Revision Blepharoplasty in Harley Street, London

Dr De Silva sees and treats many revision blepharoplasty patients who have had surgery elsewhere. The treatment of lower eyelid retraction is challenging and dependent on careful evaluation and identification of the cause.


Revision Blepharoplasty

Revision Blepharoplasty in London

The eyelids are a complex part of the face with a unique anatomy and function—millimetres are the difference between success and failure during blepharoplasty procedures.

The upper eyelid has an important function protecting the eye and in the prevention of dry eyes. The removal of too much soft tissue and skin is problematic if not performed correctly.

Complications of excessive soft tissue removal are best avoided by seeing a specialist eyelid surgeon with Oculo-Facial Plastic Surgery or Facial Plastic Surgery expertise.
Approximately thirty percent of Dr De Silva’s blepharoplasty surgeries are revisions surgeries.

Corrective surgery is complex and often requires specialist techniques to ensure preserving natural anatomy. Often additional measures are required to help with recovery.

How do you approach revision upper eyelid surgery?

Previous eyelid surgery results in scarring and changes in the underlying anatomy. Although scars can be modified and enhanced previous surgery cannot be reversed.

Dr De Silva uses a spectrum of specialised techniques to restore the position and function of the eyelids, including a variety of graft tissues (including tissue taken from the roof of the mouth, termed hard palate and spacer materials), eyelid tendon suturing, HD visualisation and bony orbital support to ensure a long-term result.

Each revision eyelid surgery is unique and requires customised treatment with respect to the position, shape, scarring and function of the eyelid.

Dr De Silva uses specialised anti-inflammatory medications to reduced scarring—a technique he has pioneered in the UK.

Dr De Silva is able to achieve excellent results in revision blepharoplasty, and will operate on cases where he feels he can achieve a success that is within the patient’s expectations. If he cannot achieve this he may advise against further surgery.

Why Choose Dr De Silva in Harley Street, London ?

Dr De Silva is a widely credited and celebrated facial plastic surgeon who specialises in the eyes, nose, face and neck areas only, and is known for natural results.

“My focus has and always will be to be the very best at what I do, to continually innovate to provide World Class leadership to all my team, all my patients and all 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.”

In a world of increasing complexity and misinformation, his passion has been focused on providing sincere advice, low risk and fast recovery procedures.

    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.

    Revision Blepharoplasty Surgery Overview

    Will I be happy after revision eyelid surgery?

    Dr De Silva only provides patients with honest information about the likely results from revision surgery. In a minority of patients, he advises against surgery altogether.

    Although most patients’ symptoms are improved significantly, it is important to have a discussion regarding realistic expectations, as previous scarring can only be improved upon, not reversed. A small proportion of patients may require two procedures.

    What is the worst complication?

    A thorough examination excludes most serious issues (eyelid tendon laxity, skin shortage, functional dryness). The key aspects are that recovery often takes longer, with the final result as long as 12-18months after surgery.

    In addition, it is imperative to have a discussion about the realistic expectations for improvement after eyelid revision surgery.

    Revision Lower Blepharoplasty

    Revision lower eyelid surgery is carried out to correct previous lower blepharoplasty surgery.

    The anatomy and soft tissues of the lower eyelid are highly intricate, and once surgery has been completed there is a degree of scarring and change in anatomy that is unique to each individual patient.

    The level of scarring is dependent upon multiple factors, including the previous surgery, the surgeon, the ethnicity of the patient, their individual genetic makeup and their body’s ability to heal.

    The treatment of patients who have undergone previous lower blepharoplasty is challenging, and is dependent upon the degree of change required and the patient’s expectations from surgery. Although for most patients a substantial improvement can be made, the key to success is achieving the patient’s expectations.

    In the lower eyelid, removal of too much soft tissue results in the increased appearance of the white sclera and the lower eyelid hanging below the coloured iris.

    Revision lower eyelid surgery (lower eyelid retraction)

    • There are a variety of causes for lower eyelid retraction including trauma, eyelid tumours and the commonest—internal scarring after a lower eyelid blepharoplasty.
      Lower eyelid retraction is often the result of a combination of factors, including the removal of too much skin tissue during lower blepharoplasty surgery, scarring and the lower lid being pulled downwards
    • The lower eyelid has intricate anatomy with three fine anatomical planes in the eyelid. Damage to any of these structures may lead to scarring and lower lid retraction. The results can be devastating to the patient as scarring changes the shape of the eye resulting in a compromised cosmetic result, tearing and discomfort.
    • Dr De Silva’s preferred technique for lower eyelid surgery involves a hidden incision on the inside lining of the eyelid. This technique preserves the natural anatomy of the eyelid and hides scarring.
    • The more traditional method that is used by surgeons practicing older surgical techniques is termed trans-cutaneous blepharoplasty. In patients with a specific anatomy, termed negative vector, it is of absolute importance not to use these techniques to ensure a risk-free result.
    • Dr De Silva’s preferred technique for lower eyelid surgery involves a hidden incision on the inside lining of the eyelid. This technique preserves the natural anatomy of the eyelid and hides scarring.

    Case Study

    A 59-year-old Asian patient who works as a nurse in a London Hospital had two previous eyelid procedures in UK hospitals with plastic surgeons.

    She felt that she had continued to look tired as there was hooding of the upper eyelids, with swelling of fat at the inner aspect of the eyelids. In the lower eyelids she had fat bags despite the previous surgery.

    She came to see Dr Julian De Silva in his London practice, for revision eyelid blepharoplasty.

    On examination, there was asymmetry with double skin creases on the upper eyelids, asymmetrical scars in the lower eyelids and fat prolapsing in the lower eyelids, as well as noticeable scarring.

    Dr De Silva evaluated her changes and discussed with her what aspects of her eyelids could be improved. With clear expectations from the surgery, she had revision upper and lower eyelid surgery under sedation anaesthesia.

    After surgery there was an improved appearance to her upper and lower eyelids. Dr De Silva hid the previous scars in natural creases in the upper eyelid and used hidden incision techniques in the lower eyelid (termed transconjunctival blepharoplasty).

    The patient was very happy with the results and has subsequently returned to her home country.

    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

    23 Harley Street
    London, W1G 9QN, UK

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    Dr Julian De Silva
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    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