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Written by Dr Julian De Silva
Blepharoplasty, more commonly known as eyelid surgery, is the most performed cosmetic operation that Dr De Silva completes for patients.
As a combination of ageing and genetics, the skin and muscle around the eyelids loosens, resulting in loose skin, puffiness and dark rings that may give you a tired appearance. In addition, there are often changes in the anatomy that results in puffiness owing to fat protruding into the eyelids forming bags in the lower and upper eyelids.
In expert hands eyelid surgery rejuvenates your facial appearance, making you look fresher and less tired. The eyelid anatomy is intricate, and blepharoplasty involves a combination of reshaping excess skin, muscle and prolapsing fat. Dr De Silva focuses on meticulous techniques to ensure a natural-looking result.
Eye contact is a key aspect of our daily communication and the appearance of your eyes form part of your first impression on meeting someone.
Loose skin, puffiness or wrinkles are readily seen, and common symptoms patients describe include being asked if they are tired, stressed or lacking sleep. Heavy upper eyelids, dark circles or bags around the lower eyes, often lead to a tired and aged look.
Although these changes are usually associated with ageing, some people develop these signs around their eyes from their late teens. The details around the eyes are of great importance, as subtle changes of even less than half a millimetre can be discernible between the right and left sides.
Patient safety is of key importance for all facial plastic surgery. The intricate anatomy of the eyelids requires precision and care. Dr De Silva is a keen advocate of patient safety and has championed the need for patient safety on Sky news and at medical conferences.
Most patients are able to return to social and professional activities after two weeks. The truth is that recovery after eyelid surgery does depend on several factors.
Dr De Silva has an avid perception for detail and utilises additional surgical techniques to enhance natural-looking and longer-lasting results.
He specialises in all facial treatments (surgical and non-surgical) and evaluates your eyelids and face as a whole. Key considerations include the position of brows, eyelid symmetry and lower eyelid position.
Dr De Silva utilizes additional techniques and advanced technology including:
Dr De Silva completed his surgical training in University Hospitals around London, which are amongst the best institutions in the UK, including Moorfields Eye Hospital. He remains the only cosmetic surgeon to have had trained in the cosmetic meccas of Los Angeles and New York, and it was there that he acquired skills in scar-less surgery and micro-incision techniques that he brought back to London. He was the only surgeon in his specialty to have been awarded funding for training in the US.
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All these patients underwent eyelid surgery with Dr De Silva. We encourage patients to watch one or two videos of patient experiences to have a good understanding of healing and the recovery period. Dr De Silva and his team will provide support and reassurance during your recovery, we believe that being a well-informed patient is helpful to most patients undergoing eyelid surgery.
History
When you attend a consultation, the surgeon will take a detailed medical history and examination of your eyelids. As a specialist in all facial plastic procedures, Dr De Silva will look at your face as a whole as all parts of the face lie in relative balance.
Dr De Silva requests patients bring older photographs to ensure that surgery is planned to suit your individual facial characteristics and ageing.
Examination
A detailed examination of the eye and eyelids and your face is important. If there is drooping of the brows or eyelids, this will be taken into consideration and a brow lift or ptosis surgery may be indicated.
Goals & Expectations
Other important factors are dry eyes, previous laser refractive surgery and the use of eye drops. A discussion of your goals and expectations of any prospective surgery will also take place.
For some patients, Dr De Silva may advise against surgery and non-surgical treatments if it is in their best interest.
Further Consultation Before Blepharoplasty Surgery
Dr De Silva and his nursing team see all patients a second time before surgery to discuss the procedure in further detail. They inform patients of measures they may take to enhance recovery, and provide details of the recovery period.
Blepharoplasty is demanding and requires in-depth knowledge of the anatomy of the eye area, as well as attention to detail.
One of the most important factors responsible for the success of surgery is the surgeon. In Dr De Silva’s hands complications are uncommon, with swelling and bruising being the most common aspects of recovery.
Pain or discomfort are uncommon and resolve within 24-hours. Infection is very rare, and the gold standard is prophylactic antibiotics to protect against infection.
Dr De Silva avoids the side effects of general anaesthetic (deep vein thrombosis and allergies) by using safer sedation anaesthesia.
Two rare and serious complications are eyelid retraction and damage to vision. Dr De Silva has never had a patient of his own have these complications. However, he takes multiple levels of precautions to avoid these issues in the first place.
The eyelids have an intricate anatomy of millimetres. Thus, an oculo-plastic surgeon specialising in this area of the face is best suited to ensure a smooth journey and successful result.
Although there are individual factors that influence the duration of the procedure, most eyelid surgery will last eight to ten years. For lower eyelid blepharoplasty, just one surgery may be adequate for a lifetime.
Dr De Silva often utilises additional techniques including fat transfer, laser resurfacing which can enhance the duration of the result.
Choosing the surgeon for your eyelid surgery is one of the most important decisions you will make. Key considerations in this choice:
An important choice in selecting the right surgeon is to look for a specialist in facial cosmetic surgery. As our understanding of the human body has evolved surgeons have become more specialised. So, it is difficult for a general plastic surgeon to have knowledge of all parts of the body.
Dr De Silva is a world-renowned specialist oculofacial plastic surgeon who focuses only on the face and has extensive expertise to give you a safe and successful outcome.
Cosmetic surgery is a different branch of medicine to reconstructive plastic surgery. It focuses on natural rejuvenation, proving discrete changes with hidden scars, whereas reconstructive surgery is to correct function or deformity, including blepharospasm and water eyes.
Dr De Silva trained at the world-renowned Moorfields Eye Hospital, London and went on to complete specialised cosmetic training in Los Angeles and New York.
The eyelids are a surgery of millimetres as less that 1-millimetre difference between the two eyes can be seen. Seeing a surgeon who specialises in the entire face is important, as the eyes exist in balance with the lower half of the face.
Eyelid surgery can be completed with 20minutes however the result will not be the same as a surgeon who completes the surgery in one and half hours.
Unfortunately, eyelid surgery can be completed incorrectly and require revision surgery. Select a surgeon specialising in this surgery, such as Dr De Silva, who treats revision blepharoplasty patients from all over the world.
No two people have the same eyes. The best surgeons are also artists who are able to modify their technique to give every patient the best possible result.
Dr De Silva is an artist and sculptor, using his knowledge of the human face to create the perfect result for each individual patient.
Choose to have surgery in a facility that does not treat the entire body or general surgery to avoid hospital acquired issues such as infections.
Dr De Silva completes surgery in a world- class facility that was custom built for facial cosmetic surgery.
It is key that you feel comfortable with the surgeon and that they will be there for you before, during and after the procedure.
The key with eyelid surgery is minimising scars. Older eyelid surgery techniques resulted in unsatisfactory scars around the eyelids. With modern techniques scars are largely camouflaged on the inside of the eyelids, or natural creases.
Dr De Silva uses advanced, scar-less techniques including the hidden incision on the inner side of the lower lid (trans-conjunctival).
Dr De Silva frequently combines blepharoplasty with other facial procedures to give a natural-looking result and avoid the use of scars associated with conventional techniques:
Patients may present with a mild shadow or depression that appears beneath the lower eyelid; this is often termed the tear trough. This appearance can give a tired appearance to patients and can be related to genetics, presenting from late teens.
As we get older, this area alters in appearance, by becoming more hollowed, darker, deeper and less revitalised. In some people, a non-surgical filler treatment is a popular solution for early treatment of these changes to the tear trough.
Dermal Fillers
The treatment involves carefully injecting a gel-like substance into specific areas around the eyes, with the objective of softening deep wrinkles and lines. For patients with mild changes this can be an effective treatment with instant results. The treatment is delicate and should be completed by a specialist as complications can occur.
Dr De Silva has customised a state-of-the-art no needle technique, using a blunt cannula to provide the treatment, which minimises bruising and swelling. Standard hygiene practices and cleaning the skin before the procedure avoids issues such as infection, which is rare after filler treatment.
Other Non-Surgical Treatments
Upper eyelid non-surgical treatments include the use of skin lasers and plasma machines to tighten the skin. These are generally of limited effectiveness and most patients achieve a modest improvement. Although these avoid surgery they tend to improve the eyelid minimally and are not generally recommended by Dr De Silva for the eye area.
Tear trough filler can be completed to reduce hollowing and a shadow beneath the eyelid in younger patients with mild to moderate changes. Technique is important as with our use of a No-Needle Cannula technique, this speeds up recovery as 95% of patients have no bruising.
Dr De Silva has published over 30 journal and book chapters in peer reviewed journals and several randomised control research studies, regarded as the gold standard in medical research.
Blepharoplasty is commonly completed in a general hospital with other surgical procedures. Although this is the norm, it does not lead to an optimal patient experience as the staff are not specialised.
Dr De Silva has built a custom state of the art facility on Harley Street to enable complete specialisation for every patient. This can avoid issues with hospital-acquired infections, such as MRSA, providing the safest environment for patients.
Dr De Silva customises his treatments based on your individual facial characteristics, which will give you a natural appearance. You will still look like you, only better!
Often, patients that have substantial rejuvenation are surprised how friends and family have not been able to tell. You will look less tired and refreshed which many people will put down to you having a good night’s sleep!
Older Patients:
There is no specific age limit for blepharoplasty and Dr De Silva has completed surgery for patients in their late eighties. Key to a successful blepharoplasty is your general health and fitness. We complete a comprehensive assessment of every patient before surgery as safety is always the number one priority.
Often there may be additional factors to consider with increasing age. These can include dry eyes, eyelid laxity and droopy eyelids (termed ptosis), these may require additional treatments at the same time as blepharoplasty to ensure a successful result.
Although loose skin, puffiness and lines around the eyelids are commonly associated with facial ageing, there are a smaller proportion of patients who have a genetic predisposition to these changes.
Younger Patients:
Lower eyelid bags or puffiness may be present in the late teens and early twenties and can be seen in other family members. The treatment of eye bags in young adults with a negative vector requires specific techniques to avoid lower lid retraction and support the lower eyelid after blepharoplasty, which Dr De Silva has written about extensively.
Note that lower blepharoplasty is not always necessary if you have very early signs of lower eyelid bags because some patients can be managed with non-surgical techniques.
Dr De Silva completes lower eyelid blepharoplasty on patients from their late teens to twenties, and some of his patients have travelled long distances as surgeons near their homes have not been able to complete surgery locally.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
