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 blepharoplasty may be combined with tightening of the lower eyelid tendon (canthopexy or canthoplasty) or rejuvenation of the lower eyelid skin (laser treatment or skin peels) or volume restoration (e.g. fat transfer) to give the best natural results.

Eyelid surgery can be completed in 1 hour. However to obtain the best natural results that are long lasting, the procedure will take 1-3 hours as it will require a combination of fat transfer, fat preservation, skin resurfacing, regenerative medicine and attention to detail for natural results that are long lasting. Many surgeons do not use fat transfer for this procedure however the results will not be as good or long lasting and other volume may be required such as maintenance with fillers. Dr De Silva customised blepharoplasty to the individual patient and most procedures take between 1.5 to 3 hours depending on the intricacy and complexity of the procedure. From Dr De Silva’s experience customised blepharoplasty surgery can last 10 years in the majority of patients and a lifetime in some patients.

The surgery generally causes mild ache or discomfort which settles over less than 48 hours, and the surgery is not regarded as painful. Most of Dr De Silva’s patients require minimal or no analgesia after blepharoplasty. Usually over the counter mild analgesia is sufficient to reduced the discomfort (e.g. Paracetamol or Tylenol).

In upper blepharoplasty, the incision is hidden in the crease of the eyelid and is often difficult to see even 1 week after surgery. In lower blepharoplasty, the incision is placed either in the conjunctiva (termed transconjunctival) of the eyelid in which case it is completely hidden. Or the incision is just below the lower lid eyelashes (termed transcutaneous) within several weeks this incision is hidden by the eyelashes of the lower eyelid. The eyelid skin is unique in that it is very thin, and although rarely patient who are predisposed to scarring my have keloid scars, keloids on the eyelids are rare.

Upper Blepharoplasty Scar at 6 weeks. All scars are initially slightly pink in colour and lumpy bumpy in appearance. Over a period of weeks to months the colour returns to normal and the scar smoothens out. Dr De Silva takes care to hide scars in natural lines and creases and avoid scars wherever possible. Issues with scars are relatively rare and occur in less than 1%. Key is the detail, Dr De Silva does not use dissolvable stitches in this delicate area, as these can result in more visible scars afterwards. 

Lower Blepharoplasty at 6 weeks. No scar is visible. Dr De Silva prefers to avoid scars in lower eyelid surgery by hiding the scars and completing the surgery on the inside of the eyelid. There are a small proportion of patients who may not be suitable for this technique however each patient’s surgery must be tailored to the individual to give the best possible natural looking result.

Video on How to avoid terrible scars after blepharoplasty surgery?

Blepharoplasty is the commonest cosmetic procedures to be completed in the world and is regarded as a safe procedure. As with any surgery there are potential risks and complications that many occur.

Complications in blepharoplasty may occur because of several reasons. One of the most important factors responsible for the success of surgery is the surgeon. The surgeon must have complete knowledge of how the surgery has to be performed. Blepharoplasty, particularly of the lower eyelid is demanding and requires in depth knowledge of the anatomy and attention to detail. Dr De Silva’s number one procedure is blepharoplasty and revision blepharoplasty.

Complications can be defined as any unforeseen occurrence during or after the surgery. The complications that can occur during or after blepharoplasty and can be divided into four categories; intra-operative, immediate post-operative, early and later post-operative.

Intra-operative complications occur during the surgery. For example, these can occur due to a reaction to some medication or due to the local or general anaesthesia given and are managed by the surgical team at the time of surgery.

Immediate post-operative complications occur immediately after the surgery when the patient is in the initial recovery stage and may include bleeding or a medication. These complications need to be handled immediately by the surgeon who performed the operation.

Early post-operative complications in blepharoplasty occur once the patient has been discharged. These appear almost immediately after the person returns to normal routine. They can include bleeding, a reaction to a medication, infection and can be corrected by contacting the doctor immediately.

Late post-operative complications associated with blepharoplasty may occur when the patient fails to take proper care after the surgery, the surgical technique used or the patient’s healing process. These complications include those of the upper eyelid (asymmetry, scarring, hollowing, inability to close the eyes, dry eyes), lower eyelid (asymmetry, residual fat bags, lower lid retraction). Most of these complications are minor and can be easily corrected, however some such as lower lid retraction require complex revision surgery with the use of graft material and reconstructive techniques.

The commonest complications are bleeding and bruising, all of which are treatable. There is a risk of asymmetry between the two eyes and this may settle with time or in approximately <5% cases may require a small revision procedure that can be completed under local anaesthesia. The most serious and feared complication of blepharoplasty is loss of vision following surgery, as a result of bleeding that collects behind the eye, this is an extremely rare complication and if recognized early on it can be treated. Blepharoplasty is generally a popular surgery with high patient satisfaction and low risk of complications.

Patients are able to have upper blepharoplasty under local anaesthesia alone, sedation or general anaesthesia. Dr De Silva has used all of these for his patients over more than 10 years, Sedation Anaesthesia offers the advantage being a more comfortable experience and faster recovery. Blepharoplasty may also be completed under local anaesthesia, however the eyelids are sensitive and delicate and the use of sedation is a useful adjunct for surgery. For best natural results eyelid surgery is often combined with other procedures such as fat grafting and skin resurfacing, with these additional procedures light sedation is generally preferred. General anaesthesia is not a requirement of blepharoplasty and associated with more recovery and potential side effects can be avoided. Dr De Silva takes time to advise each patient on the best type of anaesthesia for them. His team have pioneered the use of faster recovery sedation, aka twilight anaesthesia in London, UK, and have been awarded a patent for their innovational sedation anaesthesia technique.

The best UK surgeons in 2024 according to Rate MD

1. Dr Julian De Silval. Plastic/ Cosmetic Surgeon

23 Harley Street, London, London, ENG, W1G 9QN

2. Dr Riccardo Frati. Plastic/ Cosmetic Surgeon
3. Dr. Ayham Al-Ayoubi. 

Milner House, 14 Manchester Square, London, ENG, W1U3PP

Choosing the right blepharoplasty surgeon is crucial for achieving the best results. Here are detailed measures to help you select a highly qualified and experienced surgeon:

Key Considerations:

• Board Certification: Ensure the surgeon is board-certified in plastic or facial cosmetic surgery. This certification indicates they have met rigorous standards in training and expertise.Within plastic surgery, Oculo-Plastic Surgeons specialise in eyelids and blepharoplasty, more than general plastic surgeons or ENT Facial plastic surgeons.
• Specialisation: Look for a surgeon who specialises exclusively in facial surgery, as this indicates a deep understanding of facial anatomy and techniques. Facial surgery is detail of millimetres, body surgery is detail of centimeters Dr. Julian De Silva for example, has dedicated over 20 years to specialising in facial procedures
• Experience and Results: Review the surgeon’s portfolio of before-and-after photos to assess their skill and the naturalness of their results. Dr. De Silva has performed thousands of facelifts and has extensive experience in revision surgeries.
• Consultation: Schedule consultations with multiple surgeons to discuss your goals and assess their approach. This will also give you an opportunity to gauge their communication style and bedside manner.
• Patient Reviews and Testimonials: Read reviews and testimonials from previous patients to understand their experiences and satisfaction levels.
• Hospital Affiliations: Check if the surgeon operates in reputable hospitals or clinics with accredited facilities. Dr. De Silva operates in top-notch state-of-the-art facility, ensuring the highest standards of care.

 Dr De Silva specialises in Blepharoplasty and Face Only procedures. Blepharoplasty is the #1 Procedure he completes for his patients every day. Dr De Silva customises blepharoplasty surgery for each individual patient and often combines with other procedures including brow lifting, fat transfer, skin resurfacing, buccal fat reduction, face and neck lift surgery. Dr Julian De Silva travelled world-wide with fellowship in the USA and spent time working in some the best Cosmetic centres in the World before setting up his practice over 10 years ago. This included London, UCLA Jules Stein Eye Institute in Los Angeles and Montefiore Medical Center, Albert Einstein College of Medicine in New York. Dr De Silva wrote an extensive book that includes everything each patient needs to know regarding facelift and neck lift surgery. Dr De Silva uses specialised state-of-the-art technology to improve the natural results or enhance recovery or longevity of the procedure including oxygen therapy and regenerative medicine. In addition, Dr Julian De Silva has pioneered the use of sedation anaesthesia in the UK, and has been awarded a Patent for his innovation. Dr De Silva has always taken pride and constantly innovated on improving natural results, faster recovery with over 1000 5* reviews was voted the best in plastic surgeon in the UK on an independent review site.

Video on: How to choose the Best Eyelid/ Blepharoplasty surgeon for you? What to look for and avoid …         

Video Blepharoplasty FAQs

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