Blepharoplasty FAQs

Trans-Conjunctival blepharoplasty is the more modern surgical technique for lower eyelid surgery/blepharoplasty. The technique avoids a visible incision, as the surgery is performed from the inside of the eyelid. The transconjunctival technique accesses the lower eyelid from the inside of the eyelid, leaving important anatomy (including the skin, orbicularis oculi muscle and orbital septum) intact. The technique is more challenging to perform, but overall is safer and avoids leaving a noticeable scar.

The older surgical technique is termed transcutaneous lower eyelid surgery/ blepharoplasty and involves making a surgical incision in the lower eyelid. The older technique results in a scar in the lower eyelid skin and has a risk of lowering the lower eyelid resulting in lower lid retraction or rounding of the lower eyelid.

There is a degree of artistry in lower blepharoplasty. Key to the success of the surgical technique is removing an optimal amount of fat. If too much is removed, it results in a hollowed-out appearance to the lower eyelid. Whereas, too little fat removed results in a remaining fat bulge. Dr De Silva’s approach is conservative and preserves as much of the orbital fat as feasible with the fat translocation technique.

Increased droopiness of the upper eyelids is a common change with increasing age. It is frequently a result of ageing of the eyelids and increased laxity in the soft tissues.

Non-surgical treatment options for droopiness of the upper eyelids include lifestyle changes (healthy sleep, reduced stress), the use of wrinkle injections in the forehead area, limited skin tightening with radiofrequency or laser resurfacing. However non-surgical options are usually of only modest effect with a short and limited improvement. Only a surgical correction will improve the appearance after the changes are more readily apparent.

Assessment of the eyelids is crucial to exclude other factors that may be influencing the position of the upper eyelids including ptosis, dry eyes or thyroid eye disease. Ptosis is a condition where the fine muscle that elevates the eyelid has become weak or detached, requiring ptosis correction surgery to improve it. Patients who have undergone previous laser refractive surgery should have an evaluation to exclude dry eyes before considering upper eyelid surgery.

Upper blepharoplasty helps improve the shape of the eyelids by rejuvenating their appearance. Most changes in the upper eyelids and lower eyelids are a consequence of facial ageing. However some changes are related to both genetics and the environment (e.g. sun damage and smoking). Blepharoplasty in the upper eyelid involves trimming excess skin and shaping the underlying soft tissues, including the orbicularis oculi muscle and orbital fat.

Although fat bulging of the upper and lower eyelids is usually seen as one of the characteristics of an ageing face there are a smaller proportion of patients who have a genetic predisposition to eyelid ageing.  In these patients, fat bulges may be present in their late teenage years and early twenties.

The treatment of lower eyelid bags in young adults with a negative vector requires specific techniques to support the lower eyelid after blepharoplasty, which is essential to avoid lower eyelid retraction. Support of the lower eyelid ensures a good shape to the lower eyelid after surgery.

Some patients may require additional techniques combined with lower blepharoplasty for the best result, including lower eyelid volume augmentation, fillers and cheek implants.

Dr De Silva has had patients travel long distances for opinions on lower eyelid bags, who have been refused surgery by local surgeons. However, please note lower blepharoplasty is not always indicated if you have very early signs of lower eyelid bags.

There is no specific age limit for blepharoplasty. Key to a successful blepharoplasty is your general health and fitness. If you have any underlying medical conditions such as high blood pressure, it is important to check and control with appropriate medication.

An assessment of your general medical health and your specific eyelids is important to ensure safety and to guide surgical planning to obtain the best result. Often there may be additional factors to consider with increasing age, these can include dry eyes, eyelid laxity and droopy eyelids (termed ptosis), which may require additional treatments at the same time of surgery to ensure a successful result.

In addition, the choice of anaesthesia is important. Local anaesthesia or twilight anaesthesia has additional safety benefits over general anaesthesia and a quicker recovery time.

To look refreshed

One of the early changes in facial ageing can be attributed to softening of the contours of the eyelid skin and bulging of fat pockets above and below the eyes. With droopy eyelids or bulging pockets, the face may project an inappropriate look of fatigue and lack of vigour despite adequate rest and good health. Friends and relatives may frequently comment on how patients look tired.

Easier to apply eye makeup

One of the reasons for blepharoplasty is “I can’t put my makeup on like I used to without it getting all over the place”. Early symptoms of blepharoplasty may include various changes, including the diminishing appearance of the upper eyelid with hooding and puffiness. This is most noticeable to patients when they have difficulty applying makeup to the upper lid, and is one of the commonest features patients describe.

Dr De Silva only performs surgery to the face and does not operate on other parts of the body. By specialising in facial surgery, he has developed expertise and advanced technical skills in blepharoplasty to offer patients a tailor-made approach using hidden incisions.

Dr De Silva combines blepharoplasty with additional techniques in over eight per cent of cases to deliver outstanding results.

Dr De Silva worked in the cosmetic surgery havens of Los Angeles and New York among the world’s best facial and blepharoplasty plastic surgeons. There, he developed skills, including 3-D telescopic camera techniques & invisible incision techniques, that at the time were not available in fellowship training in the UK.
Dr De Silva uses a variety of sculpting and suturing techniques to preserve the function and structural integrity of the eyelids, which give patients a natural rejuvenation, using a combination of tried-and-tested techniques alongside new, innovative techniques.

Dr De Silva is a keen teacher, leading the development of new courses and teaching numerous instructional courses. He teaches facial cosmetic and plastic skills at the prestigious American Society of Oculo-Facial Plastic Surgery conference in the USA.
Dr De Silva is an artist having painted for exhibitions in London at the Royal Academy of Arts and National Portrait Gallery and is a sculptor who uses the medium of clay. The sculpting of the human face to balance the proportions of the face and body type require artistic interpretation, technical know-how and an eye for detail to deliver the realistic, natural results demanded of facial surgery procedures.

Dr De Silva trained in microscopic surgery before cosmetic surgery. In micro-surgery, millimetres are the difference between success and failure. Using these same principles of microsurgical finesse and obsession with detail, Dr De Silva is able to give natural-looking surgery results.

Dr De Silva recognises limitations in surgical results that may be a result of past scarring, skin thickness or trauma, and will advise you against surgery if he believes that you are unlikely to obtain the result you desire.
Dr De Silva performs a conservative blepharoplasty that preserves the natural architecture of the eyelid. By using tissue-sparing techniques, and avoiding unnecessary trauma to the intricate anatomy of the eyelids, he prevents the surgical signs of complicated blepharoplasty such as eyelid retraction or change in natural eyelid shape.

In the upper eyelid, as a result of the ageing of the soft tissues, there can be an unnecessary amount of upper eyelid skin present which would benefit from upper blepharoplasty. The skin may hang over the eyelashes and can cause a loss of peripheral vision. A cosmetic effect of the excess skin is that it can reduce the eye’s youthful appearance by decreasing the amount of visible upper eyelid, which is referred to as a reduction in tarsal show or dermatochalasis. With time, the fold of skin may cover the upper aspect of the eye, commonly affecting the field of vision and causing difficulty with activities including reading or driving.

In the lower eyelid, fat pockets may bulge forwards and lower blepharoplasty is required to improve the puffy appearance of the lower eyelids and to reduce eye bags and wrinkling of the skin.

Many plastic surgeons perform blepharoplasty in the same or similar manner for all patients. An analogy for this would be like visiting a hairstylist who can only cut everyone’s hair in the same way. Achieving a natural-looking rejuvenation that does not look like a patient has had surgery requires an artistic interpretation by the surgeon and a customised approach for each patient.

Depending upon the scope of the procedure, the operation takes approximately 1 to 3 hours to complete. The procedure may be completed only on the upper eyelids, the lower eyelids or both concurrently. Commonly, surgery may be combined with tightening the lower eyelid tendon (canthopexy or canthoplasty) or rejuvenating the lower eyelid skin (laser treatment or skin peels).

Blepharoplasty will not correct changes in the skin quality including pigmentation, discolouration or wrinkles. The procedure may be coupled with skin resurfacing techniques, including peels or laser treatments to improve skin quality. The dynamic lines that are seen at the corner of the eyes, often termed crows fee, are a consequence of the activities of the orbicularis oculi muscle underlying the skin. These wrinkles are not affected by blepharoplasty and are best treated with anti-wrinkle injections treatments.

Other medical conditions do not necessarily preclude you from blepharoplasty, but Dr De Silva will want to ensure you are in the best possible health before he considers you for surgery. Medical conditions that are a concern include:

Thyroid problems, such as hypothyroidism or Graves’ disease
Lower eyelids that droop significantly and reveal the white beneath the iris (the eye’s coloured portion)
Eye problems, such as “dry eye,” a detached retina or glaucoma
High blood pressure or other circulatory disorders
Cardiovascular disease
Diabetes

Depending upon your medical history and age, certain medical and laboratory tests may need to be ordered before eyelid surgery. An ECG/EKG or heart tracing is required on men 45 and over and women 55 and over as routine screening. Blood work may need to be performed depending upon individual health history. Women of childbearing age should undergo a pregnancy test the week before the surgery to make sure that they are not pregnant at the same time as undergoing blepharoplasty.

Smoking has a negative impact on surgery by delaying healing and may lead to unsatisfactory results. If you are a smoker you are advised to stop smoking, or at least to cut down on cigarettes for at least one week before eyelid surgery. Smoking slows down the recovery process and it can also increase the risk of complications.

It is important to avoid any medications that thin the blood and encourage bleeding before eyelid surgery. This includes aspirin, ibuprofen, vitamin E, and any type of herbal supplement. You should stop all vitamins and herbal supplements two weeks prior to surgery.