Revision Upper Blepharoplasty

Written by Dr. Julian De Silva

Revision upper eyelid surgery

  • The eyelids are complex part of the face with a unique anatomy and function, millimetres are the difference between success and failure. The upper eyelid has an important function in blinking and prevention of dry eyes, the removal of too much soft tissue and skin is problematic.
  • Complications of excessive soft tissue removal are best avoided by seeing a specialist in the eyelids, a surgeon with Oculo-Facial Plastic Surgery or Facial Plastic Surgery Specialist.
  • Approximately thirty percent of Dr De Silva’s blepharoplasty surgeries are revisions surgeries.
  • Revision surgery is more complex surgery often requiring specialist techniques to ensure preserving natural anatomy and 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 specialized 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 boney 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 specialized anti-inflammatory medications to reduced scarring; he has pioneered this technique 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 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. 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. She went to see Dr Julian De Silva, a facial cosmetic and plastic surgeon based in London for revision eyelid blepharoplasty. 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 underwent revision upper and lower eyelid surgery under sedation anaesthesia, also known as twilight anaesthesia. After surgery there was an improved appearance of her upper and lower eyelids, Dr De Silva hid the previous scars in natural creases 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.

Patient Testimonial

I am grateful to Dr Julian De Silva who did a revision on my upper and lower eye lids four weeks’ ago. The whole experience from consultation to follow ups was caring in relaxed and friendly environment. Dr Julian De Silva ensured I understood the procedure plus 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 towards his clients and professional. My eyes are getting better and better, the natural look to suit my face. Many thanks to him and his team. Highly recommended.

Blepharoplasty, woman - photo model

I had a difficult recovery after eyelid surgery, I am worried about have further surgery…

Many of our patients are anxious with revision surgery, they did not have the result they were looking after the first surgery and are worried about undergoing further treatment. Dr De Silva takes time to ensure we provide a thorough discussion regarding further treatment, recovery and 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.

Watch Video: Sky News interviews Dr. Julian De Silva about Patient Safety in Cosmetic Surgery
Sky News interviews Dr. Julian De Silva about Patient Safety in Cosmetic Surgery

Will I be happy after revision eyelid surgery?

Dr De Silva only provides patients with sincere information on results from revision surgery, and a minority of patients he advises against surgery. Although most patients’ symptoms can be improved substantially it is important to have a discussion regarding realistic expectations, as previous scarring cannot be reversed only improved. A small proportion of patients may require two procedures.

What is the worst complication?

After a thorough examination most serious issues can be excluded (eyelid tendon laxity, skin shortage, functional dryness). The key aspects are recovery often takes longer with the final result as long as 12-18months after surgery. In addition, realistic expectations for improvement are important to discuss.

I live abroad how can I have revision surgery?

Dr De Silva has a large number of revision patients that live overseas. Our specialist team can help you organise a virtual consultation and coordinate your trip to the UK. We are able to utilise the latest technology to enhance your recovery including oxygen therapy and regenerative medicine.

Why come to the UK for revision surgery?

London and Harley Street have been famous for providing world class medical services since the 19th Century. A combination of the state-of-the-art facilities, stringent safety regulation and international clinicians. Dr De Silva has treated patients from all continents of the globe looking to have the best quality of care in the world.

Consultation: Treveling map

Revision Lower Blepharoplasty

Revision lower eyelid surgery

The anatomy and soft tissues of the lower eyelid is 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 of multiple factors including the previous surgery, the surgeon, the ethnicity of the patient and their individual genetics and healing.
The treatment of patients who have undergone previous lower blepharoplasty is challenging and is dependent on the degree of change and patients’ expectations from surgery.
Although for most patients a substantial improvement can be made, key to success is achievement of patient’s expectations.

In the lower eyelid, removal of too much soft tissue results in an increased show of the white sclera and the lower eyelid hangs 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 too much removal of skin tissue in lower blepharoplasty and scarring to the lower eyelid resulting in scarring and lower lid being pulled downwards.
  • The lower eyelid has an 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 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 avoids this complication. The more traditional method that is used by surgeons practicing older surgical techniques is termed trans-cutaneous blepharoplasty. In patients with specific anatomy, termed negative vector, it is of absolute importance not to use these techniques to ensure a risk free result. Young patients with lower eyelid bags should see an experience specialise in eyelid surgery for an expert opinion to avoid these issues.
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. Lower eyelid retraction is a challenging eyelid condition to treat, although the eyelid position can be improved, Dr De Silva discusses with each patient what are realistic expectations that can be achieved through surgery.

View before and after photos: Revision Blepharoplasty

*Results May Vary

I live abroad how can I have revision surgery?

Dr De Silva has a large number of patients that live overseas. Our specialist team can help you organise a virtual consultation and coordinate your trip to the UK. We are able to utilise the latest technology to enhance your recovery including oxygen therapy and regenerative medicine.

  • Over 30% of Dr De Silva’s patients have undergone previous surgery.
  • Dr De Silva has completed numerous book chapters and research articles on eyelid surgery and revision blepharoplasty.
  • Dr De Silva published a book entitled a complete guide to eyelid surgery and blepharoplasty surgery in 2016.
Our specialist team can help you organise coordinate your trip to the UK

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