Ethnic Blepharoplasty in Middle Eastern Patients
- The Middle Eastern eyelid is anatomically different to the European eyelid. These differences are related to the underlying facial anatomy including the configuration of facial muscles, and the thickness of the skin and its subcutaneous fat layer.
- The ethnic eyelid can have a variety of anatomical variations, typically these include a relatively full brow, fine upper eyelid show, lines in the lower eyelid with or without bags and variable dark rings and facial lines. These characteristic changes usually occur as a consequence of facial ageing; however, genetics also has an important role. Some younger patients present with lines or swelling around their eyelids from their twenties. These genetic changes can give an older or more tired appearance. Dr De Silva uses techniques ensure a natural looking result, scar less surgery by hiding scars on the inside of the eyelid.
- Dr De Silva has a large number of patients of ethnic descent who request eyelid surgery in London, the most popular destination for Middle Eastern patients to have cosmetic surgery in the world.
What is Middle Eastern anatomy?
Anatomic variations include the underlying facial skeleton, contributing to facial harmony. This is particularly true for the orbital area (bone support of the eye) which is the support platform of the eyelid. Ideally, a beautiful eyelid should have a gentle arc that sweeps from the nose towards the cheek often with a small 1-2mm incline. The upper eyelid has a crease that determines the amount of upper eyelid show, often in ethnic blepharoplasty there are differences in the degree of eyelid show and the surgery must be individualised with cosmetic and plastic surgery. The position of the brow is frequently low and must be taken into consideration in ethnic blepharoplasty and for some patients’ elevation with a conservative brow lift is required, care is required to ensure the brow looks natural and as over-lifting creates an unnatural or surprised look
Dr De Silva’s eyelid surgery techniques?
Dr De Silva does not use techniques that create an unnatural appearance. Common changes in the lower eyelid include lines, swelling, bags and dark circular depressions as a consequence of loss of facial volume. The junction between the eyelid and the cheek is smooth in younger people, and with facial ageing loss of volume in the face results in a depression between the eyelid and the cheek. The lower eyelid has multiple complexities in its anatomy with attachments of ligaments muscles that must be respected with surgery.
Can I have dry eyes after blepharoplasty?
In the ethnic eyelid important consideration should be given to the septum and the orbicularis muscle. The orbicularis muscle provides a key function in blinking of the eye and in warmer countries excessive surgery on the orbicularis can result in symptoms of dryness. Dr De Silva favours conservative surgery to reduce preserve the functioning of the eyelids and by removing the correct amount of skin improve both the cosmetic appearance of the eyelid and the blinking eyelid function.
Can complications occur in eyelid surgery?
In the lower eyelid important consideration must be given to the fibrous septum, damage to this key structure results in eyelid retraction. Dr De Silva often uses specialised techniques to support the lower eyelid in the recovery period such as canthopexy.
X-ray of orbits, the bones surrounding the eye and supporting the position of the eyelids. The underlying shape of the bones in different ethnicities reflects the positions of the eyelids and must be taken into account with blepharoplasty to give a natural looking result.
What is the recovery after eyelid surgery?
Dr De Silva uses the latest in technology including regenerative medicine to enhance recovery after surgery. Utilising your own growth factors, and advanced techniques used by professional athletes your recovery can be speeded up.
What does eyelid surgery involve?
The main objective of eyelid surgery is to enhance the appearance of your eyelids and other facial features so that the final result preserves the individual’s ethnicity while improving and rejuvenating their appearance. To achieve this result, the following elements must be altered in the eyelids: the skin crease, orbicularis muscle, septum, fat pads, lateral canthus, the retractors, rhytides and eyelid-cheek junction. In conjunction with eyelid surgery often additional specialist techniques are required to give the best natural looking result including, skin resurfacing, laser treatment, ptosis correction (droopy eyelid), tear trough depression and dark circles. Dr Julian De Silva avoids changing the eyelid shape by the use of delicate lipo-sculpture of the fat prolapse in the lower eyelids making incisions on the inside of the eyelid and adding advanced support to the lower eyelid during the healing process.
What will my friends and family think?
The eyelid is a key element of facial appearance as the eyes are the first point of communication between people in the form of eye contact. Loose skin, puffiness, bags, lines and dark circles all give a more tired appearance. Good eyelid surgery is discrete with hidden scars, patient’s report to Dr De Silva every week that most of their friends and family could not tell they had undergone surgery until shown before and after photos.
Before and After Photos
What type of anaesthesia is used?
Sedative anaesthesia, also known as “twilight anaesthesia,” which is combination of local and sedative medications. At the centre we have developed our own advanced form of twilight anaesthesia, based on practices in the USA. This specialised sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience avoid the risks and side effects of general anaesthesia. A much shorter recovery period than general anaesthesia, with most patients able to leave 30 to 60 minutes following the procedure. These are the most advanced sedation techniques available, and the optimal option for patients considering Asian eyelid surgery.
For more information on sedation anaesthesia please see this link:
Will my eyes be symmetrical after eyelid surgery?
Meticulous care is required with measurements of the eyelids before surgery as less than 1mm difference between the two eyelid heights can be seen. Dr De Silva spends 10 to 15 minutes measuring and re-measuring the eyelids before surgery to enhance symmetry and ensure an even appearance. All of us have degrees of asymmetry between the right and left sides, and with eyelid surgery, the asymmetries can be improved with surgery.
Will I have visible scarring?
In ethnic blepharoplasty an important consideration is scarring. Dr De Silva uses innervational techniques to reduce scarring for patients. Key to normal healing of scars is surgical technique, choice of non-dissolving stitches and avoiding sun exposure in the healing period, as ultraviolet light, may cause darkening of the skin. Although dissolvable stitches are quicker for surgeons, in some patients these may increase scarring, for this reason Dr De Silva does not utilise these stitches. In patients who have marked propensity for scars, Dr De Silva uses additional non-scarring agents to improve healing after surgery.
What will enhance the results of eyelid surgery?
The skin around the eyelids is less than half millimetre thick. For this reason, every detail matters. A common finding in ethnic blepharoplasty patients is the appearance of a dark ring beneath the lower eyelid at the junction between the eyelid and the cheek. For these patients Dr De Silva uses an advance fat transfer technique to enhance the result, this involves taking a small volume of fat from around the belly button, concentrating the fat, and inserting this in micro-aliquots into the ring depression. Dr De Silva uses special micro-cannulas to insert the fat avoiding incisions in the skin and placing it precise locations between the eyelid and the cheek. The fat is placed into specific areas around the eyes that are specific to the individual, including the junction between the eyelid and cheek, cheek, eyebrows, glabellar, temples and lateral canthus. This specialised treatment considerable improves the longevity of the result and improves the overall quality of skin as the transfer included regenerative cells. Dr De Silva utilises the most advanced modern techniques to enhance the results from surgery.
Can laser be used in ethnic eyelid surgery?
Ethnic skin is different to Caucasian skin and caution must be taken with laser techniques to improve the skin condition, smoothening lines as well as avoid darkening of the skin and redness. Dr De Silva utilises a specialist US laser to treat the periocular skin in ethnic blepharoplasty to maximise the results. The laser is able to provide both deep skin rejuvenation with carbon dioxde laser and polishing of the superficial skin with Erbium-YAG laser.
Can ethnic blepharoplasty be combined with other procedures?
Dr De Silva frequently combines upper eyelid surgery with other facial procedures:
- Lower eyelid surgery for puffiness (eye bags)
- Rhinoplasty (enhance bridge and narrow features of nose, more definition to nasal tip)
- Chin augmentation and facial balance
- Facelift (deep plane, natural facelift)
- Regenerative medicine
- Volume enhancement with fat transfer.
- Droopy eyelid (Ptosis correction)
Revision Ethnic Blepharoplasty
Middle Eastern blepharoplasty is regarded as a challenging aspect of eyelid surgery as the degree of detail is fine and aspects including asymmetry are often present. Over 30% of all Dr De Silva’s patients have undergoing previous surgery and are termed revision procedures. Although more challenging than primary surgery often with Dr De Silva’s advanced techniques the overall appearance and symmetry of the eyelids can be improved.