Upper Blepharoplasty Surgery in Harley Street, London

• Who can benefit from blepharoplasty? Tired appearance, loose eyelid skin, puffy eyes, skin laxity, bags under eyes, dark circles, asymmetry  tired eyes appearance, smudging concealer, being mistake for being tired, lack of sleep… are all common symptoms that Dr Julian De Silva’s patients describe.
• Dr Julian De Silva developed customised blepharoplasty techniques based on conservative reshaping and repositioning that restores anatomy to where it used to be, this results in a Natural Blepharoplasty. Avoid an ‘operated appearance’ or ‘hollowed-out’ appearance to the eyelid that is unappealing. Key to excellent surgery is a less is more approach. 
• Intricate anatomy of the Eyelids ensures blepharoplasty is a detailed procedure of millimetre precision and artistry: Important to assess position of brows, asymmetry of eyelid, hollowing of eyelids, skin quality, appearance of swelling (malar bags), previous filler use, tear quality and dry eyes to mention a few. The scars should be hidden and with good surgery no one will be able to tell you have undergone a procedure. Dr Julian De Silva specialises in Natural Blepharoplasty. “People or celebrities who look like they have had a lot of work done, often their eyes have been changed by blepharoplasty, less is more to  keep a natural result.” Dr Julian De Silva.
• Young People may have Eye Bags as a consequence of genetics, often other family members can also have eyelid changes. Of key importance is anatomy, often there is ‘negative vector’ which results in eye bags at young age, Dr De Silva previously wrote a book chapter on this subject and avoid complications such as eyelid retraction. In these patients the incision should be ‘trans-conjunctival’ (inside of the eyelid) with fat transfer to preserve the natural shape of your eyelid and mid-face.

Of key importance when considering eyelid surgery is a thorough evaluation of the eyelids to exclude subtle signs of a droopy upper eyelid, termed ptosis in medical jargon. The signs of drooping may be subtle.

However, recognition is of key importance to ensure a good natural result after eyelid surgery. Oculo-facial plastic surgeons are specialists in this area of facial surgery. Drooping of the upper eyelid is a relatively common eyelid condition that usually occurs with ageing of the facial tissues

“People have an exquisite ability to recognise less than one-millimetre asymmetry between the eyelid heights, and half a millimetre or more drooping of one eyelid can be noticeable,” says De Silva. “Meticulous detail is important”.

There is a small muscle behind the upper eyelid that opens the eyelid (the levator aponeurosis) and with facial ageing, or as a consequence of genetics (inherited from your parents), the muscle can slip or it may be weak, resulting in a droopy eyelid.

Ptosis can be quite obvious and increase over a period of years. In addition, ptosis can also be subtle and vary throughout different times of the day.

Ptosis repair can be repaired in two main ways:

• Traditional skin incision technique (termed Trans-Cutaneous Approach). The most common method for repairing a droopy eyelid is by making an incision in the crease of the upper eyelid skin, reattaching the muscle and closing the skin with stitches.
• This method is used in the majority of NHS Hospitals as the treatment of choice. It is notoriously unpredictable, with a need for further revision surgery in 10-30% of patients.
• Hidden incision (internal approach) is performed from the undersurface of the eyelid, leaving no visible scars. The levator muscle is reattached further down the eyelid in order to allow a wider opening of the upper eyelid. Fewer surgeons are able to perform this surgical technique, but it has a far higher success rate, with a need for further surgery in only 3-10% of patients.
• Ptosis could also be caused by a nerve problem or from birth and can require further investigations. In rare circumstances, if the muscle is too weak a sling procedure is required to connects the forehead muscle to the eyelid muscle which helps elevate the upper eyelid.