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Eye bags / heavy eyelids


"My husband and I are really delighted with the outcome of my procedure. It’s great not to look permanently tired. You were right in that it is not overdone which does give a more natural fresher look. It took longer to heal than I had expected and after three weeks the scarring was quite white and raised but now very smooth."
From a patient who underwent ptosis correction, upper blepharoplasty and fat transfer to face

You can read one patient's diary of her surgical  treatment with blepharoplasty in this Patient experience. Or see below. 


Tired-looking eyes caused by heavy eyelids or puffy, saggy under-eye bags are one of the most common complaints of patients contemplating cosmetic surgery.


Eyelid surgery, or blepharoplasty, can restore a more energetic and youthful appearance — you should look refreshed, as if you're just back from holiday. Even so, the operation will not remove all wrinkles around the eyes, especially laughter lines.


A blepharoplasty may be performed on the upper eyelids, the lower eyelids, or all four lids. It may also be combined with other procedures, such as a droopy eyelid lift (ptosis surgery), brow lift, facelift, tear trough (under-eye hollow) fillers or skin resurfacing.


Mr Malhotra will discuss the options in detail so that you are able to make an informed decision.


In most cases, this surgery is not medically necessary and will therefore not be covered by health insurance.

Upper eyelid blepharoplasty before

Upper eyelid blepharoplasty BEFORE

Upper eyelid blepharoplasty after

Upper eyelid blepharoplasty AFTER


LOWER BLEPHAROPLASTY. Skin-approach. The patient below was asked 16 months after lower blepharoplasty surgery if she would consent to her photos being used below for Mr Malhotra's website. She replied:

"I am more than happy for these pictures to be used. I am still amazed by the results!!kind regards,"


Lower eyelid blepharoplasty skin approach 1 BEFORE

Lower eyelid blepharoplasty skin approach. BEFORE

Lower eyelid blepharoplasty skin approach 1 AFTER

Lower eyelid blepharoplasty skin approach. AFTER




Lower eyelid blepharoplasty skin approach 3 BEFORE

Lower eyelid blepharoplasty skin approach. BEFORE

Lower eyelid blepharoplasty skin approach 3 AFTER

Lower eyelid blepharoplasty skin approach. AFTER



Lower blepharoplasty (transconjunctival or internal approach) — Pre

Lower blepharoplasty (transconjunctival or internal approach) BEFORE

Lower blepharoplasty (transconjunctival or internal approach) — Post

Lower blepharoplasty (transconjunctival or internal approach) AFTER


Male patient who arranged a consultation to improve eyelid appearance and restore a less tired look.

Concerned not to look too different to old photographs.


Old Photograph taken 20 years ago


Post upper and lower eyelid blepharoplasty. Aiming for a natural, age-appropriate result 




Blepharoplasty is often performed under local anaesthesia, with no need for an overnight stay in hospital. The operation lasts one to two hours at most — less, if only the upper or lower eyelids are being done. You can have additional sedation if you choose or opt to have a general anaesthetic.


Upper eyelids


In upper eyelid blepharoplasty, a fine incision is made in the existing crease above each eye, which minimises the visibility of any scaring. A crescent of excess skin and muscle is removed. In general, Mr Malhotra avoids removing fat. The incisions are then closed with fine stitches. These are usually removed within two weeks, or dissolve.


Lower eyelids


Bulging lower eyelids can make even young people look tired, despite the absence of apparent excess skin. Under these circumstances, lower eyelid blepharoplasty surgery is often performed from the inside of the eyelid so that there is no visible scar.


If excess skin needs to be removed, then a fine incision is made in the crease immediately below the eyelash line, extending out into a natural skin crease in order to minimise the visibility of any scarring. When only skin is removed and there is no excess fat, the procedure is known as a pinch blepharoplasty.


What to expect


  • After surgery, you will experience some degree of swelling and bruising — cold compresses and elevation of the head will help to relieve any discomfort.
  • Bruising may take three or four weeks to disappear completely, although it can usually be concealed with make-up after seven days.
  • You can return to work if you want but if you deal with the public, you may want to delay your return for around ten days because of bruising and swelling.
  • It is important to avoid strenuous activity for the first week after surgery, although you may fly two days after the procedure.
  • Do not swim for four weeks because of the risk of infection.
  • Avoid heavy lifting, running or strenuous gym work-outs for four weeks or you may exacerbate bruising or swelling.
  • Antibiotic eye ointments are prescribed for several days after surgery.
  • You cannot wear contact lenses for at least 2 weeks after surgery, because the eyelids may be stiff and sore and your eyes may be dry.
  • Some people experience blurred vision or sensitivity to light for a few days.
  • In rare circumstances, tiny whiteheads may appear along the line where the stitches were — these can easily be removed in the clinic, using a needle.


You can read one patient's diary of her treatment in this Patient experience. Or see below


All procedures begin with a consultation. For full information about what to do before and after surgery, see Patient information – care plan for eyelid or orbital surgery.

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Upper eyelid blepharoplasty: a patient's diary

Initial appointment 

I had been bothered for a few years with sagging upper eyelids. The left eye in particular felt  uncomfortable and the drooping worsened towards the end of the day or when I was tired. 

My initial appointment was with Mr Malhotra at his Harley Street consultation offices. I was very apprehensive about having facial surgery but was reassured as this was his specialist area. 

We discussed my eyelid issues and the different options available. Mr Malhotra was very patient and understanding and I found it easy to discuss the procedures with him. He explained what each different procedure would achieve and how each was carried out. 

I opted for upper eyelid surgery and to have a mini brow lift at the same time. I chose to have a local anaesthetic, as I was comfortable with the idea of being awake while it was done, but I believe these procedures can also be carried out under general anaesthetic, or an in-between 
level of sedation. 

Mr Malhotra’s secretary called me the following day to confirm the total price, including hospital costs, where the operation would take place and the date. My operation was carried out at Gatwick Park Hospital. I made the decision not to have an overnight stay but this is one thing I would recommend to someone else, especially if you have your operation late in the day, as I did. 

Day of surgery 
My partner drove me to the hospital, as you are not allowed to drive yourself back – and, indeed, wouldn’t be capable of doing so. I was shown to a very pleasant room, where I changed into a hospital gown. Mr Malhotra and another doctor came in to see me and gave me an idea of what time my operation would be carried out, as he had several procedures before me that day.

At around 7.30pm, the nurses came through to take me to theatre. I had to take my contact lenses out at this point. I assumed I would walk but you are actually wheeled through on the bed. 

Once in the theatre, I did start feeling nervous again, but everyone there was reassuring. There were three additional nursing staff, as well as Mr Malhotra and the other doctor, who was observing the procedure as she was training to do the same thing. This was actually quite useful as, because he was explaining to her what he was doing, I got the run-through of how the procedures would take place. 

The brow lift was to be done first and so this was the first area the local anaesthetic was injected into – my forehead in the right upper area near the hairline and the left in the same place. This I would describe as uncomfortable and a bit painful but not unbearable and not as bad as I thought it would be. It wasn’t long at all before the whole top of my head felt completely numb – perhaps a couple of minutes. 

The next bit (sorry, I have to be honest!) was the local injections into the upper eyelid area. This was very painful and uncomfortable. One of the nurses held my hand, which really did help a lot. At this point, I would say that if you aren’t good with pain, it would probably be an idea if you are having the upper eyelid surgery to opt for sedation. However, compared with childbirth, it’s a walk in the park, as I kept telling the nurses (and myself!). If you are only having brow work, then I personally I found the local anaesthetic option fine. 

The surgery itself was utterly painless. The brow work was done first, right side then left. These were stitched with normal stitches that have to be taken out. I couldn’t feel anything other than a slight tugging. To relax me further, my choice of music was put on the in the background and I chatted while the operation was going on, which helped to take my mind off what was happening. At one point I felt a slight twinge and mentioned it, whereupon the local anaesthetic was topped up (which was painless). 

The eye surgery was also completely painless and dissolvable stitches were used. The operation lasted about two hours and I was wheeled back on the bed. The nurses were very reassuring – you can’t see anything because your eyes are covered with pads to soak up any last bits of bleeding.

I was issued with paracetamol, additional dressings, saline solution and eye ointment, along with a gel eye pack. After eating and drinking (which they insist you do before you leave), my partner came to collect me. I had to take the pads off to travel, so he did see my surgery, but it’s very difficult at this point to imagine what the end result will be.Once at home, I became slightly tearful and worried about what I’d done – the enormity of having facial surgery suddenly kicked in. Apparently this is not unusual. I’m not writing this to put anyone off – just to make you feel more normal/better if you go through it! I was fine by the following morning.

I did need to use pain killers to get to sleep and continued to use them on and off for the next three days, after which I didn’t need them. I wasn’t in great discomfort, I just felt as if I had a headache. The gel eye pack was excellent – you put it in the fridge for a while then lie down with it on your eyes. I went to sleep several times with this on, as it is so soothing.


Day 2 
I looked relatively normal in the morning but by mid-afternoon, underneath my left eye had started swelling. At this point, it appeared the eye was more stretched upwards on the right than the left eye and quite a bit more of the iris was visible on the right eye. This led to a major panicking session on my part, and I phoned Mr Malhotra’s secretary.

Within 15 minutes, Mr Malhotra had been contacted and rang me. He reassured me that the uneven swelling was probably causing this look but would look at photos, which I e-mailed over to him.

Day 3
Right eye starts to swell by lunchtime. Left eye very swollen indeed. Eyes still look unbalanced. 

Spoke to Mr Malhotra, who had seen the photos and was not concerned – he reiterated that once the swelling had gone down, the eyes should even up. 

Two points to note:
• It’s very reassuring that your surgeon is so readily contactable, especially bearing in mind that I was ringing after 10pm on a Friday night and over the weekend. 
• Try not to judge the final outcome by what you look like at this point, even if it is easier said than done.

Day 4
Came off the painkillers completely, still using the gel pack. Both eyes are extremely swollen underneath and have gone purple. When I use the gel pack, it lessens the swelling a great deal.

Days 5-6
Eyes start to look less swollen and turn yellow underneath. Eye gel pack is still in constant use. 
By day 6, eyes are starting to even up.

Day 7 
Back to hospital this am for my appointment with Mr Malhotra. By now, eyes have evened up completely. I still have the remnants of black eyes – bad enough to make me wear Victoria Beckham-sized sunglasses while waiting in the main reception. Mr Malhotra is pleased with the results and, by now, so am I. Although I was originally scheduled to have the stitches in my forehead removed today, Mr Malhotra recommends coming back next week to give the wounds a bit longer. As these stitches aren’t visible, because of my hairstyle, this isn’t a problem.

Week two
By day 9, I look pretty normal. For the next week or so, when I wake up in the morning my eyes and eye lids are quite puffy, so I schedule in a gel eye pack session for 20 minutes every am, which works well. As the day progresses, the puffiness seems to wear off.

I experience little twinges in my eyelids, like electric shocks, which I believe are the nerves healing. This lessens as the days go by.

I can finally, more than a week after the operation, see what I now look like. The effect is subtle, which is what I wanted. My eyes are more open but look very natural and the brow lift has raised my eyebrows slightly, which is what I wanted as they didn’t have much of an arch in them before. I also have fewer lines on my brow but there are still some, which looks in keeping with the rest of my face. If they had all gone, it would have looked unnatural. 

Day 13
I have stitches removed by a nurse in the hospital. 

Week three
Three weeks after the operation, the eyelid twinges have gone completely. The top of my head is slightly numb but this is slowly getting back to normal. It seems to help when I wash my hair and massage my head. The scars on the hairline from the brow lift are healing well. My eyelids are healing well too, although the dissolvable stitches don’t seem to have dissolved in many places. Apparently these dissolve at slightly different rates with different people but I am going in today to have them removed.

The finished result is very good – the droopy eyelid thing has gone completely. The brow lift has given me a better eyebrow arch and I do look a few years younger. It’s subtle, though – people who don’t know I’ve had it done haven’t realised, although this hasn’t been tested on very close female friends yet, and my family think that I still look like me but a bit better, which I think they were a bit worried I wouldn’t.

The whole process was much easier and less traumatic than I expected. I must also say that the level of care and support both during and after the operation is excellent, both from Mr Malhotra and from the nursing staff at the hospital.



"Diary of a Grateful Patient" (December 2017)

Day 0
For some time, I had been suffering from drooping of both upper eyelids and excess of skin. Mr Malhotra had proposed a bilateral upper eyelid blepharoplasty with ptosis correction. Despite being a surgeon myself, I was somewhat apprehensive about the deep sedation I was to undergo as I am more used to stand at the table than lay on it. All my worries evaporated when I met the anaesthetist, “Consider this a first-class flight, relax and enjoy” was how he introduced himself. This attitude also seemed to apply to Mr Malhotra and team who were clearly very relaxed and enjoying their work.
You doze-off while listening to music (your choice) and awake to find the surgery nearly complete. Once back in my room, a dull ache developed around the eyes but this was quickly relieved with paracetamol. There was some tightness and I could not close my eyes properly. To relieve this, I applied a generous amount of ointment in the eyes but to little effect.

Day 1
A good night’s sleep, though somewhat uncomfortable laying on my back to avoid contact between my eyelids and the pillow. My nose is very dry, this most likely due to the oxygen given via a mask during sedation. No pain now but instead a mild swelling of the eyelids with a deep red coloration, tightness when blinking and blurred vision due to the ointment.
Mr Malhotra was pleased with the result and encouraged me to blink more often. He advised to push the lower eyelid upwards to maintain wet eyes, this was very helpful.

Day 2
The swelling and redness has moved down to the lower eyelids and cheeks. Blinking is tight and uncomfortable.

Day 3
Blinking is much easier, no ointment required during the day. Back to a more normal routine, driving the car once more etc.

Day 4
Lots of ointment required at night, this giving sticky eyelashes. I find it helpful to remove the excess ointment from the lashes with cotton wool buds. The redness has reduced to a yellow discoloring of the cheeks.

Day 5
Suddenly very blurred sight in the right eye, with fresh blood weeping out with the tears. This occurs several times today. Sneezing is painful around the eyes.

Day 6
I awake with fresh bloody tears from the left eye. The swelling has now shifted towards the nose. I remove the sutures by pulling at the end as Mr Malhotra had explained to me. This was very straightforward and painless.

Day 7
Fresh bloody tears and more swelling round the right eye.

Day 8
Still visible bruising but I return to work in my private practice. At times blurred vision and soreness of both eyes, this is relieved using eye drops.

Day 10
Today a full working day. No discomfort. The left eye is slightly more swollen and raised than the right eye.

Day 13
My first night without pain when touching the pillow.

Week 2
I am now wearing my contact lenses once more. I see the scars are becoming thicker.

Week 3
My first day with no pain on touching the eyelids. The shape and height of the eyelids continues to improve, but still varies during the day.

Week 6
The right eye is perfect but the left eyelid is slightly raised. Visited Mr Malhotra who suggested correction to the left eyelid.

Month 4
Mr Malhotra advised me to take paracetamol one hour prior to the surgery. After a small injection of local anaesthetic, he made a slit to lower the left eyelid. A very quick procedure and without pain. The eyelid settled in to the desired position.
I am very pleased with the overall result and having the surgery done by Mr Malhotra! I find him a considerate, gentle and skilled surgeon.

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Raman Malhotra site map




The consultation

Academic role



Lectures and presentations

Research papers


Fellowship programme

In the news


Benign eyelid lump — Chalazion

Benign eyelid lump — Chalazion — Patient information


Cataracts — Patient information

Drooping upper eyelids — Ptosis

Drooping upper eyelids — Ptosis — Patient information

Excessive, involuntary blinking — Blepharospasm

Excessive, involuntary blinking — Blepharospasm — Patient information

Eye bags/heavy eyelids — Blepharoplasty

Eyelid skin cancer

Eyelid skin cancer — Patient information

Facial paralysis — Facial palsy

Facial paralysis — Facial palsy — Patient information

Inward-turning eyelid — Entropion

Inward-turning eyelid — Entropion — Patient information

Outward-turning lower eyelids — Ectropion

Outward-turning lower eyelids — Ectropion — Patient information

Thyroid eye disease

Thyroid eye disease — Patient information

Watery eye — Epiphora

Watery eye — Epiphora — Patient information


Artificial eyes and orbital implants

Artificial eyes and orbital implants — Patient information

Asian eyelid surgery

Asian eyelid surgery — Patient information


Botox — Patient information

Brow lift

Brow lift — Patient information

Cataract removal and lens replacement

Chemical peel

Chemical peel — Patient information


Eyelid lift — Blepharoplasty

Eyelid lift — Blepharoplasty — Patient information


Cheek and facial contouring

Cheek and facial contouring — Patient information

Lip filling and shaping

Lip filling and shaping — Patient information

Tear trough fillers

Tear trough fillers — Patient information

Upper eyelid contouring

Upper eyelid contouring — Patient information

Mohs surgery

Mohs surgery — Patient information

Ptosis surgery


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