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Lower Blepharoplasty

World Renowned Harley Street London



Dr Julian De Silva #1 Specialist Blepharoplasty Surgeon

Lower eyelid bags, excess skin, dark circles, hollowing under eyes are all common symptoms…


Lower Blepharoplasty

Lower Blepharoplasty Diagram
  • Loose skin, puffiness, bags, Tired Eyes are common symptoms Dr Julian De Silva’s  patients describe. Often friends, family or work colleagues have asked if they are tired, stressed or lacking sleep.
  • Although these changes are usually associated with ageing, some people develop these signs around their eyes from their late teens. The details around the eyes are of great importance, as subtle changes of even less than half a millimetre can be discernible between the right and left sides.
  • Many patients have tried everything possible to improve these without success, creams, lotions and non-surgical fillers. Often Dr De Silva dissolves previous fillers to get the best results. Filler treatment in the lower eyelid is challenging as it the skin is very thin, the results can be unpredictable with fillers absorbing water and becoming puffy. “Some weeks I have dissolved 3 or more patients lower eyelid filler and corrected it with intricate lower blepharoplasty combined with fat transfer, laser, canthopexy, skin pinch. Often we need to do more than just remove puffy fat, this will give a natural result that will last for years and years. I have seen some of my patients return for other procedures even 8-9 years later and still the results look really good” Dr. Julian De Silva.
  • Dr De Silva specializes in  Face Surgery Onlyand Blepharoplasty is the #1 Procedure he completes for his patients. Of key importance is to hidden incisions (termed trans-conjunctival blepharoplasty) in most lower eyelid cases. The surgery, although technically more challenging, avoids a scar on the skin.
  • How is lower blepharoplasty completed? There is intricate anatomy in the lower eyelid that must be looked after to avoid eyelid retraction complication associated with older techniques. The figure shows an incision being made on the inside lining of the eyelid with a specialised instrument (CO2 laser or monopolar electrocautery machine). This technology prevents bleeding instantaneously, thereby reducing swelling and speeding up recovery. The soft tissues are then supported both superiorly and inferiorly to enable the fibrous septum to be seen in the lower eyelid.
  • A fibrous, layer known as the orbital septum is opened, which reveals the orbital fat pockets. The appearance of bags beneath the eyes is a result of the fat pushing forwards. However, there is a controversy between surgeons whether the fat should be removed or repositioned.
  • Known as tissue-sparing, removal of excess fat may result in a hollowed appearance that is unsatisfactory and difficult to remedy. Dr De Silva uses both techniques, depending on the individual patient.
  • Dr De Silva’s preferred technique is a Conservative Blepharoplasty approach to transpose fat immediately below the eyelid at the cheek (termed fat transposition). In patients where there is a large volume of fat prolapsing forward both transposition of some fat and excision of the remaining fat may be the preferred option.
  • Dr De Silva uses state-of-the-art technology, including a US-manufactured CO2 laser or monopolar electrocautery to establish meticulous control of bleeding. This is key to reducing bruising and preserving vision after surgery.
  • Dr De Silva often utilises a supporting stitch during the healing period to improve the final result. In the figure, a canthopexy support stitch has been used to support the lower eyelid to the bony orbital rim. This stitch is completely hidden and dissolves a few weeks after surgery.
  • The older method of lower eyelid surgery involves making an incision immediately below the eyelid. This method always leads to a scar, can change the shape of the eyelid and sometimes results in eyelid retraction.
  • Dr De Silva has pioneered Advanced Sedation Anaesthesia. This means patients can avoid the risks, complications and longer recovery associated with General Anaesthesia. All of Dr De Silva’s patients are able to see after surgery and are able to go home 30-60 minutes after it is completed! No overnight hospital admission is required with Dr De Silva’s techniques.
  • For information on UPPER EYELID BLEPHAROPLASTY ->

Why Choose Dr De Silva in Harley Street, London ?

Dr Julian De Silva is a widely credited and celebrated facial plastic surgeon who specialises ONLY in the FACE. Facial surgery is intricate, your eyes, nose, face and neck areas, and is known for Natural Results and Rast Recovery technology. 

“We are proud to have over 1000 5* reviews. My focus has always been to be the very best at what I do, to continually innovate to provide World Class leadership with my team, my patients and my associates. My mission is to help every patient be the very best version of themself with World-Class services, life-long follow up with complimentary facial aesthetic procedures.” 

Author of the Blepharoplasty Book, The Patient Guide to Blepharoplasty & Eyelid Surgery, to help our patients make the best decisions we gift this book to all our patients.  In a world of increasing complexity and misinformation, his passion has been focused on providing sincere advice, low risk and fast recovery procedures.

As an Artist, all of Dr De Silva’s portrait paintings are vision in the World Class Facility at 23 Harley Street, custom built for Facial Treatments. 

Dr Julian De Silva has Taught Surgery to other surgeons in the USA for over 8 years. “I have always been a passionate teacher and as director of the course I am committed to inspiring the next generation of surgeons.”

As a father and a Family Man he understands how important our appearance, health and well being is for happiness. Dr De Silva is in demand, please be patient if we are unable to offer you an appointment immediately, Dr De Silva is a detailed surgeon, he takes extra time with every patient to understand your needs and expectations, facial treatment is a blend of both precision and artistry, and takes time.

    As Featured in Logos for Harley Street Clinic - Dr Julian De Silva

    Only the Face

    By focusing entirely on only facelift & facial cosmetic surgery procedures, Dr De Silva is able to provide the expertise that can only come with specialisation: facelift and neck lift, blepharoplasty, rhinoplasty and chin implants.

    Natural Looking Results

    Dr De Silva is a believer in the importance of artistry behind cosmetic results and focuses his skills at delivering natural looking results.

    Fast Recovery

    Dr De Silva has pioneered the advances in technology to speed up recovery with a combination regenerative medicine techniques, Oxygen and LED Therapy.

    World Class Expertise

    Dr De Silva also teaches other surgeons internationally and has contributed to the development of advanced surgical techniques, laser technology and stitch-less tissue adhesives.

    World Class Facial Cosmetic and Plastic Surgery

    Blepharoplasty Before & Afters

    Dr De Silva has transformed thousands of faces through his unique surgical techniques. Below is a small sample of some of his transformations.


    What our satisfied clients are saying

    “Having Lower Blepharoplasty with Dr. De Silva gives you the benefit of years of experience, qualifications not only in the U.K. but also the U.S. and yet you don’t lose the gentle bedside manner from this doctor. From our first meeting, Dr. De Silva won me over because he gave me the time to obtain answers and explanations to all my questions in kind details, as many times as I needed.”



    Frequently Asked Questions

    Do I need to go to hospital?

    Blepharoplasty is commonly completed in a general hospital with other surgical procedures. Although this is the norm, it does not lead to an optimal patient experience as the staff are not specialised.

    Dr De Silva has built a custom state of the art facility on Harley Street to enable complete specialisation for every patient. This can avoid issues with hospital-acquired infections, such as MRSA, providing the safest environment for patients.

    Will I look like myself?

    Dr De Silva customises his treatments based on your individual facial characteristics, which will give you a natural appearance. You will still look like you, only better!

    Will people be able to tell?

    Often, patients that have substantial rejuvenation are surprised how friends and family have not been able to tell. You will look less tired and refreshed which many people will put down to you having a good night’s sleep!

    At what age should you get blepharoplasty?

    Older Patients:

    There is no specific age limit for blepharoplasty and Dr De Silva has completed surgery for patients in their late eighties. Key to a successful blepharoplasty is your general health and fitness. We complete a comprehensive assessment of every patient before surgery as safety is always the number one priority.

    Often there may be additional factors to consider with increasing age. These can include dry eyes, eyelid laxity and droopy eyelids (termed ptosis), these may require additional treatments at the same time as blepharoplasty to ensure a successful result.

    Although loose skin, puffiness and lines around the eyelids are commonly associated with facial ageing, there are a smaller proportion of patients who have a genetic predisposition to these changes.

    Younger Patients:

    Lower eyelid bags or puffiness may be present in the late teens and early twenties and can be seen in other family members. The treatment of eye bags in young adults with a negative vector requires specific techniques to avoid lower lid retraction and support the lower eyelid after blepharoplasty, which Dr De Silva has written about extensively.

    Note that lower blepharoplasty is not always necessary if you have very early signs of lower eyelid bags because some patients can be managed with non-surgical techniques.

    Dr De Silva completes lower eyelid blepharoplasty on patients from their late teens to twenties, and some of his patients have travelled long distances as surgeons near their homes have not been able to complete surgery locally.

    Contact Details
    Call: 020 8748 2860
    Email: info@drjuliandesilva.co.uk

    23 Harley Street
    London, W1G 9QN, UK

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    Dr Julian De Silva
    5 stars based on 458 reviews

    5 Star Ratings for Dr Julian De Silva

    Renowned expert in Facelift/Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results

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