Lower Eyelid Technique in London

How is lower blepharoplasty completed?

Written by Dr Julian De Silva

Dr De Silva prefers to use hidden incisions (termed trans-conjunctival blepharoplasty) in most lower eyelid cases. The surgery, although technically more challenging, avoids a scar on the skin.
The figure shows an incision being made on the inside lining of the eyelid with a specialised instrument (CO2 laser or monopolar electrocautery machine). This technology prevents bleeding instantaneously, thereby reducing swelling and speeding up recovery. The soft tissues are then supported both superiorly and inferiorly to enable the fibrous septum to be seen in the lower eyelid.

A fibrous, layer known as the orbital septum is opened, which reveals the orbital fat pockets. The appearance of bags beneath the eyes is a result of the fat pushing forwards. However, there is a controversy between surgeons whether the fat should be removed or repositioned.
Known as tissue-sparing, removal of excess fat may result in a hollowed appearance that is unsatisfactory and difficult to remedy. Dr De Silva uses both techniques, depending on the individual patient.
Dr De Silva’s preferred technique is a conservative approach to transpose fat immediately below the eyelid at the cheek (termed fat transposition). In patients where there is a large volume of fat prolapsing forward both transposition of some fat and excision of the remaining fat may be the preferred option.
Dr De Silva uses state-of-the-art technology, including a US-manufactured CO2 laser or monopolar electrocautery to establish meticulous control of bleeding. This is key to reducing bruising and preserving vision after surgery.

Dr De Silva often utilises a supporting stitch during the healing period to improve the final result. In the figure, a canthopexy support stitch has been used to support the lower eyelid to the bony orbital rim. This stitch is completely hidden and dissolves a few weeks after surgery.
All our patients are able to see immediately after surgery and can return home thirty minutes after the procedure is completed. No patient requires overnight hospital admission with Dr De Silva’s techniques.
The older method of lower eyelid surgery involves making an incision immediately below the eyelid. This method always leads to a scar, can change the shape of the eyelid and sometimes results in eyelid retraction.
Although this is the traditional method for eyelid surgery Dr De Silva advises against this technique to ensure a natural result with faster recovery and healing times.

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Lower Eyelid (Blepharoplasty) Technique: Lower Blepharoplasty Steps

Before & After Photos

Before

After

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Other facial procedures performed with blepharoplasty

This procedure restores soft tissue changes in the lower eyelid.

To enhance the results, Dr De Silva combines surgery with other complementary procedures to give longer-lasting, natural-looking results. His philosophy is that it is better to spend a long time doing the procedure once than have to undergo additional top-up procedures in the near future.

Skin Resurfacing. The skin around the lower eyelids often has wrinkles, lines and changes in colour as a consequence of accumulated sun damage.
Fine wrinkles may be smoothened, skin quality improved, and the skin tightened slightly with laser skin resurfacing techniques. Dr De Silva tailors the type of skin resurfacing to the individual and includes the use of trichloroacetic acid (TCA chemical peel) and controlled laser resurfacing.
Volume replacement. One of the commonest changes in the lower eyelid is a semi-circular depression, termed the tear trough, between the eyelid and the cheek. This can result in the appearance of a dark circle under the eyes.
Dr De Silva customises each individual’s results with focalised fat grafting as an effective technique to rejuvenate the appearance of the lower eyelid at the same time as surgery.
Dr De Silva pioneered this technique in the UK as a way of giving patients an enhanced result. The alternative technique may require yearly non-surgical filler treatment.
Facelift surgery. Often ageing changes around the eyelids are mirrored with changes in the jawline and neck. Dr De Silva commonly completes blepharoplasty with a deep plane facelift to rejuvenation a patient’s appearance.
Rhinoplasty. Nose reshaping is a common procedure Dr De Silva completes at the same time as eyelid surgery.

What are the risks?

All surgical procedures carry a small degree of risk. However, blepharoplasty is a common procedure, and the risk is minimal, providing the surgery is performed by a surgeon, such as Dr De Silva, who specialises in eyelid surgery.

Risks and complications from lower eyelid surgery include asymmetry, residual fat bags and lower lid retraction. Most are easily resolved, but lower lid retraction is a result of too much tissue being removed and requires complex revision surgery and reconstructive techniques.

Revision Surgery

Over 30% of Dr De Silva’s patients have undergone previous surgery. Dr De Silva offers revision eyelid surgery to correct problems created from previous surgical interventions.

Click here to read more about Revision Surgery.