasting results. However, surgery cannot stop the natural ageing process.

Your skin, muscles and surrounding tissues will continue to change over time.

Even so, many patients enjoy the benefits of eyelid surgery for many years.

Several factors can influence long-term results. These include genetics, skin quality, lifestyle and the natural ageing process.

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Blepharoplasty at Eye & Laser Clinic

At Eye & Laser Clinic, Professor David Meyer provides specialist oculoplastic care at our Tygervalley centre.

Professor Meyer has worked in eye care for more than 35 years. During his academic career, he served as Head of the Department of Ophthalmology at Tygerberg Academic Hospital and Stellenbosch University’s Faculty of Medicine.

His ophthalmic background is especially important when assessing eyelid concerns.

After all, eyelid surgery involves more than appearance. Your eyelids protect the eyes and help maintain a healthy ocular surface. Therefore, surgery requires careful planning to balance appearance with normal eyelid and eye function.

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Considering Eyelid Surgery in Cape Town?

Heavy upper eyelids, excess skin and under-eye bags can affect how you look and feel. More importantly, severe upper eyelid skin can sometimes interfere with your vision.

Therefore, the first step is a professional ophthalmic assessment.

During your consultation at Eye & Laser Clinic, we will examine your eyes and eyelids. We will also determine whether your concern is cosmetic, functional, or a combination of both.

If we identify a medical indication, your ophthalmologist can advise you about the next steps. Furthermore, where clinically appropriate, your specialist can provide a medical motivation for your medical aid to consider.

Medical aid approval remains subject to your specific fund, plan, benefits and authorisation criteria.

Book your consultation with Eye & Laser Clinic to find out whether blepharoplasty is suitable for you.