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Revision Blepharoplasty

Written by Dr. Julian De Silva

Revision Eyelid Surgery
The eyelids are complex part of the face with a unique anatomy and function, millimeters 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. 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. 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 10 percent of Dr. De Silva’s blepharoplasty surgeries are revisions, of the revision surgeries, 30 percent require additional graft material to re-approximate the eyelid position.

How do you approach revision blepharoplasty surgery?

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 orbital boney drill holes to secure a long-term result. Dr. De Silva is usually able to correct the eyelid position with a single surgery, however in revision cases scarring of the eyelids has occurred, 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.

What is the preferred treatment for revision blepharoplasty patients?

The anatomy and soft tissues of the eyelids is highly intricate, and once surgery has been completed there is a degree of scarring that is specific 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 blepharoplasty is challenging and is dependent on the degree of scarring and patients expectations from surgery. Dr. Julian De Silva only recommends surgery in some cases in which a substantial improvement can be made that can achieve patient’s expectations, surgery is not suitable for all patients.

Hospital Tourism

Hospital tourism has become a common trend in the UK, patients going abroad for cosmetic surgery either in Eastern Europe or Asia, where there can be cost saving and combined with a holiday. Though this is not without risks, there is limited knowledge of the surgeons performing the surgery, unknown regulation of the facility, and a common issues is follow-up abroad is very limited. “Facial cosmetic surgery is intricate and requires a detailed meticulous approach to give every patient with their individual appearance and genetics a natural looking result”, according to Dr. Julian De Silva a London based facial cosmetic surgeon. Unfortunately the nature of growth in hospital tourism has resulted in increased numbers of patients coming to see Dr. De Silva after undergoing facial cosmetic surgery abroad. The anatomy that makes up the eyelids includes very delicate layers of soft tissues, damage to these tissues can be very difficult to repair, in some cases only a 50% improvement is possible, if patients expectations from surgery are very high, I will advise against surgery.”


Revision Blepharoplasty Case 1

NS a 30 year-old nurse based in London, had noticed excess skin overhanging her upper eyelids, with multiple lines in the eyelid, that was weighing her eyes down and making her look older and tired. While on holiday, she had decided to undergo eyelid surgery, also known as blepharoplasty, in Asia. However the surgery had been a disappointment and had not given the rejuvenation she had hoped and she had not been happy with the results. After the surgery there was asymmetry with multiple folds of skin and lines around the upper eyelids and a more tired and older appearance. She went to see Dr. Julian De Silva a facial cosmetic and plastic surgeon based in London for revision eyelid surgery. Dr. Julian De Silva found on assessment that she eyelid scars that were 50% higher than normal, making them visible on her face and creating un-natural multiple skin creases her upper eyelid. According to Dr. De Silva “Multiple skin creases and lines in the upper eyelids is an appearance that is associated with facial ageing and when asymmetrical is very noticeable. Having multiple lines can make a younger patient look older and is an avoidable with meticulous attention to detail. Scars in the upper eyelids can be very difficult to correct as once made, and Revision plastic surgery must be focused on adapting natural lines in the skin to hide these scars. The anatomy that makes up the eyelids includes very delicate layers of soft tissues, damage to these tissues can be very difficult to repair, in some cases only a 50% improvement is possible, if patients expectations from surgery are very high, I will advise against surgery” Dr. De Silva performed revision blepharoplasty surgery on NS and her eyelids are more symmetrical and she remains very happy with the results.

Patient 1 Testimonial

“My short journey with Surgeon De Silva and his entire team members has been nothing but fabulous. From My consultation day till my last post op appointment, I felt nothing but a huge satisfaction. His approach has always been so humble and generous at all time. His information in regards to my entire pre & post  surgery plan were very detailed. After noticing his achievements and awards in the world of plastic surgery, I knew straight away that I am in safe hands from day one. Every member that i met in the centre were so welcoming, friendly and made me at ease all the time. My surgery went very smoothly without any complications as planned. I am extremely thrilled, happy and satisfied with the result and can’t thank him and his entire team enough for giving me my new confidence.  I highly recommend any individual out there who wish the best result from the best surgeon in the town. Once again thank you so much doc and your entire team.”

Before Revision Plastic Surgery

Abnormally high scar on the upper eyelids (Red Arrow), 50% higher than natural skin crease (Green Arrow indicates normal eyelid crease)

Female eyelid, Before Revision Plastic Surgery, front view, patient 1

Before Revision Plastic Surgery

Female eyelid, Before Revision Plastic Surgery Treatment, front view, patient 1

After Revision Plastic Surgery with Dr. Julian De Silva

Female eyelid, After Revision Plastic Surgery Treatment, front view, patient 1



Revision Blepharoplasty Case 2

This 49-year old patient had noticed eyelid changes and undergone blepharoplasty surgery with a consultant in UK. She was very disappointed by the results as she didn’t look rejuvenated and continued to have drooping of the upper eyelid skin after the surgery. She was told this could only be improved with a further more invasive brow lift surgery. She was reluctant to have this surgery and went to see Dr. Julian De Silva a facial cosmetic and plastic surgeon based in London for a further opinion. Dr. De Silva advised her the appearance could be improved with a revision blepharoplasty and under local anaesthesia, although most of the incision could be hidden in the natural skin creases, a small 8mm part of the incision was hidden at the corner of the eye in the area where she had commonly occurring lines also know as crows feet. She underwent Revision facial plastic surgery under that gave her the result that she had always wanted. After surgery numerous people commented on how she looked rejuvenated, though no one could tell she had undergone surgery.

Patient 2 Testimonial

Dr . Dr De Silva and Anita, Frankly, when I first came to you for consultation I was a bit sceptical as I already had done my Blepharoplasty (upper eyelid) two years before at age 47 with a good surgeon on the recommendation of another good doctor…and the result was poor. One day I was reading good things about you in a Magazine and decided to check you out. As soon as I met you and Anita I had a good feeling.. After the consultation I felt reassured that it was going to be good this time as your mannerism was professional and your eye for detail impressed me. Its now two months since you did my operation and I am so grateful of the amazing results that you have achieved with me. You made me younger and, shall I dare to say, more beautiful. Just after a week my friends who did not know about this operation were complimenting me for looking so good. They were asking me if I had been on a resting holiday or if I had changed my regime on creams and diet. I must emphasise how impressed I was with the way you showed lots of passion for perfection without loosing the human side. You made me feel protected, looked after and helped me with the emotional side of my up and downs during the process. Also, I greatly appreciated the fact that you have given me lots of your time to make sure that my expectations and hopes were met and you never once showed me that you were eager to finish with me. Thank You to Both!

Before Revision Plastic Surgery 

Female eyelid, Before Revision Plastic Surgery, front view, patient 2

After Revision Plastic Surgery with Dr. Julian De Silva 

Female eyelid, After Revision Plastic Surgery, front view, patient 2

Before Revision Plastic Surgery 

Female eyelid, Before Revision Plastic Surgery, oblique view, patient 2

After Revision Plastic Surgery with Dr. Julian De Silva 

Female eyelid, After Revision Plastic Surgery, oblique view, patient 2


Revision Blepharoplasty Case 3

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). According to Dr. De Silva, “Eyelid anatomy is very delicate and some aspects can be very difficult to treat, with this patients the incisions and resulting scars made in the lower eyelid were asymmetrical, as the lower eyelid skin is the thinnest in the entire body are difficult to treat. With revision eyelid surgery, the fine swelling after surgery and scar formation means the final result can be 12-months after surgery, Dr. De Silva will sometimes use anti-inflammatory medications to speed up recovery in the post-operative period. The patient was very happy with the results and has subsequently emigrated to Malaysia.   

Patient 3 Testimonial

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.


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