Blepharoplasty London — World-Class Eyelid Surgery by Dr Julian De Silva

Upper blepharoplasty addresses excess skin and heaviness of the upper eyelid — the hooding that can make the eyes appear smaller or create a tired, heavy expression. Lower blepharoplasty addresses the under-eye area: puffiness, bags caused by prolapsing fat, and the junction between the lower lid and cheek.

Many patients require only one area treated, while others benefit from combined upper and lower surgery. Dr De Silva also assesses brow position and checks for ptosis, a drooping of the upper eyelid caused by a weakened muscle rather than excess skin, because these can closely mimic eyelid heaviness and require a different surgical approach. Getting this assessment right is as important as the surgery itself.

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.

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.

Dr De Silva places incisions along the natural crease of the eyelid, making them discreet and minimally visible once healed. With his precise technique, scars are typically well-hidden, and they continue to fade over time, leaving only subtle traces.

Most patients begin to see noticeable improvements as soon as 1 week after surgery, however there will be some swelling. Most healing occurs within 6 weeks and the final results typically appear within 9-12 months, when the eyelid area has fully healed and the skin settles into its natural position.

Lower blepharoplasty can dramatically reduce the appearance of under-eye bags and structurally caused dark circles, though the two concerns have different origins and are addressed differently. Under-eye bags are caused by fat that has shifted forward over time, creating a visible bulge beneath the eye. Dark circles caused by a shadow effect, where the fat pad above creates a convexity that deepens the hollow beneath, can be significantly improved by repositioning that fat into the tear trough, smoothing the transition between the lower lid and the cheek. Dark circles caused by skin pigmentation are a separate issue and are not resolved by surgery alone, though CO₂ laser resurfacing or skin treatments can be incorporated where pigmentation is also a factor. At consultation, Dr De Silva assesses the precise cause of each patient's concerns before recommending a course of treatment.

In most cases, Dr De Silva repositions rather than removes fat during lower blepharoplasty. This is a meaningful distinction. Removing fat reduces the bulge, but it can leave the area looking hollow or sunken - a common cause of dissatisfaction after surgery performed elsewhere, and one of the most difficult outcomes to correct. Repositioning the fat moves it from where it has prolapsed forward into the tear trough beneath, where it restores volume and creates a smooth, continuous contour from lower lid to cheek. In select cases, a small amount of removal may be used in combination with repositioning. Where additional volume is needed, micro-cannula fat transfer can be incorporated. The approach is determined entirely by each patient's anatomy, assessed at consultation.

In many cases there is no external scar at all. Dr De Silva frequently uses the transconjunctival approach, where the incision is made on the inside of the lower lid, leaving no visible mark on the skin surface. This is appropriate when the primary concern is fat; either excess or displaced, and skin elasticity is good. Where skin removal is also required, a fine incision is placed immediately beneath the lash line, following the natural crease of the lower lid; when healed, this is typically imperceptible. Healing is further supported by Dr De Silva's use of fibrin tissue adhesive at the wound edges; a technique he evaluated in a formal randomised controlled trial of skin closure in eyelid surgery, which reduces tension, minimises bruising and supports a cleaner, faster recovery than sutures alone.

Most patients experience bruising and swelling in the first week, which resolves progressively over the following one to two weeks. For the first three days, a strict ice regime (ten minutes per hour) significantly reduces bruising and swelling. The head should be kept elevated at a 45-degree angle when sleeping to prevent overnight swelling from accumulating. Sun exposure must be avoided for a minimum of six weeks; the healing skin around the eye is particularly vulnerable to hyperpigmentation, so SPF sunscreen, UV-protective sunglasses and a hat are essential whenever outdoors. Some numbness or altered sensation around the upper eyelid can occur and may take up to six months to fully resolve - this is normal. Most patients feel comfortable being seen socially within two to three weeks. Normal exercise can typically resume at four weeks. Internal stitches dissolve gradually over up to three months, and the left and right sides may heal at slightly different rates during this period. Final results are fully established at six to twelve months, as all residual swelling settles.

Lower blepharoplasty is frequently combined with upper blepharoplasty, CO₂ laser resurfacing, facelift or micro-cannula fat transfer, and for many patients a combined approach produces a more balanced, complete result than treating the lower lid in isolation. Whether surgery is the right recommendation at all depends entirely on the structural cause of each patient's concerns. Non-surgical options, including tear trough filler and skin treatments, can be appropriate for early-stage hollowing or mild laxity, and Dr De Silva will say so honestly when that is the case. Once there is true fat prolapse, significant skin laxity or structural change that injectables cannot address, surgery is the only treatment that produces a lasting result. The consultation- drawing on Dr De Silva's oculo-facial specialist training and more than two decades of experience operating on the lower eyelid specifically, is the right place to make that determination accurately.

Dr De Silva's approach to lower blepharoplasty is distinguished by three things: specialist training, evidence-based technique, and a consistent philosophy of preservation over removal. His fellowship training in oculo-facial plastic surgery at Moorfields Eye Hospital, UCLA Jules Stein Eye Institute and Albert Einstein College of Medicine means the lower eyelid is anatomy he has studied and operated within at the highest level. He is a member of the American Society of Oculo-Facial Plastic and Reconstructive Surgery and the British OculoPlastic Surgery Society; the specialist bodies for this precise area of surgery. His use of fibrin tissue adhesive in eyelid surgery is supported by his own randomised controlled trial, one of very few such studies in this field, which demonstrated meaningfully reduced bruising and improved healing compared with conventional sutures. Over 20% of his patients come to him to correct or improve results from surgery performed elsewhere- a reflection of the trust that comes from consistent, precise outcomes.