Blepharoplasty in London

Yes,  many patients choose to have both upper and lower surgery at the same time, which means one recovery period rather than returning for a second procedure. For most patients this is the most practical approach, as the combined recovery of one to two weeks is shorter overall than two separate recoveries.

Some patients prefer to stage the procedures ; having one area first, and returning for the second once they have seen and felt confident in the initial result. Dr De Silva advises based on your specific anatomy, your goals, and what is safest for you individually. Both approaches are entirely valid and the decision is made together at consultation.

The cost of blepharoplasty varies depending on a number of individual factors, including whether you are having upper eyelid surgery, lower eyelid surgery, or both, the complexity of your anatomy, and whether any additional techniques such as fat transfer or ptosis correction are appropriate for your case.

At Dr De Silva's Harley Street practice, the fee is all-inclusive; covering the surgeon's fee, anaesthetic and facility costs with no hidden additional charges. Cosmetic surgery is not covered by the NHS or health insurance. An accurate cost assessment is only possible following a consultation, where Dr De Silva can assess your eyelids specifically and discuss the approach most suited to your goals. The consultation fee is deducted from the surgical fee if you decide to proceed.

A well-performed blepharoplasty should be undetectable as surgery. The goal is that people notice you look more rested, refreshed and open and not that they can identify what has been done. Dr De Silva's approach consistently prioritises this: avoiding over-removal of skin or fat, respecting the natural brow balance, and planning conservatively.

The most reliable way to gauge whether a surgeon's results look natural is to review genuine, unedited before and after photographs of their actual patients. At consultation, Dr De Silva will discuss a realistic plan based on your specific anatomy and what a natural outcome looks like for your face.

Unnatural results after blepharoplasty most commonly arise from excessive tissue removal or from changing the eyelid shape in ways that do not suit the individual face. In the upper eyelid, an overly high crease or removal of too much skin can create a hollowed, surprised or feminised appearance, particularly problematic in men. In the lower eyelid, excessive skin tightening or inadequate support of the lid margin can cause the lid to pull downward, exposing the white of the eye below the iris.

Dr De Silva reduces these risks through meticulous measurement, conservative tissue removal, and where appropriate, the use of lid support techniques such as canthopexy. His philosophy is that what is not removed cannot be undone; precision and restraint produce more enduring, natural results than aggressive surgery.

For upper blepharoplasty, the incision is placed meticulously within the natural upper eyelid crease, so that as it heals it blends seamlessly into the existing eyelid fold. In most patients, the scar becomes virtually invisible within a few months.

For lower blepharoplasty, there are two approaches. An external incision is placed just below the lower lash line  - a fine line that heals well and is difficult to detect. Alternatively, Dr De Silva frequently uses the trans-conjunctival approach, where the incision is made on the inside of the eyelid, leaving no visible scar on the skin at all. This internal approach is particularly suited to patients whose primary concern is fat rather than excess skin, and to patients where scar minimisation is a priority.

Blepharoplasty is not regarded as a painful procedure. Most patients experience a mild ache or tightness that settles within 48 hours, and the majority require only over-the-counter paracetamol for comfort. Dr De Silva's use of twilight sedation rather than general anaesthetic means patients wake faster, feel significantly less nauseous, and are typically able to leave the clinic within an hour of surgery completing.

Most swelling and bruising resolves within one to two weeks, though lower eyelid surgery tends to bruise more than upper. Applying cool compresses to the eyelids regularly in the first three days, keeping the head elevated when sleeping, and avoiding strenuous activity in the first two weeks all support a smoother, faster recovery. Final settled results are visible at three to six months, as residual swelling fully resolves.

Upper eyelid surgery can often be performed under local anaesthetic alone. Lower eyelid surgery and combined upper and lower procedures are most commonly performed under twilight sedation, a specialist approach that keeps patients comfortable and relaxed without the risks and extended recovery associated with general anaesthesia.

Dr De Silva uses his patented Rapid Recovery Twilight Sedation, a formulation developed and refined over more than a decade. Patients breathe independently throughout, wake significantly faster, and experience far less nausea and grogginess than with general anaesthetic. Most patients are able to leave the clinic within approximately one hour of surgery completing.