Written by Dr. Julian De Silva
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.
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.
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.
Before and After photos of lower blepharoplasty revision
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
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 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 her 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 “Having multiple lines in the upper eyelid 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. Dr De Silva completed revision blepharoplasty surgery on NS and her eyelids are more symmetrical and she remains very happy with the results.
Abnormally high scar on the upper eyelids (Red Arrow), 50% higher than natural skin crease (Green Arrow indicates normal eyelid crease)
“My short journey with Surgeon De Silva and his entire team members has been nothing but fabulous. From my consultation day until 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 regard to my entire pre and 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.”
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 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 natural lines also termed “crows feet”. She underwent revision eyelid surgery that gave her the results that she had always wanted. After surgery numerous people commented on how she looked rejuvenated, though no one could tell she had undergone surgery.
Dear Dr De Silva, 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 losing 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!
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). 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 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.
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.
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.
- 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.