This lady presented with what she felt was a very tired look to the eyes and also a somewhat ‘sad’ appearance. This was due to a combination of brow droop and bag formation and midface descent in addition to the more obvious upper lid excess skin. A decision was made to go ahead with an upper and lower lid blepharoplasty with midface elevation. A lateral direct brow lift was also performed to address the lateral sagging of the eyelid which an upper lid blepharoplasty alone could not achieve. The results demonstrate a very natural looking outcome with the patient retaining her natural look but with a less tired appearance and more open eye configuration. The midface elevation has given her a definite improvement blending the cheek and midface and resolving the look of tiredness. The post operative images are three months after the surgery and the patient is delighted with the outcome. These types of surgeries are signature treatments for The Ezra Clinic providing very natural look, yet with a very definite improvement to appearance.


This demonstrates that blepharoplasty can be performed extremely well by elevating, tightening and reorganising the tissues, but ensuring that only very little tissue is removed. The philosophy of the doctors at The Ezra Clinic is to preserve as much tissue as possible. This lady had no fat removed but rather the fat was repurposed by redraping over the hollowed areas to normalise the contours. A small amount of skin and muscle was excised. The result was topped up with a small amount of filler injection to normalise the contours as there was not enough fat to fully address the hollows. Preserving tissue in blepharoplasty surgery is absolutely critical to ensure a natural outcome.

Blepharoplasty Plus

Bilateral lower lid blepharoplasty With midface lift

The patient presented with lower eyelid bags causing a tired look. The treatment involved lower lid external approach blepharoplasty. The patient was delighted with the dramatic improvement. And complete loss of the tired appearance. There was midface hollowing that limited the final outcome, but the patient was pleased with the dramatic improvement. Further refinements could be made with filler injections to the eyelid/cheek interface, a common site of volume loss as patients age.


This lady had a significant lower lid bag with a mid face descent and also a small festoon forming on the lateral part of the eyelid/cheek interface.  The mid face lift was modified to stretch out these tissues and resolve the small area of oedema/festoon.   The overall improvement with the reduction of the bag, mid face elevation, and resolution of the festoon/malar oedema have given an excellent result and contour.

Bilateral upper lid blepharoplasty with direct brow lift

This lady presented with significant hooding of the upper eyelids with overhang in the outer corners.  Blepharoplasty alone would not have been sufficient to completely clear the skin and a brow lift was employed.   She chose a direct brow lift involving an incision above the eyebrow.  The post operative images were taken at the six week post operative review, demonstrating almost no visible scarring.  The direct brow lift is a very powerful procedure demonstrated by the fact that in addition to the eyelid, eyebrow elevation, it has also raised the crow’s feet area and upper part of the cheek, opening up the lateral part of the eye with a significant aesthetic improvement.

Blepharoplasty plus: Lower lid blepharoplasty with midface lift

This lady presented with significant lower lid bags. As is often the case, the bags were made worse by cheek descent and loss of volume in the tear trough and lateral cheek area.  The focus of the surgery was to remove the bags and to focus on blending the lower lids with the rest of the face.  A special “Tissue Preservation Blepharoplasty” was performed with a midface lift, whereby all of the tissue from the bags was repurposed to fill the hollows. Our philosophy is to view all tissue as precious and we often perform complex blepharoplasty surgery without removing any tissue at all, but instead reorganising, remodelling, and lifting the tissues. As well as lifting the cheeks, the midface elevation was modified to improve the fullness in the lateral cheek, restoring the natural proportions of the face using a natural approach.  This case demonstrates the importance of adjunctive ‘Blepharoplasty Plus’ procedures in achieving an optimal outcome. These pictures were taken on the morning of surgery and then 4  months postoperatively;  the patient is delighted with the result.


This lady presented with complex issues affecting the lower eyelid.  There was some mild bag formation along with tear trough hollowing.  The main issue for her was excess and untidy skin in this area.  Surgery alone tends to be good at managing structural aspects and large contour issues of the bags, but is often not very good at dealing with fine lines in the skin.  The images demonstrate that with a very careful balance of tightening whilst still ensuring that the eyelid does not retract can deliver extremely good outcomes.  The residual hollowing was managed post operatively with micro filler deposits which have been extremely effective in levelling out the skin.  Again, in this patient the mid face elevation has been highly effective at restoring the continuum between the lower eyelid and cheek.


This demonstrates the outstanding effect of a bilateral upper lid blepharoplasty.  The lateral hooding was addressed with an internal brow pexy.  This is a gentle procedure to elevate the tail of the brow and is performed through the blepharoplasty incision with no additional incisions or downtime.  This patient wanted maximal skin show present after the procedure.  The post surgical image was taken 6 weeks after the procedure demonstrating a very good improvement and natural result.  The tail of the brow can clearly be seen to be elevated gently.  Although this is a subtle improvement it does deliver a significant impact.

lepharoplasty plus: Lower Eyelid Blepharoplasty

This patient was troubled by a tired look and puffy lower eyelids which tended to be worse in the mornings.  She felt that this appearance was not in keeping with how she felt about herself, with people constantly asking if she was tired. The consultation process identified the lower bags as the man issue and an external approach lower lid blepharoplasty was performed, involving meticulous repositioning of the fat in the the ghollow areas and also managing the lower lid/cheek interface. The post surgical images were taken 6 weeks after the procedure demonstrating  results which are natural and giving the patient a fresher and brighter look without changing their natural appearance.

Blepharoplasty plus: Upper and lower blepharoplasty with. Midface elevation and internal browpexy

This lady underwent a bilateral upper and lower eyelid blepharoplasty with mid face elevation and internal browpexy under local anaesthesia with deep sedation. This was a tissue preservation type blepharoplasty meaning that very little tissue was excised and the focus was very much on redistributing, tightening, and elevating the tissues. The photos clearly show how the lower lid bag has been redistributed into the hollow areas around the eyelid. The elevation of the mid face has given an outstanding result in blending the lid and cheek together extremely well. This patient has always had a naturally hooded appearance and this was the look that we aimed to preserve with only a conservative upper lid blepharoplasty maintaining the natural look but still giving an excellent improvement. The internal browpexy has worked extremely effectively to raise the tail of the brow opening up the outer part of the eye and giving the eyes a fresher appearance. The post operative photographs represent the result at 10 months after the surgery showing an excellent long lasting result with no complications.

Lower Lid Internal Transconjunctival Blepharoplasty:

This lady underwent lower lid internal approach blepharoplasty, meaning that the incisions were made through the inside of the eyelids without leaving any scars. She initially had a very tired and gaunt appearance which has been resolved with this procedure. The surgery was undertaken to resolve the bags by releasing the ligaments constraining the fat compartment and to reposition much of the fat into these areas. This was a ‘tissue preservation’ type of blepharoplasty which did not require the excision of any tissue, but rather redistribution, remodelling, and tightening. There has also been some cheek elevation performed to enhance this effect. These images were taken 2 months after her initial surgery.

parallax background

Bilateral upper and lower blepharoplasty with Midface elevation

This patient presented with very significant hooding in the upper eyelids and large bags in the lower lids. She had noticed very significant changes to her appearance giving her a more tired and angry look. There were significant technical challenges with performing this surgery given that she has a negative vector eye configuration. A decision was made to perform an upper and lower lid blepharoplasty with a direct brow lift to open up the upper eyelid space. A blepharoplasty alone would not have been adequate enough to achieve this. The lower lids were rejuvenated with a lower lid tissue preservation blepharoplasty and mid face lift. Treatment with neuro modulation reduced the frown lines and reduced the dynamic lines around the skin areas. These photos demonstrate the result at the six week point after the surgery.

Blepharoplasty Plus

Upper and lower lid blepharoplasty with mid face lift

This lady had an appearance she was not happy with.  There was significant overhanging upper eyelid skin and lower lid bags which were exacerbated by cheek descent.  The disjunction between the eyelid and cheek had caused long lines to form creating a more aged appearance.  She underwent an upper lid blepharoplasty, which was conservative in nature, to preserve her naturally hooded appearance but still deliver a very high impact result.  For the lower eyelid surgery, great care was taken to focus on elevation and tightening of the cheek tissues.  It shows very nicely how midface elevation can actually augment volume and improve proportions in the face.  The bags were reduced and excess fat repositioned into the hollow areas of the mid face to improve the overall look. The images shown here are 6 weeks after the surgery demonstrating an excellent result.

Tear Trough Fillers

Tear Trough Before and After Fillers

This patient was very bothered by a tired appearance around the eyes. The predominant issue was tear trough hollowing rather than any bags. This type of patient is ideally suited to tear trough fillers with an excellent result and resolution of the tired appearance.


Upper and lower blepharoplasty with midface lift

This gentleman was bothered by lower lid bags which had been present for many years and getting progressively worse.  He had quite significant midface descent illustrated by the descent of the cheeks and drawn appearance.  There is also some mild overhang of the upper eyelid skin. It is essential that male eyelid surgery ensures that the distinctive gender specific features are preserved and it is important that some imperfections should remain to avoid a more feminised appearance.  This gentleman underwent an upper and lower lid blepharoplasty and mid face elevation. The midface elevation has been extremely effective at creating a smoother at  the eyelid and cheek interface by elevating the drawn-down cheek.  The swelling settled after 3-4 weeks giving a much more natural and less tired looking appearance.

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 as seen in the before and after image.

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 Blepharoplasty


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 as seen in the before and after eyelid treatment pictures, with a very positive impact on the patient’s quality of life.

Lower Lid Transconjunctival Blepharoplasty

This young woman was bothered by significiant 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 scar-less 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 (scar-less approach) with fat re-draping. No fat was removed, but was repositioned to fill the sub adjacent 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 an excess of skin and muscle. I performed an anterior approach lower lid blepharoplasty. The scars are perfectly concealed with a natural result.

Lower lid Blepharoplasty


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 scar-less transconjunctival route with fat re-draping.

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 as can be seen in the before and after eyelid treatment image.

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

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 Blepharoplasty


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

Revision Blepharoplasty

The lady had previously undergone surgery elsewhere to remove lower lid bags. Unfortunately, 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.

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.

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 (scar-less) 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.

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.

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 and lower lid blepharoplasty was performed to remove excess skin (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.