Upper Blepharoplasty (Eyelid Surgery) in Harley Street, London

In the majority of people, there is a degree of bulging and fullness of the upper eyelids, this is a consequence of orbital fat pushing forwards through the eyelid.


Upper Blepharoplasty

Upper Blepharoplasty Diagram
      • In the majority of people, there is a degree of bulging and fullness of the upper eyelids, this is a consequence of orbital fat pushing forwards through the eyelid.
      • The eye sits in a cushion of orbital fat that line the bony orbital socket, this is important in insulating the eyelid for example with exercise to prevent the delicate eyeball coming into contact with the surrounding orbital bone.
      • With time, thinning of the soft tissues often results in a bulging of the orbital fat forwards creating a bulge on the surface of the upper and lower eyelids.
      • Although this may happen in a young adult as a consequence of genetics, it is usually attributed to a combination of factors including ageing, environmental factors, such as smoking or some medical conditions such, as thyroid eye disease.
      • If orbital fat is seen bulging, a structurally fibrous layer known as the orbital septum is opened. The fat is generally removed or shaped, although in some cases the fat is repositioned without excision.
      • Dr De Silva favours conservative removal and repositioning of fat as over-removal of fat can result in a “hollowed-out” appearance to the eyelid that is unappealing.
      • Although it is always possible to remove more soft tissue, including fat, it is far more challenging to correct if too much fat has been removed.
      • Thirty percent of the patients Dr De Silva treats have had previous eyelid surgery elsewhere and are unsatisfied with the results.
      • As the eyelids are an intricate part of the face where millimetres make a considerable difference, the expertise of a surgeon who is specialised in this surgery is always advised.
      • Rarely, there can be asymmetry in this area that can be improved with specialised techniques, including fat transposition and fat transfer.
      • Dr De Silva uses specialised state-of-the-art technology, including a US-manufactured CO2 laser or monopolar electrocautery, to establish meticulous control of bleeding which is key to preventing both bruising and preserving good vision after surgery.
      • The skin incision is closed using a combination of interrupted and continuous non-dissolving fine stitches. Non-dissolving stitches are preferred as they avoid scarring and stitch lines. On occasion, non-dissolving stitches are used which naturally fall out and do not need removal.
      • Dr De Silva also pioneered the use of regenerative medicine with blepharoplasty. This surgical innovation is preferred by his patients, as it enables natural growth factors to aid healing, improve the speed of recovery and reduce bruising.
      • All of Dr De Silva’s patients are able to see after surgery and are able to go home thirty minutes after it is completed. No overnight hospital admission is required with Dr De Silva’s techniques.

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

    Facelift & Facial Only Treatments

    By focusing entirely on only 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.

    Drooping of the upper eyelid, “Ptosis”

    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.

    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