Sydney

Facial Surgery

Sometimes it is, for the upper lids. Item 45617 covers upper eyelid reduction where one of the listed clinical indications applies, and in practice that’s usually a documented history of visual impairment. Medicare doesn’t pay benefits for non-therapeutic cosmetic services, so if the surgery is purely about appearance there’s no rebate.

One change catches people out. Since 1 November 2022 the visual field test is no longer required; a documented history of visual impairment takes its place. Photographs showing eyelid skin prolapsing over the lashes and obstructing your vision are still needed in your notes, and claims can be audited. Item 45620 covers lower lids on far narrower grounds, so bags or loose skin alone won’t qualify.

Upper eyelid surgery removes excess skin from the upper lid, and sometimes a small amount of muscle or fat as well. Lower eyelid surgery deals with the area beneath the eye, usually puffiness from fat that’s pushing forward, or loose skin. They’re separate operations, though they’re often done at the same time.

The upper lid is the one that’s more likely to have a functional element to it, because skin hanging over the lid can genuinely obstruct the top of your field of vision. Lower lid surgery is more often about appearance, and Medicare only treats it as reconstructive in a small number of circumstances. It’s worth knowing before you book that neither operation lifts the eyebrow, softens crow’s feet or removes dark pigmentation under the eyes; those come up as assumptions surprisingly often.

Earlobe reduction, or lobuloplasty, reshapes an earlobe that’s become elongated, stretched or split. Heavy earrings worn over many years will do it, and so will an earring that has torn through the lobe, gauges that have been deliberately stretched, and the gradual lengthening that comes with age.

It’s usually a small procedure done under local anaesthetic, and the technique depends on whether you’re dealing with a lobe that’s split, stretched or simply long. Repairing a torn lobe and reducing an elongated one are related, but they aren’t the same operation. Most people get back to normal activity fairly quickly. You will need to wait before re-piercing, though, and it’s worth planning where the new piercing goes rather than putting it back through the old hole. When it’s done for appearance, earlobe surgery is cosmetic and there’s no Medicare rebate.

If the surgery is being done to improve appearance, then yes, the Medical Board of Australia’s cosmetic surgery guidelines apply, and that includes a cooling-off period of at least seven days after informed consent before anything can be booked or a deposit paid. You’ll need a GP referral to see A/Prof Bish Soliman either way.

The guidelines also ask for a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who’ll be operating, and assessment for psychological conditions using a validated screening tool. If you’re under 18 there’s an independent evaluation as well, and the cooling-off period stretches to at least three months. Where the surgery is reconstructive, say repairing an eyelid after a skin cancer has been removed, or where it meets the criteria for a Medicare eyelid item, those guidelines don’t apply in the same way. Ask at your first appointment which pathway you’re on.

The reported risks include:

• Bruising and swelling
• Dry or irritated eyes
• Blurred vision in the early period
• Asymmetry
• Scarring that stays visible or thickens
• Difficulty closing the eyes fully
• The lower lid pulling down
• Infection
• Bleeding
• The possible need for revision surgery

Loss of vision is rare, but it’s a recognised complication.

Dry eye symptoms are one of the more commonly reported problems after eyelid surgery, and if your eyes are already dry, or you wear contact lenses, you’re more likely to notice them. Tell your surgeon about any existing eye condition, any previous eye surgery and any medication that affects bleeding. Some things shouldn’t wait until morning: sudden severe pain, swelling behind the eye that’s increasing quickly, or vision that’s getting worse all need urgent medical attention. There’s a dedicated risks and complications page on A/Prof Bish Soliman’s website that covers surgical risk in more detail.

For eyelid surgery, the visible bruising and swelling is usually a matter of days to a couple of weeks, and most people feel comfortable in public at around the two-week mark. Earlobe surgery tends to be quicker. What people don’t expect is the finer swelling, which sticks around longer than that.

Expect bruising around the eyes that changes colour before it fades, and plan on sleeping with your head elevated early on. Reading and screen work can be tiring for the first few days. When you’re working out how much time to take off, think about what your job involves and how visible you are, not just about wound healing. Ask for written guidance specific to your procedure covering driving, exercise, contact lenses, eye makeup and getting back to work, because those timelines aren’t the same and they’re the details people most often get wrong.

Every incision leaves a scar, although facial incisions are planned to sit inside natural creases and shadows. On the upper lid the incision follows the natural fold. On the lower lid it may sit just below the lash line or inside the eyelid, depending on the technique that’s used.

Eyelid skin is thin and tends to heal fairly inconspicuously compared with skin elsewhere on the body, which is part of why these incisions settle well for most people. That’s a tendency rather than a guarantee, and some people do scar more visibly than others. On the earlobe, the scar sits along the repaired edge or in the crease behind the lobe. Scars look their worst early, then flatten and pale over the following months, and most keep changing for around 12 to 18 months. Keep them out of the sun while they’re healing and follow the wound care instructions you’re given.

Eyelid surgery removes excess tissue rather than changing the shape of your eyes, so it shouldn’t leave you looking obviously operated on. An unnatural result usually comes from taking too much away, which is why conservative planning matters more than maximum removal.

People often bring in photographs of celebrities, or of themselves twenty years ago. A more useful conversation is about what specifically bothers you when you look in the mirror, because a specific concern is much easier to address than a general wish to look younger. Ageing doesn’t stop after surgery, and surgery won’t change skin quality, pigmentation or expression lines. If anyone promises you a particular look, treat that with caution and ask instead what’s realistic for your anatomy.

Sometimes, although they’re doing different things. Surgery removes tissue or repositions it, while non-surgical treatments work on the skin surface, on volume or on muscle activity. Neither is a substitute for the other, and nothing non-surgical will remove excess eyelid skin.

If you’re already having non-surgical treatments, tell your surgeon what you’ve had and when, because the timing around surgery matters. Anything involving prescription medicines requires an individual consultation and assessment, and it can’t be recommended or described in advance on a website. Be wary if you’re told a non-surgical option will achieve what surgery does, and just as wary if surgery is suggested when something simpler would deal with the concern you actually came in with.

Most of the visible swelling and bruising settles within two to three weeks, but the final result takes longer than that. Fine swelling in the eyelids can hang on for a few months and scars keep maturing well beyond that, so judging the outcome early will give you a misleading impression.

The eyelids are a small area, so small changes are noticeable. Some asymmetry while you’re healing is common, usually because swelling settles unevenly between the two sides, and it generally resolves. Give it time before you draw any conclusions. If something still concerns you once healing has finished, raise it at a follow-up appointment rather than assuming it’s permanent or that nothing can be done. Results vary between patients and no specific outcome can be promised.

In Australia, only practitioners with specialist registration in surgery, obstetrics and gynaecology, or ophthalmology can use the title surgeon; that restriction has been in place since 20 September 2023. For eyelid surgery specifically, you’ll find specialist plastic surgeons, oculoplastic surgeons and some ENT surgeons all working in the area.

A Specialist Plastic and Reconstructive Surgeon holds FRACS (Plastic Surgery), which is awarded after accredited training with the Royal Australasian College of Surgeons. You can check any practitioner’s registration and specialty yourself on the AHPRA register; it takes a couple of minutes and it’s worth doing before a first appointment rather than after. A/Prof Bish Soliman holds FRACS (Plastic Surgery), MS (Plastic Surgery) and MBBS (Hons 1), and is AHPRA registered (MED 0001679053) with specialist registration in plastic surgery.