Before and After

Blepharoplasty Plus: Bilateral lower lid blepharoplasty with midface lift and fat transposition.

This gentleman presented with significant fat hernaiation causing lower eyelid backs. There was also significant excess skin present. The size of the bags was being accentuated by midface descent and tear trough hollowing which is not fully correctable with blepharoplasty alone.  He underwent lower lid external approach blepharoplasty  with midface lifting. Much of the fat from the bags was preserved and used to volumise the eyelid-midface junction giving a smoother and refreshed appearance. The improved midface positioning has also significantly contributed to the overall result.

Bilateral upper blepharoplasty and direct brow lift

This patient had significant amounts of sagging skin affecting the upper eyelid. However, blepharoplasty alone would not be sufficient to fully deal with the problem as there was also significant brow descent causing compaction of the upper eyelid tissues. There is always a wide choice of brow lifting techniques, but given the extent of the brow droop, only a direct brow lift would provide a sufficiently powerful lift. This procedure requires a small incision above the brow hairline which usually settles well. The patient elected for an upper lid blepharoplasty and direct brow lift with excellent results.

Blepharoplasty Plus

Bilateral upper and lower lid blepharoplasty with internal browpexy
Skin treatments with Profhilo

Upper lid blepharoplasty was performed along with an internal browpexy to raise the brow and to relieve the upper lid compaction caused by crowding of the brow. Profhilo treatments were undertaken postoperatively to reduce lines and create a gentle lift throughout the face.

Lower Lid Blepharoplsty


This young woman with severe lower lid bags complained of an exhausted look and profound skin discolouration. She underwent a scarless transconjunctival blepharoplasty which has had an excellent result. The lower lid contours are normalised and the discolouration is vastly improved. These images demonstrate how effective the posterior approach can be, and how dark and discoloured lower eyelids can improve with blepharoplasty.

Blepharoplasty plus.

Upper and Lower Blepharoplasty with midface lift

This lady with severe eye bags came to see me for treatment. A diagnosis of Thyroid eye Disease was made which had been causing the bag formation. She was treated initially with an orbital decompression to restore the position of the eyes. This was followed by upper and lower lid blepharoplasty with midface lift to restore the cheek volume and smooth interface with the eyelid. The results were transformational with a very positive impact on the patient’s quality of life.

Lower Lid Transconjunctival Blepharoplasty.

This young woman was bothered by signficiant bags which were giving the appearance of tiredness. She was also very bothered by a reddish discolouration around the bags which is common. Given that no skin removal or tightening was required, she underwent scarless internal transconjunctival blepharoplasty which has been highly effective.

Lower Lid Transconjunctival Blepharoplasty

This lady presented with significant lower lid bags. Again, the skin quality was good with significant retained elasticity. This made her an ideal patient for an internal transconjunctival eyelid blepharoplasty (scarless approach) with fat redraping. No fat was removed, but was repositioned to fill the subadjacent tear trough hollowing. The patient was warned that she may require filler injections to fully correct the tear troughs after the surgery, but this did not prove to be necessary.

Lower lid blepharoplasty

This gentleman presented with severe lower lid bags caused by fat herniation and excess skin and muscle. I performed an anterior approach lower lid blepharoplasty. The scars are perfectly concealed with a natural result.

Lower lid Blepharoplsty


Under the eye bags and the excess skin around the upper eyelid were removed to give this lady a natural look which complemented her youthful, clear complexion. The lower lid blepharoplasty was performed through the scarless transconjunctival route with fat redraping.

Blepharoplasty plus

Upper and lower lid blepharoplasty with midface lift and fat transfer

This lady presented with lower lid bags and midface volume loss. This patient presentation was technically complex as a result of a negative vector configuration of the eyes. This means that the eyes were at very significant risk of lower lid retraction with blepharoplasty. The patient had an upper and lower lid blepharoplasty and with a midface lift to support the lower lids. In addition, fat transfer was also provided to improve the contour between the lid and cheek to good effect. The patient was delighted with the natural and more refreshed appearance.

Blepharoplasty Plus

Upper and Lower Eyelid Blepharoplasty 
Midface Lift
Fat Transfer

This patient was bothered by overhanging upper lid skin and lower lid bags. She was found to have excess upper and lower lid skin with orbital fat herniation. In addition, there was midface descent causing a disjunction between the eyelid and cheek complex. This patient wanted a natural look without any excessive changes. I carried out lower eyelid blepharoplasty to remove the under eye bags and an upper blepharoplasty to eliminate upper lid hooding. The midface lift rejuvenated the overall appearance of the face by reversing the cheek droop and providing a better continuum between the eyelid and cheek. The fat transfer re-volumised the cheeks for a natural contour. The fat transfer was also very helpful in improving the overall skin quality. The patient was delighted with the results, which have given her a natural, refreshed and less tired look.

Blepharoplasty Plus

Lower lid blepharoplasty with midface lift and fat transfer

This lady presented with significant lower lid bags. The bags were due only in part to fat bulging. There was significant midface hollowing and descent of the cheeks. A full restorative approach was adopted to include lower lid blepharoplasty with midface elevation to restore the continuum between cheek and eyelid. Fat transfer was very effective at rejuvenating the cheeks and filling the hollowed areas which the blepharoplasty alone would not have been able to address. This case demonstrates the importance of adjunctive ‘Blepharoplasty Plus’ procedures in achieving an optimal outcome. These pictures are taken 4 months after the initial surgery and the patient is delighted with the result.

Tear Trough Fillers

This patient presented with significant hollowing around the tear troughs causing a tired and sunken appearance. Fillers were administered to the tear troughs and to the upper cheeks to good effect. The overall appearance after the treatment was a less tired and more natural look.

Tear Trough Fillers

This young woman experienced notable bags under the eyes. She complained that she always looked tired regardless of how much sleep she had. To remedy this filler injections were administered to the tear trough. This case demonstrates how effective lower lid fillers can be, particularly in younger patients.

Tear Trough Fillers

Another example of an effective result for a young patient presenting with early lower lid bags requiring treatment with under-eye fillers. The treatment takes approximately 10 minutes and typically lasts for several years

Lower lid Blepharoplsty


This young woman with severe lower lid bags complained of an exauhsted look and profound skin discoluration. She underwent a scarless transconjunctival blepharoplasty which has had an excellent result. The lower lid contours are normalised and the discolouration is vastly improved.

Blepharoplasty Plus.

Upper and Lower Eyelid Transconjunctical Blepharoplasty and A Full Face Fat Transfer

 This gentleman was concerned by the prominent bags under his eyes which had been present since his twenties. To correct this I conducted an upper lid blepharoplasty, lower lid transconjunctival blepharoplasty and, most importantly, a full face fat transfer. This corrected the hollowing, gauntness and and age-related deflation of the face which was contributing to the tired and exhausted look

Ptosis Surgery

This lady initially came to see me for blepharoplasty surgery but, upon examination, I saw that her droopy upper eyelids required ptosis surgery to correct the issue. Her eyes are now much more open and she feels less tired. Ptosis correction is highly specialised and can only be performed by an oculoplastics specialist.

Revision blepharoplasty

The lady had previously undergone surgery elsewhere to remove lower lid bags. Unfortiuantely, the previous surgery was not effective and the bags were still present. I undertook revision lower lid blepharoplasty surgery to remove the bags. At the same time midface a lift was provided to raise the cheek to its normal position providing a smoother contour to the cheek, eliminating the hollows.

Blepharoplasty Plus

Upper lid blepharoplasty with browpexy

This lady had significant overhanging upper lid skin and brow droop. The brows were being maintained by forehead overaction which was causing deep lines . A blepharoplasty was performed together with an internal browpexy. The patient has been delighted with the results giving a more youthful yet natural appearance. The stabilisation of the brow position has improved the forehead lines.

Upper Lid Blepharoplasty and Ptosis Correction

This lady had heavy upper eyelids and a drooping upper lid. She required combined blepharoplasty and ptosis correction which delivered a natural and rejuvenated look.  The combined surgery is performed through the same incision.

Lower lid transconjunctival blepharoplasty

This young patient was concerned about lower lid bags which were out keeping with the rest of her complexion. Given that there was minimal excess skin laxity, I performed a lower lid transconjunctival blepharoplasty (scarless) through the inside of the eyelid. Fat was remodelled and sculpted with no significant scarring. This type of surgery works best for younger patients with little skin laxity. This procedure has a significantly lower risk profile.

Blepharoplasty Plus

Upper lid blepharoplasty and internal browpexy

This patient was concerned about drooping upper lids causing a sad appearance. The heavy brows were also making the patient feel tired. She was keen on a fresher look. The presenting problems were due to a combination of brow droop and excess upper lid skin. A blepharoplasty and internal browpexy was performed which has transformed the patient’s appearance. The browpexy is a minimally invasive adjunctive procedure  designed to suspend the brow internally and enhance the result of blepharoplasty in selected patients. There is no significant additional downtime.

Direct Brow lift

This patient had a very significant lateral brow ptosis, meaning that the outer part of the brow had dropped. This often gives a ‘sad’ appearance and can contribute to eyelid closure. This patient underwent a direct brow lift. Unfortunately, the extent of the brow ptosis meant that more minimally invasive techniques would not have been powerful enough to achieve a lift. Direct Brow lift is a powerful lifting technique which is effective in these cases. The downside is a skin scar, although this is hidden above the brow and usually is not noticeable.

Revision blepharoplasty

This patient suffered significant lower lid retraction as a result of poorly planned and excessive lower lid blepharoplasty surgery. He developed significant scleral show with poor lid closure leading to an unwanted change in appearance and chronic ocular surface pain. He underwent  a lower lid septo-retractor recession with cadaveric alloderm implants and lateral canthoplasty. He is delighted with the restoration of his normal appearance.

Tear Trough Filler

This patient has mild bagginess but a very good overall complexion. Tear trough fillers are extremely effective in this context.

Tear Trough Filler

Even much larger bags can be significantly improved with Tear trough fillers. In this context, midface fillers must also be placed to provide a foundation on which to build the tear trough component of the fill.

Tear Trough Filler

This Patient has deep furrows in the tear trough which have excavated the lower lid bags, giving a tired appearance. A small volume of tear trough filler to the hollowed area has given a fresh and rejuvenated look.

Blepharoplasty plus: Upper lid blepharoplasty with ptosis correction, internal browpexy and tear trough filler injections. 

This patients’ upper lids were affected by a ptosis, excess upper lid skin and a low brow position. In addition, the lower lid tear trough contributed to the tired look. The maximum improvement of the upper lid required ptosis correction to raise the lid margin, blepharoplasty to remove excess skin and also brow elevation. This has worked effectively to create a more open eyelid configuration.  The tear trough fillers have also been effective at enhancing the result by addressing the lower lid hollows.

Blepharoplasty plus: Upper and lower eyelid blepharoplasty with ptosis correction and midface lift.

This patient presented with numerous featured giving the eyes a tired appearance. The upper lid position was low and there was excess skin in both the upper and lower lids. This was associated with bulges and bags caused by fat herniation from the eye socket into the eyelid tissues. The surgery lifted the upper eyelid position and removed the excess skin and fat. In addition, the midface lift has been highly effective in reversing the cheek descent and blending the lower lid with the cheek to give a more pleasing result. This example demonstrates how a midface lift can enhance the result of lower lid blepharoplasty by addressing cheek descent.

Blepharoplasty plus: Upper and lower eyelid blepharoplasty with  midface lift.

This patient had excess skin affecting the upper lid and also coarse lines in the lower eyelid. There was associated cheek descent present.  An upper lid blepharoplasty was performed to remove excess skin and a lower blepharoplasty was also performed to remove excess skin, rather than to deal with bulges.  The midface lift has again helped to blend the eyelid and the cheek.