Eyelid Surgery (Blepharoplasty) London

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Upper Eyelid Blepharoplasty | Lower Blepharoplasty

What is Blepharoplasty?

Blepharoplasty is a type of cosmetic eyelid surgery, which is also known as eyelid surgery, eye bag surgery or an eyelid lift, is a surgical procedure that improves the appearance of the eyelids. It can rejuvenate puffy, sagging, drooping or tired-looking eyes by tightening muscles and tissue or removing excess fat and skin from the upper and/or lower eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Blepharoplasty is one of the most commonly performed facial cosmetic surgery procedures. The popularity of cosmetic eyelid surgery procedure reflects the importance of the eyes in perfecting overall appearance.

Why Consider Having a Blepharoplasty?

Blepharoplasty (eye bag surgery) tightens the eyelid’s muscles and tissue, and removes excess fat and skin. Upper Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision and making daily activities such as driving easier. It is also performed for strictly cosmetic reasons. The thin eyelid skin is prone to aging faster, accelerated by heredity factors, skin type, sun damage, smoking and diet. Blepharoplasty may become necessary when these factors cause the muscles and tissue that support the eyelids to weaken allowing the eyelid fat to herniate forwards. These changes can create a heavy feeling over the eyes, make you look tired and older. Blepharoplasty can restore a more energetic and youthful appearance.

If the appearance of the eyes causes a patient to be unhappy, the patient may want to consider lower eyelid blepharoplasty to improve their look and boost their confidence. A lower eyelid blepharoplasty is used to treat under-eye bags, drooping lower eyelids, excess skin, fine wrinkles and circles under the eye. A lower eyelid blepharoplasty can be performed on adult men and women alike and offers a younger, more refreshed look with more defined eyes that reflects across the whole face.

A blepharoplasty is ideal for correcting


  • Loose, sagging and/or folded upper eyelids that may interfere with vision
  • Puffy fat deposits in the upper or lower eyelids
  • Under-eye bags
  • Sagging lower eyelids that may show the whites of the eyes below the irises
  • Excess skin in the upper or lower eyelids
  • Fine wrinkles in the lower eyelids

A blepharoplasty cannot raise the eyebrows, or treat deep wrinkles, dark circles under the eyes, or crow’s feet.


Functional Blepharoplasty

If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. The surgeon can assess the patients’ peripheral visual field using an instrument called the Humphrey Visual Field (HVF) Analyser.

Cosmetic Blepharoplasty


Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person’s looking younger and more refreshed. Brining old photographs with you can be helpful in planning your surgery.


It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face.


Complementary Surgeries

Though blepharoplasty is often performed as a single procedure, your surgeon may also recommend a brow lift, droopy eyelid lift (ptosis surgery), fillers to correct lower eyelid hollowing or skin resurfacing to achieve the best results. Botox® will help maintain your improvements. You can discuss these with your surgeon.

This information will give you a basic understanding of blepharoplasty surgery but will not be able to answer all of your questions, as every one’s clinical case is different. You can ask your surgeon any further questions you may have.



Who is a Good Candidate for Blepharoplasty?

The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. It is important to be psychologically stable and have realistic expectations of the surgical outcome. If a patient has loose, sagging skin or puffy bags beneath their eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh.

A few medical conditions make blepharoplasty surgery more risky or the outcome unpredictable. They include thyroid problems such as hypothyroidism and Graves’ disease, when there can be increased post-operative swelling and inflammation; Dry eye or lack of sufficient tears, which can result in uncomfortable eyes; High blood pressure or other circulatory disorders, cardiovascular disease, which can complicate surgery and the administration of anaesthesia; diabetes which can increase the risk of post-operative infection and slow down healing and the use of blood thinners like aspirin and warfarin which can increase bleeding and bruising and compromise the outcome of surgery.

It is important for patients to have realistic expectations before undergoing an eyelid blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance their appearance and may improve self-confidence as a result, it cannot alter a patient’s entire appearance or change the structure of their face.



How is a Blepharoplasty Performed?

Blepharoplasty is typically performed as an outpatient procedure requiring local anaesthesia and sedation. General anaesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 3 hours, depending on whether both the upper and lower eyelids are operated on.



Upper Eyelid Blepharoplasty Procedure

If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed.

After the procedure, the incisions are closed with sutures, or tissue glue. Eye pads may be applied for several hours to minimize swelling.



Lower Eyelid Blepharoplasty Procedure

The method or procedure to be used in lower eyelid blepharoplasty will be determined by the amount of fat that needs to be removed, the location of the fat and how tight to make the eyelid.

There are several different surgical approaches that can be used in a lower eyelid blepharoplasty. They are as follows:

Transconjunctival Lower Lid Blepharoplasty:

Often chosen when no skin needs to be removed, a transconjunctival lower lid blepharoplasty creates an incision on the inside of the lower eyelid, leaving no visible scar or other evidence of the surgery.

Transcutaneous Lower Lid Blepharoplasty:

A transcutaneous lower lid blepharoplasty is performed with a subciliary incision, also known as a pinch technique, to remove protruding fat and excess skin.

A Transconjunctival Arcus Marginalis Release

A transconjunctival arcus marginalis release moves the fat within the lid to maintain some volume in the soft tissue. It prevents the ridge of orbital bone from becoming too prominent, which causes the eyes to look hollow and the face to appear older.

After the lower eyelid blepharoplasty procedure is performed, the incisions are closed with fine sutures. Eye pads may be applied for several hours to minimize swelling.



Planning Your Blepharoplasty Surgery

At the initial consultation with your surgeon it is important to give a complete medical history including any allergies, so be ready to provide this information and bring with you any medical records and a list of prescription or over-the-counter medications and vitamins. Bring with you a record of your most recent eye exam by an ophthalmologist or optician and any glasses or contact lenses you regularly wear. You vision will be tested and your tear production assessed.

You and your surgeon should carefully discuss your goals and expectations for this surgery. Your surgeon will explain the techniques of surgery, whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat should be removed, and whether any additional procedures are appropriate. The type of anaesthesia used will be discussed with you and the risks involved. Surgery is performed under local anaesthesia with sedation or general anaesthesia as a day case or outpatient basis -rarely does it require an inpatient stay. You will need to arrange an escort home and you should not be alone at home on the first night after surgery.

Don’t hesitate to ask your surgeon any questions you may have, especially those regarding your expectations and concerns about the results.



Preparing For Your Surgery

Specific instructions will be given to you on how to prepare for surgery, including guidelines on fasting, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.



Recovery After Blepharoplasty

After a blepharoplasty procedure, the surgeon may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as swelling, bruising, irritation and dry eyes. Bruising varies from person to person; it reaches its peak during the first week, and generally lasts anywhere from 2-6 weeks. Most swelling and other side effects usually subside within 2 weeks after surgery.

For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring. The skin may be itchy which is a sign of healing. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Your surgeon will give specific instructions on how to care for the eyes post-procedure. It is preferable to avoid alcohol as it can cause fluid retention and can worsen eyelid swelling.

Typically patients can return to work within a few days to a week, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed after 7-10 days after the procedure. Contact lenses and eyelid make-up may not be worn for 2 weeks after surgery.



What are the Side Effects, Risks & Complications of Blepharoplasty?

Complications of blepharoplasty are infrequent and usually minor when the surgery is performed by a qualified plastic surgeon. However, as with any surgical procedure, there are certain risks associated with a blepharoplasty procedure. A common side effect is swelling and some bruising around the surgical site, however these will subside on their own, and the eyelids will improve in appearance over the first few weeks, although the healing process can continue for up to a year. Eyes may be irritated and dry due to a temporary change in tear distribution. Uncommon side effects and risks include infection, post-operative bleeding, reaction to anaesthesia, skin discoloration, an inability to fully close the eyes and double or blurred vision and very rarely loss of vision. Risks and side effects such as uneven healing, malposition of the eyelid and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.



What are the Long Term Results of a Blepharoplasty Procedure

The results of eyelid blepharoplasty procedures are visible as swelling and bruising subside and will continue to improve for up to a year after surgery. The blepharoplasty procedure is designed to produce long-lasting results. Healing is a gradual process, and the scars may remain slightly pink for a few months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line. On the other hand, the positive results of eyelid surgery, the more alert and youthful look will last for years. While surgery cannot prevent the eyes from the continued aging process, for many people, these results are permanent. The majority of people are very satisfied with the outcome of their surgery.




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My NHS practice is based at the world-renowned Moorfields Eye Hospital in London. I consult private patients at Moorfields Private Eye Hospital, Optegra London Eye Hospital and The Harley Street Clinic.