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Blepharoplasty Basics (Eyelid Surgery)

Written by Dr. Julian De Silva

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The Complete Guide to Eyelid Surgery & Blepharoplasty: The Patient's Must Read Guide before undergoing Eyelid Surgery & Blepharoplasty: Volume 1The Complete Guide to Eyelid Surgery & Blepharoplasty

The eyes are the first center of attention on meeting a person, any small imbalance or asymmetry is readily seen. Heavy upper eyelids, dark circles or bags around the eyes, often leads to a tired and aged look. Although these changes are usually associated with ageing, some people develop changes around their eyes from late teens. The detail around the eyes are of great importance, as subtle changes of even less than half a millimeter can be discernible between the right and left sides. For subtle changes between the eyelids Dr. De Silva uses techniques that have been specifically developed in Los Angeles and rarely utilized in the UK. Dr. De Silva customizes his approach to eyelid surgery based on the patient’s facial balance, utilizing scar-less hidden incision techniques and latest technology to give the most natural looking results. Sometimes he will use additional measures to improve the result, as harmony is required with both the brow and mid-face areas to give his patients a natural looking result.

Dr. De Silva has been a leading innovator in promoting developments in technique, publishing over 30 journal and book chapters in peer reviewed journals and several randomized control research studies regarded as the gold standard in quality of evidence. To give the best looking and natural looking results Dr. De Silva will use a combination of innovation techniques and fine microsurgical adjustment of the eyelids optimizing symmetry and natural looking results.

The eyes are the first part of the face we look at when we look at a persons face. One of the early signs of facial aging, are changes in the skin and soft tissues around the face, this can result in the appearance of saggy overhanging eyelid skin, eyelid bags, and dark circles or lines around our eyes.

Blepharoplasty surgery (eyelid lift) is statistically the most commonly performed cosmetic operation and may substantially rejuvenate facial appearance and may make you look less tired and roll the years back between five and ten years. As we age, the skin and muscle associated with the eyelids tends to loosen, this produces bags or dark rings that may make us look old and tired. In addition, tissues that separate the cushioning orbital fat that surrounds the eyeball becomes weak and fat protrudes into the eyelids forming bags under the lower and upper eyelids. In severed cases, the excess tissue can also obstruct vision and by having cosmetic eyelid surgery, and in such cases patients don’t only look better, but oftentimes see better as well.

Dr. De Silva has pioneered the use of stitch-free fibrin tissue glue in the use of eyelid surgery, and to date has conducted the only gold standard study to prove their effectiveness. Patients that undergo eyelid surgery, blepharoplasty, are usually able to return to work and normal activity within one week, looking refreshed and better.


Eyelid surgery and blepharoplasty is usually performed in the out-patient/ office setting, local anaesthesia is usually adequate and may be combined with light sedation to aid patient comfort. The procedure takes between 45 to 90 minutes and the patient is able to go home after the procedure. It is important to use ice-packs over the eyelids after the procedure as these prevent swelling and improve recovery time, patients are usually able to return to normal activities with 1-week. The procedure is very well tolerated and most patients require no analgesia after their surgery. Dr. De Silva may combine the technique with other procedures such as plasma-rich-protein in order to enhance a patients natural-looking result.

Click here to read Dr. Silva’s publication on Eyelid Surgery (Ptosis).

Dr. De Silva completed his surgical training in London University Hospitals amongst the best institutions in the UK. 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 super-specialty to have been awarded funding for training in the US by the World famous Moorfields Eye Hospital.

Dr. De Silva has an avid perception for detail and utilizes numerous modern techniques for eyelid surgery. He utilizes advanced scar-less techniques including the use of a hidden incision on the inner side of the lower lid (trans-conjunctival) that requires no stitches for closure. In the upper eyelid he commonly utilizes hidden incision technique that lift the eyelid from the inner lining, a technique that was pioneered in Los Angeles.

Aging of the upper face often includes changes in skin, soft tissues and boney structures. Dr. De Silva utilizes additional techniques such as skin resurfacing, volume replacement and specialized eyelid tightening procedures (canthopexy, canthoplasty) to give the most natural looking and long lasting result.

Dr. De Silva prior to training in facial cosmetic surgery worked in the field of ophthalmic surgery, and performs a thorough eye examination of all patients undergoing eyelid surgery. This includes an evaluation of visual function and corneal surface for sub-clinical or masked dry eye. Few cosmetic surgeons are able to offer this higher level of patient care or quality. Dr. De Silva specializes in facial cosmetic surgery and does not perform surgery on the rest of the body. In all patients, Dr. De Silva evaluates the whole face and body, as harmony and balance are required for a natural looking result. He may recommend a procedure or treatment with eyelid surgery that will enhance the result making you look not only younger, but better than you did before.

Dr. De Silva has advocated the development and innovation of improved techniques. He has described the use of a special type of eyelid tightening procedure, termed canthopexy, that restores the naturally occurring gentle upslope of the outer aspect of the lower eyelid.

Click here to read Dr. Silva’s publication on Eyelid Surgical Technique.

What are the contraindications to having blepharoplasty or eyelid surgery?

Dry eyes that can have no symptoms may be made worse, all patients undergoing eyelid surgery should be evaluated for dry eyes. Dr. De Silva has previously trained in the field of ophthalmic surgery and is able to provide a fully comprehensive evaluation in the office. In patients with dry eyes, Dr. De Silva uses modified ultra-conservative techniques to preserve normal function of the eyelids and tear lubrication. Other soft tissue conditions such as thyroid eye disease results in characteristic eyelid changes that are best evaluated and stabilized before considering cosmetic surgery. Dr. De Silva is highly experienced in this area having worked at Europe’s largest Specialist Moorfields Eye Hospital.

How do I choose an eyelid surgeon?

Your best choice in selecting the right doctor is to look for a surgeon who specializes in facial cosmetic surgery; one who has an extensive background of experience to give you a safe and successful outcome. The eyelids are a surgery of millimeters as less that 1-millimetre difference between the two eyes can be seen. Seeing a surgeon who specializes in the entire face is important, as the eyes exist in balance with the lower half of the face. A surgeon with artistry will be able to advise you if other techniques utilized at the same time as the eyelid surgery will enhance the result. Dr. De Silva frequently uses a myriad of options including skin resurfacing to give the enhanced natural-looking result. It is always worth asking the surgeon to see before and after pictures of patients he or she has treated. It is key that you feel comfortable with the surgeon and that they will be there for you after the procedure.

How does Dr. De Silva’s surgical technique differ from the traditional approach to eyelid rejuvenation?

Dr. De Silva uses a myriad of surgical techniques taken from his experience in London, Los Angeles and New York. For both the upper and lower eyelids the removal the exact amount of soft tissues is required to ensure harmony between the two eyes and natural looking result. Dr. De Silva favours the use of hidden scar-less incisions in the upper and lower eyelids, and the use of non-excision transfer of fat. Intricate incisions that are hidden in the inner lining of the eyelids avoids stitches and scars. Excision of excessive fat in the upper or lower eyelid can result in a hollowed out appearance that has the opposite effect to rejuvenation. Dr. De Silva prefers to move any fat to an area of the mid-face will volume deficiency, this is one of the most recent innovations in eyelid surgery. Experience and care is required in the setting of the upper eyelid crease in men. An exaggerated crease results in feminization of the face and is one of stigmata of cosmetic surgery that is sometimes seen in Hollywood stars. Dr. De Silva utilizes techniques that avoid this appearance and result in a natural looking rejuvenated eye. Dr. De Silva specializes in cosmetic surgery of the face and utilizes his experience to use additional techniques to enhance the result. Deep lines and wrinkles in the face are best treated with skin resurfacing, with the use of a chemical peel, laser device or other treatment. Dr. De Silva has been a lead innovator in aspects of eyelid surgery having published over 30 peer reviewed journal articles, including pioneering research into the use suture-free fibrin glue. The use of volume augmentation to restore the natural contour between the lower eyelid and cheek can make the difference between a good result and an amazing result. The use of fat augmentation at this junction is a highly specialized technique to prevent over filling of the cheek. Dr. De Silva has managed numerous patients that have had fat overfilling or irregularities by general plastic surgeons and would advice against having this technique except in specialist hands. The eyelid skin of the lower eyelid is the thinnest skin in the entire body, and fine surgical technique and finesse is required to give a completely natural looking result.

blepharoplasty surgery eyelid - figure

Dr. Julian De Silva teaches on Advanced Facial Anatomy at the ACE Aesthetics Conference in London, UK.

Can eyelid surgery be combined with other procedures?

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 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 crows feet

Upper third of the face:

Lower third of the face:

Medical Research & 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


Professional membership organizations that focus on Eyelid Surgery






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