Eyelid Surgery
Upper Blepharoplasty:
- This procedure involves the precise removal of excess skin through an incision carefully placed in the natural tarsal crease, ensuring it is discreet once healed. In addition to skin excision, subtle refinement of the upper eyelid fat pads may be performed to prevent a hollowed appearance and maintain natural volume. Mr Orfaniotis does not perform any muscle resection during upper blepharoplasty, as this can lead to long-term functional issues. Occasionally, excess fat in the upper eyelid needs to be addressed. Mr Orfaniotis’ technique involves carefully preserving and repositioning this fat re-draping it across the upper lid to restore smooth, youthful contours and avoid the sharp, sunken features that result from over-resection.
- When treating upper eyelid heaviness or fullness, a thorough assessment of the brow–eyelid complex is essential to determine whether the brow position is contributing to the issue. Brow descent often presents as lateral hooding and, in these cases, can be effectively addressed by re-draping the outer brow toward the temple through a lateral or full brow lift. You can read more about this on our Brow Lift page.
- In some patients, what appears to be excess upper eyelid skin may instead be due to a weakness in the levator muscle, the muscle responsible for lifting the eyelid. This condition, known as levator ptosis, can cause partial obstruction of the pupil and requires a different surgical approach ptosis correction rather than a standard blepharoplasty. Accurate diagnosis during your in-person consultation is vital, as performing a traditional eyelid lift alone would not adequately correct the problem in such cases.
Upper Blepharoplasty:
- Some patients experience significant volume loss in the upper orbit, which creates a hollow appearance in the middle portion of the upper eyelid, a condition often referred to as an “A-frame deformity.” In such cases, the issue is rarely due to excess skin. Instead, the most effective correction involves restoring volume to the upper orbit through a precise fat grafting procedure. Learn more on our Fat Grafting page here.
Lower Blepharoplasty:
- Lower eyelid surgery targets puffiness, shadowing, and loose skin beneath the eyes common signs of ageing that contribute to a tired appearance. In most patients, these issues are caused by herniation of the orbital fat pads through the weaking of a structure called the orbital septum. This leads to bulging under the eyes, often followed by a hollow or indented area over the bony rim, known as a tear trough deformity. The goal of modern lower blepharoplasty is not to remove the bulging fat, but to mobilise and reposition it, smoothing the lid-cheek junction and correcting the tear trough simultaneously. This preserves volume and creates a natural, refreshed look avoiding the hollowed or “over-operated” appearance that can result from aggressive fat removal.
- Mr Orfaniotis takes a bespoke approach to each case, tailoring the technique to suit the patient’s anatomy and the quality of their skin and support structures. In most cases, he uses a transconjunctival approach, accessing and reshaping the fat pads through an incision placed inside the lower eyelid, leaving no external scar. When skin laxity or fine wrinkling is also present, a gentle skin pinch excision may be added via a fine incision just beneath the eyelashes (subciliary). In selected cases, a procedure called canthopexy which tightens the outer corner of the eye may be performed to address scleral show and enhance lower lid support.
- Mr Orfaniotis does not routinely resect muscle during lower blepharoplasty, as preserving the orbicularis muscle helps maintain eyelid tone and reduces the risk of complications such as ectropion. His background in reconstructive surgery ensures a careful balance between natural aesthetics and long-term eyelid function.
- An accurate history and examination are essential before surgery particularly regarding previous filler treatment in the under-eye area. Filler can disrupt lymphatic drainage and trigger chronic inflammation, affecting both healing and final results. This may present as persistent puffiness or a bluish hue under the eye, known as the Tyndall effect. To ensure the best outcome, Mr Orfaniotis may refer patients to a specialist practitioner for high-definition ultrasound imaging and pre-operative filler dissolving where appropriate.
- Some patients also present with malar swelling in the region of the cheekbones. This can be due to either festoons or malar mounds, which are distinct but often confused.
○Festoons are caused by excess skin and soft tissue and appear as dry, lax folds over the malar area. While their exact cause can be multifactorial (often related to ageing and laxity), they can be improved through direct surgical excision though they are complex.
○Malar mounds, in contrast, are fluid-filled pockets between the skin and underlying muscle. Their causes may include lymphatic congestion, allergies, or genetic predisposition. Surgery is not usually the first-line treatment for malar mounds; instead, they are best assessed and managed with input from a specialist oculoplastic surgeon.
- In some patients, under-eye hollowness may be better addressed with fat grafting, either as an alternative to surgery or in combination. See the Fat Grafting page for more information.
Recovery After Upper Blepharoplasty
- Swelling and Bruising: It’s normal to experience mild swelling and bruising around the eyes, which usually subsides within 1-2 weeks. Applying cold compresses can help reduce swelling.
- Pain Management: Discomfort is usually mild, and over-the-counter painkillers can be sufficient to manage it. Most patients do not require stronger medications.
- Activity Restrictions: Avoid strenuous activities, bending over, or heavy lifting for at least 2 weeks to reduce the risk of complications.
- Wound Care: Gentle cleaning and applying antibiotic ointment to the incision will be recommended to prevent infection and promote healing.
- Suture Removal: They will be removed after 7 days.
Blepharoplasty Surgery Facts
Anaesthesia
Upper Blepharoplasty : Local anaesthesia with sedation. When combined with Brow lift twilight or a short anaesthetic is advised.
Lower Blepharoplasty: General Anaesthetic.
Length of Stay
Day case
Surgery Duration
Upper Blepharoplasty: 60 minutes
Lower Blepharoplasty: 90 minutes.
Aftercare
We offer a comprehensive recovery support package designed to ensure a smooth recovery. Read more about our first-class recovery support package here.
Post-Op Appointments to plan for.
- Removal of sutures at one week.
- 6 week and 6 month appointment with Mr Orfaniotis.
Risks and Complications Upper Blepharoplasty
- Scarring: While scars are well-concealed in the natural eyelid folds, some patients may experience noticeable scars.
- Dry Eyes or Irritation: Temporary dry eyes or sensitivity to light may occur after surgery, but these symptoms typically resolve within a few weeks.
- Infection or Bleeding: These complications are rare but can occur, which is why post-operative care and follow-up appointments are essential.
- Asymmetry: Although the procedure is designed to create balanced results, there is a small chance of slight asymmetry.
Risks and Complications Lower Blepharoplasty
- Scarring: In a standard lower blepharoplasty, scars are well-concealed inside the eyelid. However, patients requiring additional techniques such as a skin pinch or festoon removal may have external scars, which can be more visible.
- Chemosis: Swelling of the conjunctiva can occur, leading to a gluey or irritated sensation. This usually resolves within two weeks, though in rare cases it may persist longer. Treatment typically involves a short course of antibiotic and steroid eye drops.
- Prolonged Swelling: More likely in patients with a history of filler in the under-eye area or those with pre-existing malar mounds.
- Prolonged Bruising: In some cases, bruising may lead to post-inflammatory hyperpigmentation, particularly in darker skin types.
- Contour Irregularities: Following fat transposition, minor contour irregularities can occur due to partial loss of blood supply to the fat. In fat grafting cases, palpable or visible lumps may develop. These usually resolve with conservative measures, though in rare instances minor revision surgery may be needed.
- Dry Eyes or Irritation: Temporary dryness, light sensitivity, or a gritty sensation may occur in the early healing phase. These symptoms typically resolve within a few weeks.
- Infection or Bleeding: Although uncommon, these risks exist with any surgery and are minimised through careful technique and close post-operative follow-up.
- Asymmetry: While the goal is to achieve symmetry, minor differences between the two sides may remain, particularly in cases of pre-existing asymmetry.
- Eyelid Malposition: Rarely, lower eyelid malposition (e.g., ectropion or retraction) can occur. Mr Orfaniotis’ technique is specifically designed to preserve eyelid support and minimise this risk.
- Double Vision: This is usually temporary in the initial phases of recovery caused by the pressure effect of the swelling of the ocular muscle called the inferior oblique muscle. This usually resolved when the swelling subsides and the muscle regains full activity.
