Cosmetic eyelid surgery (Blepharoplasty)

See also Dr Kremer's signature "Turn Back Time" TBT eyelid lift blepharoplasty procedure.

Harley St Aesthetics offers London eyelid surgery performed by top plastic surgeon Dr Dirk Kremer. Read about the blepharoplasty procedure, and get in touch with Dr Kremer to discuss if eyelid surgery is right for you.

Upper eyelid

With increasing age there may be a hang of the upper eyelids. This leads to a weary expression that is perceived by many patients as disturbing. Younger patients complain of swelling of congenital upper eyelid, so-called drooping eyelids.

In both cases, blepharoplasty can help to regain a fresh, radiant face.

In this operation performed by London plastic surgeon Dr Dirk Kremer, a cut is made in the natural skin fold of the upper lid. Excess skin and fat are removed and tightened if necessary from the orbital septum. After closure of the incision, the scar is in the skin fold of the upper lid, and therefore hardly visible.

Lower eyelid

Orbital Septum  Blepharoplasty LondonThe so-called tear bags are actually made of fatty tissue that bulges into the lower lid more with increasing age. This natural ageing process leads to an unpleasant change in the eye area and affects a youthful visage. A barely visible cut is made just below the lashes of the under lid, to remove the bulging fat and restore the septum to its original "youthful" position. If there are sufficient excess skin folds, a small strip of the eyelid is surgically removed. After wound closure there remains a fine, thin line that follows the natural skin folds.


  1. Orbit - In anatomy, the orbital bone is the cavity or socket of the skull in which the eye and its appendages are situated.
  2. Orbital Septum - The orbital septum (palpebral ligament) is a membranous sheet that acts as the anterior boundary of the orbit. It extends from the orbital rims to the eyelids. It forms the fibrous portion of the eyelids.

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I am afraid of general anaesthesia. Can I do the necklift under local anaesthesia?

Generally speaking, yes, it is technically possible to perform a necklift under local anaesthesia. BUT, here are some things that the patient should carefully consider: When undergoing a necklift under local anaesthesia, large areas of the lower face and neck have to be infiltrated with local anaesthetic. The infiltration can be painful at the beginning. Also, it is important that you are aware that you are fully awake during the procedure. You will feel pulling and tagging, and even though this is not painful, many patients can’t handle being fully aware of what is going on. On top of this, you will have to lay for up to 3.5 hours on the theatre table while remaining completely still. Many people experience back pain after a while, and feel that they need to change their position. This must be avoided under all circumstances.

I generally prefer performing necklifts under general anaesthesia. If you feel uncomfortable about general anaesthesia, it may help if you speak to our anaesthetist, as they can answer all your questions and put your mind at ease.

If you decide that you do not want the necklift performed under general anaesthesia for personal reasons, I would advise that you have the necklift surgery performed with local anaesthesia while under sedation. Our anaesthetist will administer painkiller and sedatives through an IV line. You will sleep during the procedure, but you have full control of your breathing and will be fully awake as soon as the sedative administration is stopped.

How long does the neck lift procedure take?

For my neck lift procedures, I usually take 1.5 hours. In combination with eyelift or submental liposuction, the whole procedure can take up to 2.5 hours. A short surgery time is important to avoid dramatic swelling after the neck lift.

I don’t lift the SMAS during the neck lift because it stops at your jawline and doesn’t continue into the neck. I do lift and tighten the platysma muscle, a flat and thin muscle which expands from your jawline down on both sides of the neck. Loss of tightness results in the so-called platysma bands, which run over the middle of the neck. By tightening this muscle in a neck lift I can return or create a defined angulation and definition of your neck.

What are the complications of a necklift?

Complications of a neck lift are rare. An acute complication (within the first 24 hours) would be a post-operative bleeding. If the bleeding doesn’t stop or the built-up haematoma is too big, you will need to be re-operated on, so that the bleeding can be stopped or the haematoma emptied. Risk of an infection and seroma is small but existent. Parts of the skin dying (this is a major risk if you are smoking), loss of sensitivity, asymmetry, stretched earlobes, and visible scars (stretched or hypertrophic) are also other potential, but rare, complications.

I am a smoker. Can I have a neck lift?

You definitely shouldn’t have a neck lift at the moment. Due to the constriction of blood vessels, the blood supply to your face is compromised. Undermining and lifting your skin, as required in a neck lift, further compromises the blood supply of your skin and there is a real possibility that part of it could die. A further risk is that the wound might not heal successfully, and you could develop a seroma which would need to be drained a few times until you did successfully heal. My patients often say to me, ‘you are a fantastic doctor, this won’t happen with you’. I am afraid this has nothing to do with how qualified, experienced or skilled you are as a surgeon, and therefore it can happen to any surgeon operating on a smoker. Therefore, you must stop smoking at least 4 weeks prior to your planned neck lift procedure. This will provide your body with the time in needs to regenerate its blood vessels within the skin of your face and neck. A neck lift can then be performed without this heightened risk.

How long do I need to stay in the hospital after my neck lift?

I like my patients to spend one night in the hospital after their neck lift procedure. I will ask you to wear a tight head bandage which will put a considerable amount of pressure on your ears. Many patients find that this can cause some pain. While you are in the hospital, we can administer IV pain relief as well as monitor you closely in case you have some post-operative bleeding. In the hospital, you can relax and put your mind at ease. The following morning, I will remove your bandage before assessing your neck. If all is well, I can then discharge you from hospital and you can return home. If you live in London, it is possible for you to leave the same day. Many of my patients have requested this and there were no complications.

Does a neck lift hurt?

You should not feel much pain with a neck lift procedure. The head bandage can cause quite a lot of discomfort, but I only ask that you wear it for the first night. It can cause a lot of pressure on the ears, and this is what many patients find quite uncomfortable. Once the bandage has been removed the following morning, you will feel much better. You will experience tightness, but rarely any pain. I discharge you with painkillers, though many of my patients tell me that they never had to use them.

How long must I wear the compression bandage for after my neck lift?

I will ask you to wear the compression bandage for just the first night, then I will take it off the following morning. If I added a submental liposuction to create a sharper definition, I advise my patients to wear a chin strap for another week at home, and another week only at night.

I usually decide if you will need small drains (mini-vacs) during your neck lift procedure. If you are not bleeding very much during your neck lift I won’t use drains. If you are bleeding more than expected during your neck lift, then I will use two mini-vacs. These drains are removed before you leave the hospital the following morning.

In most cases, a patient that has undergone neck lift surgery doesn’t have to hide because the swelling is minor, and bruises can be easily covered. Your earlobes and lower face may appear swollen during the first few days, and in this case patients tend to avoid public places, even though it can be easily hidden with long hair and your choice of clothes. A scarf, or a turtle neck sweater usually conceals the swelling very well. The stitches are in front of the earlobe, but clear sutures are used which are not so visible. Again, long hair can easily hide the stitches.

Will I have drains?

I will usually decide during your neck lift procedure whether or not you will need small drains (mini-vacs). If you are not bleeding, or if you are only bleeding a small amount during your neck lift, then I will not be using drains. If you are bleeding quite a lot during your neck lift surgery, then I will use two mini-vacs. These drains are then removed before you leave the hospital the next morning.

What can I expect once i am home?

Usually, I do not expect any swelling on your neck after your neck lift procedure. The lower face and jawline area may be a bit swollen, which can sometimes cause your mouth to be stretched a little, though this is only for the duration of the swelling. Once this swelling settles after a few days, your mouth will look completely normal again. Your earlobes can also swell during the first 3 days, and this will usually begin to settle from day 4 on wards. Also, you may find that you develop some bruising around the neck. The bruises can drop with gravity into your decollete, before fading away over the next 10-14 days. Bruising and swelling is of course different with each individual, but rest assured, if you do happen to experience any bruising or swelling, it will soon begin to improve after just a few days with many patients returning to work after just one week of recovery. Your neck will feel very tight, and some patients express concern about mobility, but you should be able to turn your neck without any problems. The tightness that you feel around your neck is caused by the tightened Platysma muscle. After the first few weeks of recovery, this feeling of tightness should subside.

What should I do to not risk complications after my neck lift and to ensure i heal successfully?

I would ask that you please avoid drinking any coffee or black tea in the first 2 days, because these can raise your blood pressure and cause bleeding. Also, please avoid smoking cigarettes. This is because smoking can compromise the blood supply to your skin, potentially causing facial skin to die. You shouldn’t smoke for at least 2-3 weeks following your neck lift surgery. Avoid exercise during the first month of recovery. Ensure that you sleep with your upper body elevated under a few pillows so that any swelling is reduced. Also, avoid bending over during the first few weeks.

How long do I need to hide after my neck lift? When can I go back to work?

Usually, the swelling after neck lift surgery is minor, and any bruising on the neck can be easily covered, therefore there is no need for a patient to hide away following their neck lift procedure. Your earlobes and lower face may experience some swelling during the first few days of recovery, and in this case patients generally avoid public places, although again, this can be be easily hidden by covering your ears with long hair or with your choice of clothing, such as a scarf or a turtle neck sweater. The stitches are visible in front of the earlobe, but clear sutures are used which are much less noticeable. Again, long hair and clothing can easily hide the stitching.

Will a necklift leave visible scars?

The incision starts at the front of the earlobe, and runs around the earlobe and back up behind the ear in the post-auricular sulcus. The incision then crosses from the top of the sulcus into the area of the occiput. Behind the ear you will find that the scar is not visible, and only a very small part of the incision is exposed at the front. These areas can be hidden very easily with longer hair. If you have short hair, it can be more difficult to disguise. Men in particular who have short hair can find it a problem when covering it up. Once the sutures are removed, any scarring will turn red and become slightly elevated, which is all part of the normal process when a scar is healing. During this period, it can help if you cover the scar with some concealer. Once the scarring has completely healed, they are very fine, light lines, which are difficult to spot as they are almost invisible.

How long will the result of my neck lift last?

This is a very common question i get asked by many of my patients! Well, a neck lift can last 10-15 years, but this doesn’t mean that your face will look the same over this period of time. With a neck lift we only turn back the time (10-12 years), as unfortunately we can’t influence nature and the ageing process. But, you will surely look much better 12 years after your neck lift procedure, as opposed to how you would have looked without the neck lift!. It is vital for a long lasting result to condition your skin with a strict skin care regime. I advise my patients to use products from my skin care range, SkinDoc formula, which has proven to be very effective for my patients.

When are the stitches removed?

The stitches are removed 12 days after your neck lift surgery. Around the ear I use sutures, and in the hair I use staples as they cause less harm to your hair follicles.

Do you shave my hair?

No, I do not shave your hair, so there is no need to worry about that.

How much does a necklift cost

The prices of a necklift vary and are specific to the individual and the type of surgery required. If you are considering having necklift surgery in London then please get in touch with us to book in for a one-to-one consultation with Dr Dirk.

Eyelid surgery


Blepharoplasty: before

Blepharoplasty: before


Blepharoplasty: after

Blepharoplasty: after

Six months later:

Turn Back time eyelift: six months later

What risks does a blepharoplasty bring with it?

In general, surgery on the eyelids has a very low associated risk factor. However, during an operation complications can never be completely ruled out and in some cases unpredictable results can occur.

Swelling and bruising

The extent and duration of swelling and bruising after the operation are very different and individually marked.


Infection of the wound area is extremely rare. With proper treatment the result does not necessarily deteriorate.

Impaired wound healing in the lids is also very rare. Additional factors usually play a role in delayed healing, such as in diabetics, smokers or patients with bleeding disorders. These risk factors should be included in the detailed patient interview.

Infection in the lower eyelids can cause a distortion or deformity of the lower lid. This is a very unpleasant complication and is rare. If infected tissue is removed to prevent infection or wound healing, it can lead to a distortion of the eyelid. Massage of the lower lid can rectify the result, or else we do a corrective operation.

When selecting a good surgeon with diligence and compliance the desired postoperative aesthetic result is generally achieved without complications and with good success. If you would like to discuss any other risks associated with the operation, you can talk to Dr Dirk Kremer in your pre-op consultation.

How do I prepare myself for the operation of the Blepharoplasty?

It is advisable to plan for around seven days off after the operation. This will give your procedure time to heal and for the proper results to become evident.

In the days before eyelid surgery, you should also take the time to be rested mentally and physically.

Aspirin and similar blood-thinning medications should for their inhibitory effect on blood clotting not be consumed for at least 1-2 weeks before surgery. For questions and doubts before the surgery, please call your surgeon in Harley Street.

Where is the surgery?

Lid tightening will be an outpatient procedure as a rule. After surgery, you will have a short recovery and observation period before going home. In no case should you ever drive a car.

What is used for anaesthesia?

In general, eyelid surgery is performed under local anaesthesia. With local anaesthesia, you will also receive a sedative (either as a tablet or by intravenous injection in the arm vein) which puts you in a kind of twilight sleep; you are awake, but relaxed and insensitive to pain.

Prior to the operation, if general anaesthesia is planned you will have a consultation and discuss the procedure with your anaesthesiologist. In this case he/she will monitor you throughout the operation controlling the anaesthetic.

However, general anaesthesia is usually the exception.

About the plastic surgery

A tightening of the eyelids usually takes about 45-60 minutes, depending on how pronounced is the result. The streamlining of the lower eyelids takes about the same time.

The plastic surgery is as follows:

Upper eyelid:

In the natural crease of the upper lid the incision is made, this runs out laterally just above the outer edge of the lid in the so-called laugh lines.

How much skin is removed will be assessed before the operation and determined by alternately closing the eyes.

The designated skin is then dissected and removed from the underlying muscle.

After dividing the superficial eye sphincter, a very fine membrane (septum) is cut and thereafter, the pre-expressed fat in the eyelid is removed.

In order to operate on tissue preservation, a tightening of the sagging septum is performed and positioned back into the orbit. This method is useful, especially in younger patients, as you can assume that in the course of life (usually after 10-12 years) a renewed tightening of the eyelids will be required. Thereafter, the upper lid is again closed with a continuous, outwardly invisible skin suture.

Lower eyelid:

With the lower eyelid, an incision is made just below the eyelashes.

It cuts through the skin and allows the underlying subcutaneous tissue and muscle to be gently lifted. 

After partial transection of the annular sphincter at the lower eyelid, and the opening of the septum away from the orbit to the lower eyelid, fat is gently pushed forward. This fat gives the patient the appearance of the popularly known "eye bags". Then the excess skin is removed very carefully and strictly, followed by the closure of the eyelid with a continuous, outwardly invisible skin suture.

What is a transconjunctival blepharoplasty?

Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids. Incisions may be made from the inside surface of the lower eyelid ( transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed.

What must be done if the eyelid surgery?

The first 24 hours after surgery (Blepharoplasty):

Talk with your surgeon, Dr Dirk Kremer, if you:

Eye Care:

General advice after blepharoplasty


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