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Blepharoplasty

Written by Dr. Julian De Silva

What is blepharoplasty?

Blepharoplasty, more commonly known as eyelid surgery, is the most commonly performed cosmetic operations that Dr De Silva completes for patients. As a combination of aging and genetics, the skin and muscle around the eyelids loosens, this 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, known as blepharoplasty, rejuvenates your facial appearance, making you 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 technique to ensure a natural looking result.

Why have blepharoplasty?

Eye contact is a key aspect of our daily communication and the appearance of your eyes forms 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 detail 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.

Dr De Silva’s Blepharoplasty Technique

Patients travel long distances for Dr De Silva’s natural rejuvenation techniques. Dr De Silva has developed signature blepharoplasty that incorporate his artistry and experience from working in the cosmetic centres of Los Angeles and New York. Dr De Silva customises every blepharoplasty to the patient’s facial characteristics, hiding scars on the inside of the eyelid or utilising natural lines. Dr De Silva often combines blepharoplasty with other technology to give the most natural-looking results. He uses advanced, scar-less techniques including the hidden incision on the inner side of the lower lid (trans-conjunctival) that requires no stitches for closure. For some patients he will use complementary treatments to improve his patients results and enhance their recovery.

Will I look like myself?

This is a common concern for many patients. Dr De Silva asks patients to bring an old photo from their 20s to 30s, as he is able to use this as a blueprint for the surgery. Dr De Silva’s philosophy is less is more, to keep a natural rejuvenation, where patients look like themselves yet refreshed.

Will people be able to tell?

With good surgery friends and family members will not be able to tell you have undergone eyelid surgery. Dr De Silva customises his treatments based on your individual facial characteristics, often patients that have substantial rejuvenation are surprised how friends and family have not been able to tell.

Dr De Silva and patient safety

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 medical conferences.

What is the recovery after blepharoplasty?

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.

  • Bruising & Swelling
    By one to two weeks after eyelid surgery 80-90% of the bruising and swelling will have resolved. Rarely there can be a marked bruise that can take six-weeks to resolve, though it could be covered with concealer make up after one-week. Occasionally swelling can persist for several weeks, though usually there is pre-existing medical condition.
  • Pain
    In terms of pain, there is surprisingly little, and usually for less than 24 hours, more than half of my patients never take any analgesia medication to relieve pain.
  • Vision
    Blepharoplasty is surgery on the eyelids and not the eye itself. Although the vision may be a little blurred as a result of eyelid swelling and using eye drops after the surgery, your vision will still be reasonably good after the surgery. Using your eyes such as watching television, using the internet or similar activities are fine and will not harm the eyes, uncommonly the eyes may feel dry over the first week. Most patients are able to use their eyes for reading and sedentary activities even on the day of surgery.
  • Scars
    In the upper eyelid the scars can be hidden in the natural crease in the skin, often they are discrete and difficult to see after a couple of weeks, they reach their final endpoint as long as 12-18 months later. There are steps that can be taken to speed up their recovery and hide their appearance. In the lower eyelid Dr De Silva hides the incisions on the inside lining of the eyelid so they are invisible in over ninety percent of patients.
  • Activities
    Reading, computer work, these kinds of activities can be started even on the day of surgery. Strenuous activities, such as lifting, should be avoided as this will raise your blood pressure and increase swelling.
  • Social activities
    Most can be restarted after two weeks, there may be some residual bruising and swelling, this can be covered up with make-up after 1-week.
  • Exercise
    As a general rule, this can be restarted 3-weeks after blepharoplasty.

Fast recovery techniques with Dr De Silva

  • The type of surgery you have will influence your healing, not all blepharoplasty is the same, whether the surgery is principally on the skin, muscle or underlying fat will influence the recovery. There are additional procedures and technology that can enhance recovery by reducing swelling and bruising including eyelid lifting (e.g. Canthopexy), electrocautery and regenerative medicine.
  • The techniques your surgeon employees to complete the surgery. Dr De Silva uses techniques that hides incisions in both the upper and lower eyelids, this aims to hide the scars and shorten the recovery period. Conservative surgery reduces trauma to the eyelid tissues and influences recovery, and innovative surgical techniques can be used to enhance recovery including technology (modern lasers and equipment) and regenerative medicine.

What are things you can do to speed up recovery?

  • There are many prescription and herbal medications that should be avoided both before and after surgery as they can encourage both bruising and swelling. Dr De Silva and his team gives comprehensive advise to all his patients on what should be avoided before and after surgery. In addition, there are some herbal medications, such as arnica, that should be taken to reduce bleeding, Dr De Silva provides his patients with a specialist herbal medicine than enhances recovery.
  • Icing the eyelids for the first three days, in the form of ice in a zip lock bag, frozen peas or gel mask all have a beneficial effect on reducing swelling when applied to the eyelids for ten minutes regularly after surgery. There are other factors such as resting and taking things easy during the daytime that will maintain a relatively low and stable blood pressure. Keeping your head elevated when sleeping, will also reduce bruising and swelling.

What are the factors that influence your recovery?

  • If you have any medical conditions like diabetes or high blood pressure these should be well controlled before surgery. Smoking delays healing therefore avoiding smoking both before and after surgery will speed up your recovery and improve the results. Two people having identical surgery will not heal in the same time, we all heal differently. Another factor is your mental attitude, cosmetic surgery can be an emotional experience for some patients, and having a positive mental attitude goes a long way towards a faster recovery.

How long will blepharoplasty take?

Eyelid surgery takes sixty to ninety minutes to complete depending on whether the upper or lower eyelids are undergoing surgery and additional techniques such as fat transfer and laser. Dr De Silva spends additional time to complete surgery for his patients as the eyelids are intricate and all the surgery is millimetres. Although the surgery can be completed faster, it is not possible to complete the same amount in lesser time.

Do I need to go to hospital?

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Blepharoplasty is commonly completed in a general hospital with other surgical procedures. Although this is the norm, it does not lead to the 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 feared issues with general hospitals such as MRSA and hospital acquired infection.

An alternative to general anaesthesia?

Dr De Silva and his team have developed a specialised form of advanced sedation anaesthesia for our patients. This technique is safer that general anaesthesia, with a faster recovery and avoids the side effects associated with general anaesthesia. The recovery after eyelid surgery with this twilight sedation technique is usually thirty minutes and all patients are able to leave the facility within one hour after surgery. Approximately twenty percent of all our patients have undergone previous general anaesthesia and they overwhelmingly prefer the experience of twilight sedation anaesthesia.

I live abroad how can I have surgery?

Dr De Silva has a large number of patients that live overseas. Our specialist team can help you organise a virtual consultation and coordinate your trip to the UK. We are able to utilise the latest technology to enhance your recovery including oxygen therapy and regenerative medicine.

Private entrance for VIP

At our specialist facility on Harley Street we have a private entrance for VIP patients, please notify us in advance of your specific requirements.

Performing Arts & Recovery

For patients whose profession involves high definition cameras it is important to modify surgery to enhance recovery. A common concern is looking different, with Dr De Silva’s natural looking techniques, most patients find that friends and family were not able to tell they had undergone surgery. Dr De Silva may recommend additional techniques and advancements to enhance your recovery after blepharoplasty based on your specific requirements.

I have never had surgery and am really nervous…

Many of our patients are very nervous and have not undergone previous surgery. We take a great deal of time to ensure we provide both emotional support before and after surgery. Our aim is to provide the best possible experience and to foster a long-term relationship with our patients to provide ongoing care for years to come. Please read about some of the glowing patient experiences with us.

Patient recovery experience

Some of Dr De Silva’s patients recorded on video their recovery experience in the form of a video diary. Please watch one or more of these true patient experiences if you would like to understand more healing and recovery after blepharoplasty.

Support Journey

Most patients recovery after eyelid surgery is rapid and patients return to normal activities after a couple of weeks. Everything in life including surgery is an emotional experience and for some patients the recovery may be longer. We have a supportive and empathetic team that will continue to guide every patient through their recovery.

At what age should you get Blepharoplasty?

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. Lower eyelid bags or puffiness may be present in late teenage and early twenties and can be seen in other family members. The treatment of lower eyelid bags in young adults with negative vector requires specific techniques to support the lower eyelid after blepharoplasty, this is essential to avoid lower eyelid retraction. Dr De Silva has had patients travel long distances for opinions for lower eyelid bags, who have been refused surgery by local surgeons. Please note lower blepharoplasty is not always indicated if you have very early signs of lower eyelid bags and some patients can be managed with non-surgical techniques.

There is no specific age limit for blepharoplasty and Dr De Silva has completed surgery for patient in their late eighties. Key to a successful blepharoplasty is your general health and fitness. We complete a comprehensive assessment of every patients 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.

What are associated techniques?

Dr De Silva has an avid perception for detail and utilises additional surgical techniques to enhance natural looking and longer lasting results. Dr De Silva specialises in all facial treatments (surgical and non-surgical) and evaluates your eyelids and face as a whole. Key considerations include position of brows, eyelid symmetry, lower eyelid position. Dr De Silva utilizes additional techniques and advanced technology including:

  • Laser skin resurfacing
  • Volume replacement
  • Fat transfer including regenerative multipotent cells
  • Regenerative medicine & enhanced healing
  • Growth factors
  • Wrinkle relaxing treatments
  • Hidden 3D brow lift
  • Skin enhancement

100s of experiences of Dr De Silva’s patients

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.

What happens during consultation?

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.

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. Other important factors are dry yes, previous laser refractive surgery and the use of eye drops. A discussion of your goals and expectations of any prospective surgery. For some patients, Dr De Silva may advise against surgery and non-surgical treatments if in a patient’s best interest.
Dr De Silva and his nursing team sees all patients a second time before surgery to discuss your procedure in further detail, inform patients of measures you can take to enhance recovery and provide detail regarding the recovery period. We recommend that you write a list of questions to ensure that you have covered all of your concerns.

What complications can occur?

Blepharoplasty, particularly of the eyelids is demanding and requires in depth knowledge of the anatomy and 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, swelling and bruising are the most common aspects of recovery. Pain or discomfort is uncommon and resolves 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 takes multiple levels of precautions to avoid these issues in the first place. The eyelids have an intricate anatomy of millimetres, an oculo-plastic surgeon specialising in this area of the face is best suited to ensure a smooth journey and successful result.

How long will it last?

Although there are individual factors that influence duration, most eyelid surgery will last eight to ten years, and for lower eyelid blepharoplasty one surgery may be adequate for their lifetime. Dr De Silva often utilises additional techniques including regenerative medicine, fat transfer, laser resurfacing. These techniques enhance the duration of the result.

How do I choose an eyelid surgeon?

Choosing the surgeon for your eyelid surgery is one of the most important decisions you will make.

Key considerations in this choice:

  • Specialist. 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 it is difficult for a general plastic surgery to have knowledge in all parts of the body. Dr De Silva is a World-renowned specialist oculo-facial plastic surgeon who focuses only on the face and has an extensive background of experience to give you a safe and successful outcome.
  • Cosmetic focus. Cosmetic surgery is a different branch of medicine to reconstructive plastic surgery. Cosmetic surgery focuses on natural rejuvenation hiding scars and discretion. Reconstructive surgery including blepharospasm and water eyes. Although Dr De Silva trained at hospitals including Moorfields he went onto complete specialised cosmetic experience in Los Angeles and New York.
  • Detail orientated person. 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.
  • Revision surgery. Unfortunately, eyelid surgery can be completed incorrectly and require revision surgeon. Select a surgeon specialising in this surgery. Dr De Silva treats revision blepharoplasty patients from all over the world.
  • Artistry. 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 sculpture and uses his knowledge of the human face for each individual patient.
  • Medical Facility. Chose 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.
  • Rapport. It is key that you feel comfortable with the surgeon and that they will be there for you after the procedure.

Will I have visible scars?

Key with eyelid surgery is minimizing scars. Older eyelid surgery techniques resulted in unsatisfactory scars around the eyelids. With modern techniques scars can 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).

Can blepharoplasty be combined with other techniques?

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:

Middle third of the face:

  • Volume augmentation of the cheeks with fillers, fat transfer or facial implants.
  • Fat-transfer to the mid-face and cheeks (Fat Transfer)
  • Skin resurfacing for lines & deep wrinkles (Skin Resurfacing)
  • Anti-wrinkle injections for fine lines at the junction of the eyebrows, forehead and crow’s feet

Upper third of the face:

Lower third of the face:

Books & Publications

  1. The use of stitch-free fibrin tissue glue compared to stitches following blepharoplasty and blepharoptosis surgery. A large mutli-centred randomized control study considered the gold standard in high quality research.
  2. Outcome following surgery for contact lens-induced ptosis. De Silva DJ, Collin JR. Ophth Plastic & Reconstructive Surgery. 2011 May-Jun;27(3):186-9
  3. Surgical technique: modified lateral tarsorrhaphy. De Silva DJ, Ramkissoon YD, Ismail AR, Beaconsfield M. Ophth Plastic & Reconstructive Surgery. 2011 May-Jun;27(3):216-8
  4. An unusual cause of acute lid swelling. De Silva DJ, Strouthidis NG, Tariq S, Davies N. Eye. 2006 Feb;20(2):271-2

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.


The Complete Guide to Eyelid Surgery & Blepharoplasty

Dr. Julian De Silva authored two book chapters on latest innovations in Cosmetic Eyelid surgery.
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