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Revision Blepharoplasty in London

Revision Upper Blepharoplasty

Written by Dr. Julian De Silva

  • The eyelids are a complex part of the face with a unique anatomy and function—millimetres are the difference between success and failure during blepharoplasty procedures.
  • The upper eyelid has an important function protecting the eye and in the prevention of dry eyes. The removal of too much soft tissue and skin is problematic if not performed correctly.
  • Complications of excessive soft tissue removal are best avoided by seeing a specialist eyelid surgeon with Oculo-Facial Plastic Surgery or Facial Plastic Surgery expertise.
  • Approximately thirty percent of Dr De Silva’s blepharoplasty surgeries are revisions surgeries.
  • Corrective surgery is complex and often requires specialist techniques to ensure preserving natural anatomy. Often additional measures are required to help with recovery.
Revision Asian Blepharoplasty - line surgery around eyelid

How do you approach revision upper eyelid surgery?

  • Previous eyelid surgery results in scarring and changes in the underlying anatomy. Although scars can be modified and enhanced previous surgery cannot be reversed.
  • Dr De Silva uses a spectrum of specialised techniques to restore the position and function of the eyelids, including a variety of graft tissues (including tissue taken from the roof of the mouth, termed hard palate and spacer materials), eyelid tendon suturing, HD visualization and bony orbital support to ensure a long-term result.
  • Each revision eyelid surgery is unique and requires customised treatment with respect to the position, shape, scarring and function of the eyelid.
  • Dr De Silva uses specialised anti-inflammatory medications to reduced scarring—a technique he has pioneered in the UK.
  • Dr De Silva is able to achieve excellent results in revision blepharoplasty, and will operate on cases where he feels he can achieve a success that is within the patient’s expectations. If he cannot achieve this he may advise against further surgery.
Revision upper eyelid surgery - scheme lines around eyelids

Revision Blepharoplasty Case

This 59-year-old Asian patient who works as a nurse in a London Hospital had two previous eyelid procedures in UK hospitals with plastic surgeons.

She felt that she had continued to look tired as there was hooding of the upper eyelids, with swelling of fat at the inner aspect of the eyelids. In the lower eyelids she had fat bags despite the previous surgery.

She came to see Dr Julian De Silva in his London practice, for revision eyelid blepharoplasty.

On examination, there was asymmetry with double skin creases on the upper eyelids, asymmetrical scars in the lower eyelids and fat prolapsing in the lower eyelids, as well as noticeable scarring.

Dr De Silva evaluated her changes and discussed with her what aspects of her eyelids could be improved. With clear expectations from the surgery, she had revision upper and lower eyelid surgery under sedation anaesthesia.

After surgery there was an improved appearance to her upper and lower eyelids. Dr De Silva hid the previous scars in natural creases in the upper eyelid and used hidden incision techniques in the lower eyelid (termed transconjunctival blepharoplasty).

The patient was very happy with the results and has subsequently returned to her home country.

Blepharoplasty, woman - photo model

Patient Testimonial

I am grateful to Dr Julian De Silva who did a revision on my upper and lower eyelids four weeks ago. The whole experience from consultation to follow-ups was caring and performed in a relaxed and friendly environment.

Dr De Silva ensured I fully understood the procedure and gave me pre and post-surgery instructions. He phoned me in the evening after the surgery to ensure I was alright. Three weeks later, I left the country. He emailed me to ask whether I was okay.

The recovery period was what I expected by following the instructions. I found him passionate about his work, caring toward his clients and professional. My eyes are getting better and better, the natural look suiting my face. Many thanks to him and his team. Highly recommended.

“I had a difficult recovery after eyelid surgery and am worried about having further surgery…”

Many of our patients are anxious about having blepharoplasty correction surgery as they did not have the result they were looking for after the first surgery.

Dr De Silva takes the time to provide a thorough discussion regarding further treatment and recovery while offering 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.

Will I be happy after revision eyelid surgery?

Dr De Silva only provides patients with honest information about the likely results from revision surgery. In a minority of patients, he advises against surgery altogether.

Although most patients’ symptoms are improved significantly, it is important to have a discussion regarding realistic expectations, as previous scarring can only be improved upon, not reversed. A small proportion of patients may require two procedures.

What is the worst complication?

A thorough examination excludes most serious issues (eyelid tendon laxity, skin shortage, functional dryness). The key aspects are that recovery often takes longer, with the final result as long as 12-18months after surgery.

In addition, it is imperative to have a discussion about the realistic expectations for improvement after eyelid revision surgery.

Consultation: Treveling map

Revision Lower Blepharoplasty

Revision lower eyelid surgery is carried out to correct previous lower blepharoplasty surgery.

The anatomy and soft tissues of the lower eyelid are highly intricate, and once surgery has been completed there is a degree of scarring and change in anatomy that is unique to each individual patient.

The level of scarring is dependent upon multiple factors, including the previous surgery, the surgeon, the ethnicity of the patient, their individual genetic makeup and their body’s ability to heal.

The treatment of patients who have undergone previous lower blepharoplasty is challenging, and is dependent upon the degree of change required and the patient’s expectations from surgery. Although for most patients a substantial improvement can be made, the key to success is achieving the patient’s expectations.

In the lower eyelid, removal of too much soft tissue results in the increased appearance of the white sclera and the lower eyelid hanging below the coloured iris.

Revision lower eyelid surgery

Revision lower eyelid surgery (lower eyelid retraction)

  • There are a variety of causes for lower eyelid retraction including trauma, eyelid tumours and the commonest—internal scarring after a lower eyelid blepharoplasty.
  • Lower eyelid retraction is often the result of a combination of factors, including the removal of too much skin tissue during lower blepharoplasty surgery, scarring and the lower lid being pulled downwards
  • The lower eyelid has intricate anatomy with three fine anatomical planes in the eyelid. Damage to any of these structures may lead to scarring and lower lid retraction. The results can be devastating to the patient as scarring changes the shape of the eye resulting in a compromised cosmetic result, tearing and discomfort.
  • Dr De Silva’s preferred technique for lower eyelid surgery involves a hidden incision on the inside lining of the eyelid. This technique preserves the natural anatomy of the eyelid and hides scarring.
  • The more traditional method that is used by surgeons practicing older surgical techniques is termed trans-cutaneous blepharoplasty. In patients with a specific anatomy, termed negative vector, it is of absolute importance not to use these techniques to ensure a risk-free result.
  • Dr De Silva’s preferred technique for lower eyelid surgery involves a hidden incision on the inside lining of the eyelid. This technique preserves the natural anatomy of the eyelid and hides scarring.
Revision Blepharoplasty - female model

Dr De Silva sees and treats many revision blepharoplasty patients who have had surgery elsewhere. The treatment of lower eyelid retraction is challenging and dependent on careful evaluation and identification of the cause. The techniques require tailoring to the individual and include:

  • Skin grafting for shortening of the lower eyelid skin
  • Use of fillers to prevent recurrent scarring
  • Elevation of the mid-face
  • Tightening of the lower eyelid to the bony rim with canthoplasty
  • Use of material (termed spacers) to elevate the lower eyelid
  • Use of graft (hard palate from roof of mouth) to elevate the lower eyelid
  • Post-surgical use of lower lid elevation
  • Post-surgical use of anti-inflammatory agents

Depending on the cause of the lower eyelid retraction, severity and previous surgery, Dr De Silva utilises a combination of different approaches to elevate the lower eyelid and prevent recurrence.

View before and after photos: Revision Blepharoplasty

*Results May Vary

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.

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