Written by Dr Julian De Silva
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.
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.
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.
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.
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.
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.
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:
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.
*Results May Vary
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
