Natural blepharoplasty in both gentle repose and dynamic smile is one of the most challenging and satisfying aesthetic surgery aims. I have relentlessly studied the many hundreds of eyelid procedures that I have done for my patients; for comfort, function, restoration, and appearance.
Lower blepharoplasty (lower eyelid lift) surgery is a complex procedure in both analytics and surgical technique, nonetheless it brings great reward in both comfortable function and confidence in appearance.
Eyelid surgery for the upper and lower eyelids is perhaps the most sought-after set of procedures requested from Jonathan, based on the detail of his analysis and the expertise of his surgery, which has been honed in years of oculoplastic surgery for reconstruction (in adults and children) and the restoration of appearance and function.
As with upper blepharoplasty, lower lid blepharoplasty comprises a ‘family’ of related surgical procedures, the aim of which is to create a natural balance between the eye itself, the lower eyelid margin position, and the balance of shape of the lower eyelid to the cheek
Lower eyelid aesthetic balance is all about the uniform reflection of light from the lower lid to the cheek, and the vertical height of the lower eyelid. A short vertical lower lid height brings a youthful appearance. The uniform reflection of light from the eyelid and cheek in harmony banishes shadow and the effects of premature ageing and fatigue.
‘Eyebags’ are a wide description! Many patients will present with shadow in the lower eyelids which they describe as eyebags. The shadows are usually semicircle, and the dominant shadow separates the lower eyelid from the cheek. Other shadows may also characterise the eyelids/cheek junction, resulting from different types of ‘eyebags’, including heavy festoons in the lower eyelids or the cheek. Not all lower lid ‘eyebags’ are the same. Some come from excess skin, others from saggy muscle, and yet others from herniating fat below the eyeball into the eyelid. The principles are timeless, but the indications, aims, alternative procedures, and expectations of outcome are bespoke.
The key to beautiful surgical outcomes is the preparation in the clinic and in consultation. Jonathan will point out, at the mirror and iPad screen how the shadows are formed by the different anatomical layers of the eyelid, and what surgical techniques are required to address them: to banish shadow and restore the reflection of light. Jonathan’s knowledge of the layered anatomy of the lower eyelids and cheek, and the effects of aging or illness upon these layers informs his surgical precision. Each layer of the eyelid and if necessary the cheek can be elevated and rebalanced. The scars are hidden in the crease below the eyelash line and into the crow’s feet wrinkles. The orientation of the smile lines of the natural smiling face are retained in the results to maintain naturalness and hide the fact that surgery has taken place.
Working with you, your photographs from throughout the years, and observing your natural face in conversation, animation, and in different light, he will restore and rejuvenate for you in a bespoke manner. Jonathan will combine his master craftsmanship of surgery with the artistic principles of light and shadow, definition and shape, to deliver comfortable eyelid function with natural beautiful and youthful appearance.
Some lower eyelid blepharoplasty is “functional” to support, elevate, and tighten the lower eyelid margin to better support the tear film, and to hydrate the surface of the eye.
Perhaps more commonly, lower eyelid blepharoplasty is requested to improve confidence in appearance. It is very common for blepharoplasty, requested for appearance change, nonetheless to deliver an unexpected improvement in comfort….
At the Jonathan Britto clinic the natural bespoke restoration of facial features underlines everything we do. Scars that are well placed, and as controlled in quality as possible. Function that is retained and comfort that is restored. Meticulous analysis, meticulous technique, and meticulous care, but all delivered with a warm smile and a personal welcome.
Canthopexy (lower lid tightening) can be incorporated with blepharoplasty to improve eyelid shape, tone and functional outcomes. Extended lower blepharoplasty techniques incorporate the upper cheek (malar area) to provide an aesthetic lid/cheek balance and lower eyelid support. These options are discussed and compared to provide a bespoke surgical plan on an individual basis.
Time in planning, time in preparation, and time to develop the relationship between patient and surgeon, and with the members of the team, to deliver best care and confident results. Blepharoplasty delivered at the age of 40 is not the same, and does not have the same aims, as blepharoplasty delivered at the age of 75.
We will undertake a comprehensive ‘analysis phase’ based on two or three pre-surgical consultations (as many as required), looking at the structure of the face and eyelids together – today and in comparison to photographs from the past (if available). We will study your skin, offering advice on affordable daily skin health prescribed products that work. Our aesthetician, Karen, will be on hand to mentor and advise your skincare for the best of skin health from season to season. This approach is particularly valuable for the “dark circles” which are a common feature of southern Mediterranean, African, and Asian skin types.
Prepare and repair! Our Lifestyle Medicine physician and consultant anaesthetist, Shyamala, will advise you on how best to prepare for your surgery, and the simple strategies you can incorporate into daily life to facilitate healing in the repair phase of recovery.
Many patients seek to pre-empt the signs of aging that they see in the senior members of their family (“I can see it in my Mum”), others seek a confidence boost after a midlife challenge or change of circumstance. They hear comments about “looking tired”, “are you unhappy?” that do not reflect their inner confidence and vitality. All our patients have their story to tell – and they come to Jonathan for the appearance they wish to tell that story.
The range of surgical and non-surgical techniques that are currently available offer a perplexing minefield of choices. The lower eyelid carries great risk for non-surgical injectable procedures. Jonathan and his team will guide you through the options with clarity. What is your desired outcome? What recovery time is available to you? How do you approach matters of cost, and how do you perceive matters of risk? There are many horror stories about both surgical outcomes and non-surgical therapies. Which are true? What is the balance of risk, reward, recovery time and cost? All these questions will be answered by Jonathan with clarity, in plain and simple language, and backed up with a written report.
Many patients are referred to Jonathan from across the country and internationally and by referral from colleagues who seek restoration from a poor surgical outcome elsewhere. These patients come to the clinic in a state of distress, and regret, and some feel aggrieved because of the costs they have faced. They feel torn between the feeling they cannot continue as they stand, but they are fearful of further surgery and further cost. We are very much aware of the psychological aspects of expectation unmet. Jonathan has worked with psychology teams who are expert in facial appearance from the beginning of his career, and he has built an expert psychology team which is available to all our patients. We never rush our patients, our philosophies and plans are explained in simple language, and we measure our outcomes and are happy to share them.
Combination approaches are often considered and requested by patients who have learned of Jonathan’s comprehensive skills. Blepharoplasty techniques come from a ‘family’ of related procedures, many of which Jonathan has had a major hand in developing and presenting to colleagues. Jonathan will often combine blepharoplasty with specialized face and neck-lifting techniques or browlift. The aim is to create naturally balanced face, at rest and in emotional expression, where each “aesthetic unit” of the face moves seamlessly with its neighbour.
Jonathan’s team has been at the forefront of developing the “twilight technique” of facial surgery, where patients are kept comfortable and pain-free as can be – throughout the surgery, but without being completely asleep. This allows for a relaxed patient with the ability to open and close the eyes, or smile, with dynamic facial movement during the surgery for bespoke surgical technique. The ‘twilight technique’ also allows rapid recovery, minimal bruising and swelling, and no post-anaesthetic downtime.
– Jonathan Britto –
We understand that it is a big step to consider blepharoplasty surgery. It is your face, it is on show, it is deeply personal, and it matters.
The consultation is usually a 2-3 step ‘analysis phase’ at either our London or Essex clinics. Alternatively we can arrange a video consultation from the comfort of your own home.
1. Discretionary free-of-charge video-call
Jonathan will enjoy introducing himself to you in a free video-call to discuss your request. It would be very useful if you could send us some selfie photographs (to medsec@jonathanbritto.com; held securely as part of your medical record), which will help inform the conversation.
2. Face-to-face consultation
If you would like to receive a detailed written analysis, with a quote for treatment, Jonathan will meet you in clinic for a face-to-face appointment. You are welcome to bring a friend or family member for support. The medical history and physical analysis in the privacy of the consulting room is an essential part of making the treatment plan. After this meeting you will receive a detailed plan and a written quote, together with a suite of information about our ’twilight’ surgeries, relevant comments from prior patients, and some insights about the psychology and holistic care that is part of our commitment to you.
3. Face-to-face or remote catch up…
Jonathan recommends that you open a “procedure diary” on your phone, into which you can drop any questions that occur to you throughout the day, and after receiving the clinic letter and information from your face-to-face consultation.
This third conversation is to answer any questions you have, and to allow Jonathan to ask you about any reflections he has had to refine your care.
…. Step 4…..
In truth, our door is always open, and Jonathan will be very happy to see you face-to-face or remotely if you have further questions about your requested procedure.
Consultation fees: £295 is charged prior to Step 2
Data Security:
Please be aware we use a data security software to encrypt any correspondence that we send you which includes your personal data. These emails may fall into your junk folder, so following your consultations please keep a regular check on this folder.
If you wish to receive un-encryped, ‘open’ email to your inbox – please can be requested via an online, ‘one click’ consent form.
After blepharoplasty surgery, (depending upon the combinations which may be requested), Jonathan recommends a minimum of 1-2 weeks away from work. Many patients in today’s world will work partly from home and remotely and may consider an early return starting with 2 to 3 hours per day. The repair phase is important, and rest is a vital part of this.
Swelling and bruising are an inherent part of blepharoplasty surgery and are usually not perceptible to regular social contacts after two weeks. Return to driving is at at 7-10 days. Stitches are dissolving/removed between two and three weeks. Return to the gym is between 1 to 2 weeks with a gentle increase, and return to swimming at six weeks. You can shower at 48 hours. Sleeping position is best on your back with three pillows for gentle elevation to reduce swelling.
Every surgical procedure carries inherent risk, and risk events may happen despite every person in the team performing without error. In the ‘analysis phase’, Jonathan will discuss matters of risk for each type of procedure, backed up with a concise and clearly written document of risk. Jonathan is proud to run a practice that is low risk for patients, and, when a risk event rarely occurs, to provide a comprehensive open – door service to resolve matters.
All lower blepharoplasty (and extended blepharoplasty) scars are hidden in natural crease lines of the lower eyelid – beneath the eyelash line and extending a little into the ‘crow’s feet’ smile lines beyond the corner of the eye. Scars are controlled by good planning, good surgical technique, (which Jonathan can control) and the individual patients genetics of healing (which we can modify but cannot control completely).
Note: Some lower blepharoplasty surgery and extended blepharoplasty surgery can be done through the conjunctiva from the back of the eyelid. This does not leave a visible scar on the skin of the lower eyelid. “Transconjunctival blepharoplasty” is a powerful, but limited option for certain types of blepharoplasty request.
Yes.
Much depends upon how well the original surgery was done, and the aims of the current surgery. This will be discussed with Jonathan in the “analysis phase”. He will point out what the original blepharoplasty surgery has achieved well, and what has deteriorated, or has not gone well from the first surgery.
There is impact of all of this on the aims and indications of the proposed secondary blepharoplasty, on the alternatives available, and on the risks and responsibilities and expectations of outcome – all of which are comprehensively discussed.
There is impact of all of this on the aims and indications of the proposed secondary lower blepharoplasty, on the alternatives available, and on the risks and responsibilities and expectations of outcome – all of which are comprehensively discussed.
Immediately after the surgery, the lower eyelids will have Steri-Strips placed. These help to seal and dress the surgical incision. The strips will reduce eyelid opening for the period of time (one week) that they are usually in place, and this helps with healing. The visual field is therefore reduced in this early phase.
After the surgery the scars of the blepharoplasty are initially tight and non-compliant, becoming softer and softer as the weeks pass. The eyelids will open normally, and the visual field will be unaffected. For combination surgery with upper and lower eyelids, artificial tears or topical antibiotics and gels may be used that cause blurry vision – washing away of the gel and blinking to spread the surface drops will solve the problem.
In contemporary practice, about 50% of the patients that seek blepharoplasty/facelift combination surgery from Jonathan have had previous fillers to their faces. With a well conducted “analysis phase” Jonathan will explain how the filler has affected the eyelid function and appearance, and how the filler might affect the proposed surgical plan.
If the previous fillers have been done well, with a light touch, in sensible parts of the face, then the risk is reduced. Jonathan will always urge patients to keep a “filler diary” of the product they have received, and the area of the face that has been treated.
Other non-surgical therapies such as Plexr or radio-frequency will also change the way that the skin of the face and eyelids behaves, this may bring challenges during surgery, which is why Jonathan’s experience with a wide range of facelift techniques is particularly valuable for these challenging situations.
The cost of blepharoplasty surgery is divided into surgical fee, which includes a schedule of follow-up for one year (in practise unlimited), the anaesthetic fee, and the facility fees (hospital or clinic). A full explanation of terms and conditions, including fees for secondary surgery or return to theatre is provided during the ‘analysis phase’.
We will ask you to fill out some short pre-operative questionnaires, and then again at set times after the surgery. The ‘QPROM’ questionnaires were developed in the United States and have been recommended by the UK Royal Colleges of Surgeons to be adopted to measure results in aesthetic surgery. Jonathan’s consecutive facelift results are audited independently and ‘blindly’ on a quarterly basis, and are presented in peer review and professional appraisal.
