Blepharoplasty in London

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.

The cost of blepharoplasty depends on whether the procedure involves the upper eyelids, lower eyelids or both, and whether additional techniques such as fat transfer or laser resurfacing are incorporated. As a specialist oculo-facial plastic surgeon operating exclusively on the face and eyes from his Harley Street practice, Dr De Silva's fees reflect his level of expertise, the personalised care provided throughout the patient journey, and the standard of the facility. An accurate cost can only be given following a consultation, at which point a specific surgical plan will have been formed based on your anatomy and goals. If you proceed with surgery, the consultation fee is deducted from the surgical fee.

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.

There is no specific age limit for blepharoplasty. The procedure is appropriate whenever the changes to the eyelids are causing genuine concern; whether that is in someone’s 30s due to genetics, or in their 70s or 80s due to the natural ageing process. Dr De Silva has treated patients across this full range, including older patients for whom excess eyelid skin was beginning to affect their field of vision.

What matters more than age is general health and fitness for surgery. With increasing age, additional factors sometimes require consideration — dry eyes, eyelid laxity, and drooping of the eyelid muscle (ptosis), which may need to be assessed and addressed as part of the surgical plan. A thorough pre-operative assessment ensures that surgery is safe and that the result is the best achievable for each individual patient. For an accurate assessment of suitability and cost, a consultation with Dr De Silva is the right first step.

Blepharoplasty is eyelid surgery; a procedure that addresses structural changes to the upper or lower eyelids that create a tired, heavy or aged appearance. In the upper eyelid, the most common concerns are excess skin that hoods the eye and reduces its apparent size, puffiness caused by prolapsing fat, and heaviness that can in some cases begin to affect peripheral vision. In the lower eyelid, the most common concerns are under-eye bags, hollowing in the tear trough, loose or crepey skin, and dark circles with a structural rather than pigmentation cause. Blepharoplasty is one of the most frequently performed facial cosmetic procedures worldwide, and when planned and executed precisely, it produces results that look naturally rested rather than surgically altered. Dr De Silva has written extensively on blepharoplasty, including published book chapters on upper, lower and ethnic eyelid surgery used to educate surgeons internationally.

Dr De Silva's approach to blepharoplasty is grounded in three principles: 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 eyelid is anatomy he has studied and operated within at the highest level. He is a Fellow of the Royal College of Ophthalmologists, 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. 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. Every procedure is planned using Golden Ratio facial analysis, ensuring the outcome reflects each patient's individual face rather than a generic aesthetic standard.

Blepharoplasty produces long-lasting results - the changes it addresses are structural, and once the tissue has been repositioned or excess skin removed, those specific changes do not return. Upper eyelid surgery typically lasts ten years or more before any further intervention might be considered. Lower eyelid results are similarly durable, though the ageing process continues in the surrounding tissue over time. The longevity of results is influenced by genetics, sun exposure and skin quality, all of which Dr De Silva discusses at consultation. Protecting the delicate skin around the eyes with SPF sunscreen and UV-protective eyewear, and maintaining good skin health, all contribute to preserving your results over the long term.

Several medical conditions are particularly relevant to blepharoplasty and should always be disclosed at consultation. Dry eye syndrome can be temporarily exacerbated by eyelid surgery, and patients with significant dry eye may require additional assessment and management before proceeding. Thyroid eye disease — specifically Graves' disease, can cause eyelid changes that mimic those requiring blepharoplasty but require a different clinical approach entirely. Patients taking blood-thinning medications, including aspirin, warfarin and certain supplements, will need specific guidance on managing these around the time of surgery. Any previous eye surgery, including laser eye surgery or cataract surgery, should also be disclosed. Dr De Silva's background as a Fellow of the Royal College of Ophthalmologists means he assesses the eye itself - not just the eyelid, as part of every blepharoplasty consultation.

Yes, in patients where excess upper eyelid skin has descended sufficiently to obstruct the visual field, upper blepharoplasty can meaningfully improve sight as well as appearance. This is termed functional blepharoplasty, and it is one of the few cosmetic procedures that can have a direct clinical benefit beyond aesthetics. Dr De Silva assesses visual field impairment at consultation - if the hooding is significant enough to be affecting peripheral vision, this may have implications for the procedure planning and, in some cases, for insurance or medical funding. Even when vision is not clinically affected, the feeling that the eyes are heavy or that it takes effort to hold them open can indicate that the upper lid skin has descended beyond a comfortable level.

Ptosis is a drooping of the upper eyelid caused by weakness or stretching of the levator muscle- the muscle responsible for raising the lid. It looks similar to the heaviness caused by excess skin, but it has a different cause and requires a different surgical correction. Removing skin from a ptotic eyelid without addressing the underlying muscle will not produce the right result, and in some cases can worsen the appearance. Dr De Silva assesses for ptosis at every upper blepharoplasty consultation, as distinguishing between the two conditions is one of the most important diagnostic steps before planning surgery. His background as a Fellow of the Royal College of Ophthalmologists and his specific training in ptosis surgery means this assessment is carried out at a specialist level that not all cosmetic surgeons offer.

Yes, blepharoplasty is one of the most commonly combined procedures in facial cosmetic surgery, and for many patients combining it with other treatments produces the most harmonious and complete result. Facelift and blepharoplasty are frequently performed together, ensuring the eye area and the lower face are refreshed in proportion. Fat transfer to restore volume loss around the eyes, CO₂ laser resurfacing to improve skin texture and fine lines, and brow lift to address a low or heavy brow are all commonly incorporated. Combining procedures means one recovery period rather than two or three, and allows Dr De Silva to assess the whole face at once, ensuring that one area does not look refreshed while another tells a different story. All decisions to combine are based on clinical appropriateness and each patient's specific goals.

Brow position is one of the most important considerations in upper blepharoplasty planning, and it is one that is easily overlooked by surgeons who do not assess the face as a whole. A low or descended brow pushes skin down onto the upper eyelid, creating heaviness that can look like, and is often mistaken for, excess eyelid skin alone. Operating on the eyelid without addressing a genuinely low brow can produce a result that looks incomplete, or in some cases make the brow descent more apparent. Dr De Silva assesses brow position at every upper blepharoplasty consultation. In some patients, a temporal or endoscopic brow lift is the more appropriate primary treatment, either instead of or in combination with upper blepharoplasty. Getting this distinction right is as important as the surgery itself.

Upper blepharoplasty alone typically takes forty-five minutes to one hour. Lower blepharoplasty takes approximately one to one and a half hours. Combined upper and lower surgery takes between one and a half to two and a half hours depending on complexity and whether additional techniques such as fat transfer or laser resurfacing are incorporated. All blepharoplasty procedures at Dr De Silva's Harley Street practice are performed as outpatient surgery- patients go home the same day. Under twilight sedation, most patients are able to leave the clinic within approximately one hour of surgery completing, without the extended recovery period associated with general anaesthesia.

Before surgery, smoking must be stopped well in advance; nicotine significantly impairs wound healing and increases the risk of complications. Blood-thinning medications and supplements including aspirin, ibuprofen, fish oil and vitamin E should be paused as advised at your pre-operative appointment, as these increase the risk of bruising and bleeding. After surgery, cool compresses applied for ten minutes per hour during the first three days significantly reduce swelling. The head should be kept elevated at 45 degrees when sleeping. Sun exposure must be avoided for a minimum of six weeks- the healing skin around the eyes is particularly vulnerable to hyperpigmentation, and SPF sunscreen, a hat and UV-protective sunglasses are essential whenever outdoors. Contact lens wear should be paused until cleared by Dr De Silva at your post-operative appointment.