Patients often book a blepharoplasty consultation because their upper eyelids look heavy or tired. In some cases, the issue is genuinely excess upper eyelid skin — and a cosmetic blepharoplasty is the appropriate procedure. In other cases, the underlying issue is ptosis — a drooping eyelid caused by a different problem in a different layer of tissue. Mistaking one for the other can lead to a procedure that does not solve the actual concern.
This page explains the difference in plain language, why the distinction matters, and how the assessment process at Dr Georgina Konrat's Bondi Junction practice identifies which pathway suits you.
Two Different Problems in the Same Area
The upper eyelid is made of layered tissues — skin on the outside, then fat, then muscle (the orbicularis), then deeper structures including the levator muscle and aponeurosis that lift the lid, and the conjunctiva on the underside. Cosmetic upper blepharoplasty addresses the outer layers: usually excess skin, sometimes a small amount of fat. Ptosis repair addresses the deeper levator complex.
Because both issues sit in the same general area, a heavy-looking eyelid can come from either cause — or from a combination. Without a proper assessment, it is easy to assume excess skin is the problem when in fact the eyelid margin itself is sitting too low.
How Cosmetic Blepharoplasty Differs from Ptosis Repair
Cosmetic upper blepharoplasty
The procedure removes a defined amount of excess skin from the upper eyelid through an incision placed in the natural crease. A small amount of fat may also be removed if it is contributing to puffiness. The levator muscle is not disturbed. The eyelid margin is in a normal position before surgery and remains in a normal position after surgery — what changes is the amount of skin sitting above it.
Cosmetic blepharoplasty is a cosmetic procedure under AHPRA rules. It requires a GP referral, two consultations, and a mandatory seven-day cooling-off period before booking. Medicare and private health insurance rebates do not apply when the surgery is performed for appearance only.
Ptosis repair
Ptosis repair tightens or shortens the levator aponeurosis (or, in some cases, uses a different muscle as a sling) to lift the eyelid margin back to its normal position. The skin is generally not removed unless excess skin is present alongside the ptosis. The procedure is performed by an ophthalmologist with oculoplastic training or by an oculoplastic specialist, often in a hospital theatre.
Where the ptosis is documented as obstructing the visual field by formal testing, Medicare item numbers may apply through the appropriate referral pathway. Where the ptosis is mild and cosmetic only, the funding situation is the same as for cosmetic blepharoplasty.
Why the Distinction Matters Before Booking
Performing a cosmetic blepharoplasty on a patient whose underlying problem is ptosis can leave the patient disappointed: the skin is tidied, but the eyelid margin still sits too low, and the heavy look remains. The reverse is also true — operating on a low margin without addressing genuine excess skin can leave a patient with a higher lid but skin still folding over the lash line.
That is why the consultation process at Dr Konrat's practice includes specific assessment of eyelid height (the margin reflex distance), levator function, and skin redundancy. If the assessment suggests ptosis is the dominant issue, Dr Konrat will explain that and refer you to the appropriate pathway, rather than offering cosmetic blepharoplasty alone.
What Happens at the Consultation
At your first consultation for upper eyelid concerns, Dr Konrat will:
- Review your medical history, current medications, and any previous eye surgery or injury that may have affected the eyelid muscles.
- Examine the position of the eyelid margin relative to the pupil, both at rest and when looking up.
- Assess the amount of skin sitting above the lid crease and whether it folds onto the lash line.
- Test levator function — how far the eyelid can lift from full down-gaze to full up-gaze.
- Identify any asymmetry between the two eyes.
- Discuss whether the appropriate operation is cosmetic blepharoplasty, a referral for ptosis assessment, or a coordinated approach.
A GP referral is required before the first consultation under AHPRA cosmetic procedure rules. Two consultations and a mandatory seven-day cooling-off period apply for any cosmetic procedure booking.
Self-Check Before Your Consultation
This is a rough self-test, not a diagnosis — but it can help you go into your consultation with a clearer picture of what is going on.
- Stand in front of a mirror in good light.
- Look straight ahead with your eyes relaxed.
- Note where the upper eyelid margin (the lash line) sits relative to your pupil.
- With your finger, gently lift any loose skin off the upper eyelid so it is no longer folding down.
- Look at the lash line again.
If the lash line was sitting low before, and now sits at a normal height once the skin is lifted out of the way, the heavy look is probably driven by excess skin — a cosmetic blepharoplasty pathway. If the lash line is still sitting low even with the skin held up, the underlying issue is more likely to be ptosis — and the appropriate pathway is different. Either way, the assessment at consultation is what confirms it.
How Dr Konrat's Practice Handles Both Pathways
Dr Konrat performs cosmetic blepharoplasty at her Bondi Junction practice — that is the focus of her eyelid surgery service. Her practice does not perform functional ptosis repair. Where the consultation assessment suggests true ptosis is the dominant issue, Dr Konrat refers patients to an appropriate ophthalmologist or oculoplastic specialist for functional assessment and surgery. Where both issues are present, the cosmetic component can be handled by Dr Konrat with the functional component coordinated through the specialist pathway.
The point of this page is not to diagnose your specific case — it is to make sure you arrive at consultation with realistic questions and an understanding of why the doctor may not just say "yes, book you in for blepharoplasty" on the first visit. A careful assessment is part of getting the right operation, not a delay tactic.