Blepharoplasty

Blepharoplasty, also known as eyelid surgery or eyebag removal in London, is a surgical procedure of the upper or lower eyelids to rejuvenate the periocular region. Ageing of the periorbital region often creates that undesirable tired look which often makes us look much older. An eyelid lift or blepharoplasty is a cosmetic surgery procedure to address tired, sagging to puffy looking eyes. By removing excess skin, fat or muscle, the procedure provides restoration of the periorbital region. An eyelid lift can be performed on the upper eyelids, the lower eyelids or both upper and lower eyelids. Blepharoplasty can also be combined with facial fat grafting and / or laser resurfacing for even more enhanced results.

Blepharoplasty Expected Results

• Upper and lower eyelid rejuvenation
• Reversal of the “tired” eyes look with removal of lower eyelid bags and saggy and droopy upper eyelids
• Some patients may develop impaired vision as a result of excess loose skin and a blepharoplasty is able to medically correct this

Our surgeons can help revitalise the periorbital region including the eyelids and support tissues, improving the appearance of the upper eyelids, lower eyelids or both. This provides patients with a more youthful, rested and more alert look. Centre for Surgery even offers male blepharoplasty and Asian blepharoplasty.

Eyelid surgery is often performed alongside a brow lift.

If you would prefer a non-surgical option for periorbital tightening – read about SmoothEye with the Fotona laser which we offer.

All our surgeons are on the GMC specialist register.

Our clinic at 106 Crawford Street was recently inspected and rated as good across all 5 domains.

1. Over 15 years experience with all types of blepharoplasty surgery – upper eyelid, lower eyelid and combined procedures
2. We regularly receive patients from overseas at our facial plastic surgery specialist centre
3. Our surgeons are UK trained NHS consultant plastic surgeons who live and work in London. We don’t work with ‘fly-in, fly-out’ surgeons from Italy. This is very important because whilst your surgeon takes all precautions to minimise complications, complications can and do occur and our surgeons are readily available to manage any issues if and when they arise.
4. We own and manage our own surgical facilities. Properly performed eyelid surgery takes time and should not be rushed. Mr Mitsakos performs a maximum of two blepharoplasty procedures in a day. We do not cram 5-6 procedures into one day like other providers. You want your surgeon to be well-rested and mentally and physically sharp to perform eyelid surgery which is a very intensive procedure to get the very best results.

Trust a facial plastic surgeon

A facial plastic surgeon is trained to undertake aesthetic surgical procedures in the facial region. They are dedicated sub-specialists. Compared with general plastic surgeons, facial plastic surgeons are inherently better trained to perform delicate facial procedures. The extra years of surgical training by facial specialists focused on the facial region results in an exceptionally high degree of skill.

Dr Antonios Mitsakos is a fully qualified plastic and cosmetic surgeon. His name appears on the GMC register for plastic surgery (GMC number: 6148715). He completed his plastic surgery training at the world-renowned St Thomas Hospital in London. Dr Mitsakos has performed reconstructive surgery in his NHS roles and his expertise in doing this forms the foundation of his aesthetic practice.

Dr Antonios Mitsakos has extensive experience in performing all aspects of facial rejuvenation surgery including blepharoplasty, browlift, facelift and necklift surgery. Dr Mitsakos regularly combines facial fat grafting with eyelid surgery to volumise and create projection – restoring the natural contours of the youthful face.

Dr Antonios is also a highly regarded teacher and trainer of non-surgical aesthetic techniques to the next generation of doctors. He currently holds highest level 7 accredited trainer status. His friendly, relaxed yet confident manner is frequently remarked upon by many of his former trainees.

Dr Mitsakos specialises in minimally invasive surgical techniques to minimise scarring and is proficient in the FaceTite procedure.  Meticulous preoperative planning is very important to Dr Mitsakos to achieve optimal results and he follows very strict clinical protocols for all his patients.

At consultation, Dr Mitsakos will listen to your specific needs and requirements and where appropriate will tailor a bespoke surgical solution using Crisalix 3D imaging to visualise how you could look after your procedure.

The most common indications for blepharoplasty are:

Loose skin: Laxity of the skin and tissue under the eyes gives an aged appearance, and blepharoplasty is used to smoothen out the fine lines.

Droopy eyelids:  Having excess upper eyelid skin can lead to droopy lids, which give the appearance of tiredness and fatigue. Severely droopy eyelids can even impair vision.

Eye bags:  During the ageing process, people can develop bags underneath the eyes. Excessive stretching of the lower eyelid layers is often the most common reason for the formation of eye bags and is a problem that is efficiently corrected with a blepharoplasty procedure.

Heavy, droopy eyes: Eyelids that have excessive amounts of fat can make you look tired all the time. This fat can be extracted during the surgery, leaving you with a more alert appearance. The key, however, is to extract the right amount of fat to avoid the sunken appearance. Choosing a plastic surgeon at Centre for Surgery means you get specialised expertise delivered within excellent day surgery facilities.

Upper Blepharoplasty

An upper blepharoplasty is also known as upper eyelid surgery. An upper blepharoplasty allows upper eyelid rejuvenation without undergoing significant facial changes as with a facelift. It is normal to have eyelid skin but with the aging process, the reduction of collagen and elastin leads to eyelid laxity and this can make a person look more tired and patients will often remark their work colleagues think they look tired all the time. With women, the application of make-up can become more difficult due to the extra loose skin and applying cosmetics like eyeshadow becomes more difficult to apply. With younger women in their thirties, one of the most common reasons for seeking upper blepharoplasty is the difficulty with applying make-up. Patients often notice their upper eyelid to feel more heavy and patients may actively elevate their brows without thinking to open up their eyes more. Constant activation of the frontalis muscle which is the main elevator of the brow may increase the incidence of horizontal forehead wrinkles. Treating these forehead wrinkles with neurotoxin is not effective until the extra skin of the upper eyelid is removed. Many practitioners will incorrectly treat the frontalis muscle with neurotoxin when the patient actually needs an upper blepharoplasty. This is because the neurotoxin will prevent the brows from being able to be raised and this will amplify the impression of the upper eyelids looking even more saggy and droopy. In these cases, the priority is always to treat the upper eyelids before the horizontal forehead lines.

Lower Blepharoplasty

Patients often seek a lower blepharoplasty to address the presence of under eye bags. Patients both feel as if they look constantly tired as well as being remarked upon by work colleagues. The skin of the lower eyelid is the thinnest skin on the entire face. It is therefore very prone to undergoing premature aging changes with the appearance of wrinkly skin. Patients will often have targeting injections of HA filler to this area and these are referred to as ‘tear trough’ injections. Injection of the tear trough is one of the most challenging areas to treat and sometimes the area is inappropriately treated with HA filler when the more suitable treatment is a lower blepharoplasty. The treatment of dark circles, hollowness of the lower eyelids and loose skin is optimally addressed with a combination of lower blepharoplasty, fat grafting and laser resurfacing. It is important to consult with a specialist facial plastic surgeon to ensure you get optimal outcomes.

Types of Blepharoplasty

Aesthetic Blepharoplasty

An aesthetic blepharoplasty is performed on the upper and lower eyelids. Aesthetic eyelid surgery is indicated for rejuvenation of the upper and lower eyelid region.

Reconstructive Blepharoplasty

A reconstructive blepharoplasty is used when the extra upper eyelid interferes with the patients vision or due to some other medical issue such as excessive tearing, thyroid eye disease, removal of eyelid lumps and bumps or revision blepharoplasty.

Prior to any surgical procedure, you will need to have a consultation with one of our blepharoplasty surgeons.

During the blepharoplasty consultation, you will be able to state your ideas, concerns and expectations about a proposed blepharoplasty procedure and what it can achieve.

The blepharoplasty surgeon will:

• Take a full history and perform a thorough examination
• Explain the procedure of blepharoplasty
• Provide an opinion on your suitability based on your needs and preferences

The specific technique of which blepharoplasty procedure to employ will depend on your underlying condition and the degree of skin laxity.

A blepharoplasty surgeon can be either from a plastic surgery, ENT surgery, maxillofacial surgery or ophthalmology background. All four surgical specialities are fully trained to perform blepharoplasty of the upper and lower eyelids. 

During the aging process, the skin will gradually lose collagen which results in a reduction in skin elasticity. A combination of a loss of skin elasticity combined the effects of gravity will cause the skin to descend and lead to sagging.

With the eyelids, the edges of the upper eyelids will descend first. The small tendon of the eyelid muscle which normally functions to lift the upper eyelid will also undergo stretching. The upper eyelid muscle will therefore struggle to properly lift the upper eyelid.

With continued aging, the loss of elasticity and muscle atrophy act in concert to create the appearance of a droopy upper eyelid. Those who habitually rub their their eyes or have a degree of eyelid retraction will also lead to laxity of the upper eyelids. Ophthalmic surgery such as surgery for cataracts is also a common cause for droopy eyelids. The reason for this lies in the stretching of the eyelid to keep the eye open during surgery leading to muscle atrophy or weakening. Droopy eyelids or eyelid ptosis can also be present from birth where it is then referred to as congenital ptosis.

On top of the development of eyelid laxity, the aging process also affects the entire face. The most noticeable feature of facial aging is often a loss of facial volume. This may make bony structures on the face appear more prominent. When the cheeks begin to descend, the aged appearance of the lower eyelids can be more evident due to the development of hollowness.

Blepharoplasty or eyelid surgery will enhance the periorbital region. It is commonly performed for older people as well as those of Asian origin. During the ageing process, skin elasticity diminishes which often causes drooping eyelids because of the added effect of gravity over the decades. Lower blepharoplasty is used for skin laxity and loose muscle which often needs to be tightened up.

Ideal Candidate for Blepharoplasty

Good Candidates for Upper Blepharoplasty

• Good health
• No history of immunosupression
• Non-smokers
• Excess upper eyelid laxity
• Loss of the normal upper eyelid skin
• Impairment of vision due to excess upper eyelid skin
• Realistic expectations

Good Candidates for Lower Blepharoplasty

• Good health
• No history of immunosupression
• Non-smokers
• Lower eyelid bags
• Eyelid puffiness
• Wrinkly skin of the lower eyelid
• Presence of dark circles
• Realistic expectations

Preparation for Blepharoplasty

At Centre for Surgery, we believe the success of any cosmetic procedure including blepharoplasty can be improved with optimal patient preparation.  Our surgeons strive to go above and beyond to ensure all patients are fully prepared – mentally, physically and emotionally.

Expertly performed eyelid surgery demands millimetre accuracy and precision. Centre for Surgery now offer Crisalix 3D imaging to help you visualise how you could look after your blepharoplasty procedure. We offer Crisalix 3D imaging as standard for all facial surgical procedures.

Centre for Surgery perform both upper blepharoplasty and lower blepharoplasty:

Upper and lower blepharoplasty can be performed together or separately. An upper blepharoplasty can be performed under a local anaesthetic with or without oral sedation. Combined upper and lower eyelid blepharoplasty need to be performed under general anaesthesia for optimal patient comfort

Types of eyelid surgery:

Upper Blepharoplasty overview

Upper blepharoplasty involves the removal of loose skin that can cause multiple wrinkles or hooding on to the eyelash line. A repair of the eyelid muscle must also occur if there is droopiness in this structure. An upper blepharoplasty can be performed under a local anaesthetic but you have a choice on your preferred method of anaesthetic – local or general anaesthetic.

Lower Blepharoplasty overview

Surgery on the lower eyelid is known as a lower blepharoplasty. Lower blepharoplasty surgery is more complex to perform than upper eyelid surgery. A lower blepharoplasty often requires a general anaesthetic. The procedure involves making a small incision either below the lashes (trancutaneous approach) or inside the eyelid (transconjunctival approach). Prolapsed fat in the lower eyelid/cheek area will either be removed or repositioned, in order to improve the eyebag appearance. In some instances, excess skin may also be removed. Sutures and paper strips will then be applied to the eyelid for extra support. 

Eyebag removal can be performed as part of a lower blepharoplasty / combined blepharoplasty. This will help to reduce puffiness without causing an unsightly ‘hollowed-out’ look.

Combined upper and lower blepharoplasty

For patients who present with significant degrees of skin laxity, a combined procedure may be required for a comprehensive periocular rejuvenation.

Male eyelid surgery or male blepharoplasty

Male eyelid surgery is available for men who wish to tighten their eyelids, remove excess fat or to appear more youthful. This is also an appropriate procedure for men whose eyesight is impacted by sagging eyelid skin.

Asian Blepharoplasty

An Asian blepharoplasty differs from traditional blepharoplasty surgery because the eyelid is changed to a double eyelid. Eyelids that do not have a crease can then have a crease. The Asian blepharoplasty is not meant to alter a patients appearance but the changed achieved will often be subtle in nature. Asian blepharoplasty is performed in a very similar manner to an upper eyelid blepharoplasty. The difference lies in the fact that a small strip of eyelid muscle is precisely reconstructed to form a new eyelid crease. The incisions are closed with very fine sutures and the appearance is one without a ‘heavy’ appearance to the eyelid – a more natural looking appearance.

Upper eyelid surgery

Procedure duration: 1 – 1.5 hours

Type of incision: Eyelid crease incision

Anaesthetic: Local anaesthetic or general anaesthetic

Recovery period: Day case and minimal downtime

Lower eyelid surgery

Procedure duration: 1.5 – 2 hours

Type of incision: Transcutaneous (below the eyelashes) or transconjunctival (inside the lower eyelid)

Anaesthetic: General anaesthetic recommended

Recovery period: Longer than an upper blepharoplasty. Depends on the individual.

Combined eyelid surgery (upper and lower eyelids)

Procedure duration: Approximately 3 hours

Type of incision: As above

Anaesthetic: General anaesthetic compulsory

Recovery period: As for a lower blepharoplasty with 2-3 days extra.

As blepharoplasty is a minimally invasive surgical procedure, there is a very short recovery period.

The surgeon uses very fine sutures which are removed about 4-5 days after your procedure.

You may notice some bruising or swelling, which will subside after five days.

We recommend avoiding putting any pressure on the nose for at least five days. You will also have to avoid wearing any glasses for two weeks, as this may impact the filter and change the appearance of the nose.

You will have to avoid sleeping on your side or front; make sure you sleep on your back for at least five days.

Complications can potentially occur with any surgical procedure, blepharoplasty is no different. At consultation, your surgeon will always take time to fully discuss the risks and complications associated with blepharoplasty surgery. All risks need to be outlined regardless of how rare they are. By choosing Centre for Surgery for your blepharoplasty procedure, you can be confident in having highly experienced and expert surgeons to perform your procedure.

Potential complications associated with blepharoplasty

• Anaesthetic risks
• Visual impairment
• Double vision
• Visible surgical scarring
• Eyelid malposition
• Over resection of eyelid skin
• Eyelid sensory changes

There are a number of factors which will determine the overall cost of your blepharoplasty procedure and the final quotation will be given after your face to face consultation with your specialist plastic surgeon.

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Eyelid surgery recovery

6 facts about blepharoplasty

Our aftercare programme was recently described as ‘outstanding’ by our regulator, the Care Quality Commission. 

Our postoperative support team phone all our patients the day after their procedure and then every other day thereafter for the first two weeks. The proactive nature of our postoperative support gives every patient the best opportunity for a smooth postoperative recovery free of complications. In many cases if complications were to occur, their impact is markedly lessened by early detection, prompt clinical assessment and correct treatment. Where a patient expresses concern to our team over the phone, then we often call patients in the same day for assessment with one of our expert nursing team. Even if there is no significant issue, the careful explanation and calm reassurance provided by our team can help to alleviate any worries you may have experienced.