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Blepharoplasty (Eyelid Surgery) in London

What is blepharoplasty?

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.

Why have blepharoplasty?

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.

Blepharoplasty - eye

Common reasons why patients ask Dr De Silva for help

  • Tired appearance; feel or look older
  • Self-conscious; avoid photos
  • Impact on relationships & profession
  • Difficulty with makeup; concealer to camouflage changes
  • People ask if you are tired; lack of sleep
  • Genetic component; starting to look like your mother or father
  • Tried every lotion and potion to improve eyelids; minimal effect
  • Disappointed with non-surgical treatments like Plexa; <10% improvement

Benefits of eyelid surgery performed by Dr De Silva

  • Every person’s eyes are different, so bring an old photo from your 20s to your consultation
  • Scars must be positioned discreetly; 99% virtually invisible (meticulous technique, multiple levels of stitches, no shortcuts)
  • Additional procedures can enhance blepharoplasty, including laser resurfacing and fat transfer. They are of key importance to give a long-lasting result that will last 10 years or more and avoid the need for filler
  • Older techniques in the lower eyelid can result in scars and change in shape in the eyelid. Dr De Silva uses modern techniques, performing surgery on the inside of the eye (Trans-Conjunctival blepharoplasty) for scar-free results
  • Uses modern anaesthesia (termed sedation anaesthesia) which is far safer and with a faster recovery than traditional general anaesthesia
  • With Dr De Silva’s sedation anaesthesia avoid general anaesthesia. All patients experience rapid recovery less than 30 minutes after procedure

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 at medical conferences.

What is the recovery like 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

  • 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 may take up to six weeks to resolve, although it could be covered with concealer makeup after one week.
  • Occasionally swelling can persist for several weeks, but usually, there is a pre-existing medical condition that exacerbates it.

Pain

  • In terms of pain, there is surprisingly little – and typically for less than 24 hours.
  • More than half of my patients never take any analgesic 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 procedure.
  • Watching television, using the internet or engaging in similar activities are fine and will not harm the eyes. Most patients are able to use their eyes for reading and sedentary activities, even on the day of surgery.
  • Uncommonly, the eyes may feel dry over the first week.

Scars

  • In upper eyelid blepharoplasty, the scars can be hidden in the natural eyelid crease. They are discrete and difficult to see after a couple of weeks, but it may be as long as 12-18 months later before the scars settle down completely.
  • Taking the appropriate steps recommended by Dr De Silva speeds up the healing process and reduces the appearance of scars.
  • In lower eyelid blepharoplasty, Dr De Silva hides the incisions on the inside lining of the eyelid, rendering the scars invisible in over ninety per cent of patients.
Scars - female model

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

  • You can restart most social activities after two weeks, but there may be some residual swelling and bruising, which you can cover up with make-up after the first week.

Exercise

  • As a general rule, exercise may be restarted 3 weeks after blepharoplasty, but take it gently.

Fast recovery techniques with Dr De Silva

  • The type of surgery you have will influence your healing. Not all blepharoplasty is the same, and whether the surgery is principally on the skin, muscle or underlying fat will affect the recovery.
  • There are additional procedures and technologies that can enhance recovery by reducing swelling and bruising, including eyelid lifting (e.g. Canthopexy), and electrocautery.
  • The techniques your surgeon employs to complete the surgery also influences healing. Dr De Silva uses techniques that hide the 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. Innovative surgical techniques can be used to enhance recovery, including technology (modern lasers and equipment).

What are things you can do to speed up recovery?

  • Dr De Silva and his team gives comprehensive advice to all his patients on what should be avoided before and after surgery. For example, there are some herbal medications, such as arnica, that should be taken to reduce bleeding.
  • 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.
Woman's face - blepharoplasty

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 heal differently. One 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 finish. Although the exact time is dependent on whether Dr De Silva is performing additional techniques.
  • By necessity, it is intricate and requires precision to achieve the best results.
Office. Clinic Reception scaled

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.

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:

  • Laser skin resurfacing
  • Volume replacement
  • Fat transfer
  • Enhanced healing
  • Growth factors
  • Wrinkle relaxing treatments
  • Hidden 3D brow lift
  • Skin enhancement
Associated techniques Blepharoplasty - woman's face

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.

reviews

Reviews

5.00 from 547 reviews

By EL, Lower Blepharoplasty with fat transfer, laser and milia removal on May 19, 2020

I had lower eye blepharoplasty, with fat transfer, laser resurfacing and milia removal. I had researched and wanted the surgery for about 2 years before deciding to have some consultations I had two consultations with a well known surgery group but did not feel confident. I then met with Dr. De Silva and knew as soon as the consultation was over that I felt confident enough to go ahead and am so glad that I did. My pre treatment appointments and advice were so thorough, and any questions that I had were answered so quickly by the clinics staff. The day of my surgery was seamless, and I felt in completely safe hands the entire time from the nurse Ellie, to the Dr performing sedation and Dr De Silva.
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By Upper & lower blepharoplasty Jan 1, 2020

I recently underwent an upper & lower Blepharoplasty with Dr DeSilva and the results are outstanding! From my very first consultation and after lots of research, I knew that I had made the right decision to go with Dr DeSilva. Naturally I was nervous but his amazing team were all very kind, extremely friendly and totally relaxed. The procedure was carried out under sedation and that too was fantastic. I can honestly say I felt no pain during and after the procedure and within 1 hour afterwards I was on my way home. I would 100% fully recommend Dr DeSilva to anybody considering a procedure such as mine. Thank you Dr DeSilva, you have instilled a new found confidence in me.
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Lower Blepharoplasty Dec 25, 2019

I had lower blepharoplasty surgery as I had a lot of wrinkles in my lower eyelids. I have big eyes so the wrinkles were very obvious and only being in my mid-thirty’s I felt it aged me. The surgery was only an hour long and Dr Julian and his team were all really nice and caring. I am extremely happy with the results and my eyes look so much better! The wrinkles are hardly there and I actually like how my eyes look in photos now! I definitely recommend Dr Julian and his team.
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Read More Reviews Here *Results May Vary

Patient experiences with Dr De Silva

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.

What happens during a consultation for 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.

During consultation: Julian De Silva M.B.B.S, M.D.

What are the risks of eyelid surgery?

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.

How long will the result of blepharoplasty last?

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.

Blepharoplasty - View Before and After photos

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. 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 focus

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.

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 surgery. Select a surgeon specialising in this surgery, such as Dr De Silva, who 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 sculptor, using his knowledge of the human face to create the perfect result for each individual patient.

Medical Facility

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.

Rapport

It is key that you feel comfortable with the surgeon and that they will be there for you before, during and after the procedure.

Photo: Julian De Silva M.B.B.S, M.D

Will I have visible scars?

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).

blepharoplasty, surgery techniques

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:

  • Minimal incision brow lift (Brow & Forehead Lift)
  • Correction of droopy eyelid (Ptosis Correction)
  • Anti-wrinkle injections for fine lines at the junction of the eyebrows, forehead

Lower third of the face:

  • Face or neck lift procedure (Facelift)
  • Augmentation of the chin (Chin Implant)
Male sculpture: body and face muscul schema

Is there a non-surgical alternative to blepharoplasty?

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.

non-surgical alternative to blepharoplasty, female model

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.

Before and After Upper eyelid non-surgical treatments - female patient

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 research & publications on eyelid surgery

Thr Complete Guide to Eyelid Surgery and Blepharoplasty - Dr. Julian De Silva

A Complete Guide to Eyelid Surgery & Blepharoplasty

Dr. Julian De Silva authored twobook chapters on latest innovations in cosmetic Eyelid Surgery

Master Techniques in Blepharoplasty and Periorbital Rejuvenation
  • 1The 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.
  • 2Outcome following surgery for contact lens-induced ptosis. De Silva DJ, Collin JR. Ophth Plastic & Reconstructive Surgery. 2011 May-Jun;27(3):186-9
  • 3Surgical technique: modified lateral tarsorrhaphy. De Silva DJ, Ramkissoon YD, Ismail AR, Beaconsfield M. Ophth Plastic & Reconstructive Surgery. 2011 May-Jun;27(3):216-8
  • 4An 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.

Upper Blepharoplasty FAQs

Facelift Frequently Asked Questions and Answers

  • Do I need to go to hospital?

    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.

  • Will I look like myself?

    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!

  • Will people be able to tell?

    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!

  • At what age should you get blepharoplasty?

    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.

About the Author

Finding the most reputable facelift expert is never easy. Therefore, you should always research the best surgeons in your area and ask plenty of questions. Dr. De Silva is a facial cosmetic and plastic surgeon, author, global educator, with a track record of doing procedures for top celebrities. He is based at world-renowned Harley Street in Central London and specializes in three main procedures: Face and Neck lifts, Blepharoplasty, and Rhinoplasty.

Come witness a custom-built surgical centre that is not your average hospital. You are guaranteed to experience natural-looking results and fast healing thanks to growth factors, oxygen therapy, and state of the art technology.

By specialising in only the face, you can rest assured knowing that you’re getting premier results. Dr. De Silva achieves natural-looking results for his patients using the latest technology, so they can heal quickly and look their absolute best. No matter what your reason for wanting a cosmetic treatment is, Dr. De Silva and his team are here to help. To find out more information about Dr. Julian De Silva and his work, check out our website.

Dr Julian De Silva's Google Scholar

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