Hooded eyelid surgery, or blepharoplasty, is a cosmetic procedure that more and more UK patients are approaching with their eyes wide open. Not simply in terms of a thorough assessment to check their suitability, but also by opting to have their eyelids surgically reshaped under local anaesthetic.
This means patients remain fully awake through every moment (albeit with their eyes completely closed and immovable at the crucial moment) as their excess eyelid skin is removed. While that idea may provoke understandable trepidation, not to mention repulsion among the squeamish, it’s a technique now used as the preferred option at clinics such as London’s Face Restoration.
‘Having the operation under local anaesthetic offers both physical and emotional benefits,’ says Face Restoration's co-founder, oculoplastic surgeon Dr Rachna Murthy. ‘There’s faster recovery, lower risk and greater comfort immediately after the procedure. Patients remain fully aware yet relaxed, thanks to anti-anxiety medication, used alongside local anaesthetic injections to completely numb the pain. People are often surprised by how straightforward it feels.’
Having the patient awake and able to open and shut their eyes mid-operation allows surgeons to more accurately assess their reshaping work throughout the process and check that eyelids can close comfortably. ‘It allows us to do the best and safest possible job for our patients,’ says Dr Murthy, who performs blepharoplasty in a two-person team alongside her clinic co-founder Dr Jonathan Roos.
Patients don't need to worry about seeing a blade or opening their eyes accidentally, Dr Roos adds. 'The local anaesthetic stops the eyes opening for the first part of the operation as it causes swelling which then dissipates during op,' he explains.
To find out more, GH spoke to one of their patients, Beth, a 52-year-old HR professional from London, who candidly shared the reality of undergoing eyelid surgery wide awake.
‘I was a bag of nerves, waiting for the calming drugs to kick in’
Beth says: ‘I was always destined to develop hooded eyelids. My mum had them all her life and I was aware I’d inherited that shape from her. I could see my own lids getting slacker and heavier, especially as I went through my 40s. What I wasn’t expecting, though, was the physical problems that came with droopy lids. These got worse and worse every year: sagging skin creeping over my vision, bad headaches and waking up to watery eyes every morning.
It was really affecting my quality of life, and I remember confiding in a friend about it one day. “Well, you could have that operation for it,” she said, like it was the most obvious thing in the world. I was totally baffled. What operation? She looked surprised. “You know. Surgery to tighten your eyelids. The one that everyone’s having...”
That was news to me, as I hadn’t heard the word “blepharoplasty” before, but soon I was deep in research. I’d never had surgery in my life, unless you counted bunion removal, but after seeing all those eye-opening before and after photos, I began to consider it very seriously.
It wasn’t something I rushed into, however. I find the thought of cosmetic surgery very frightening in general, and this was going to be on my own face. If you don’t like the results, you can’t exactly get a refund! But over a year or so, I warmed to the idea, especially after a work acquaintance had it done and looked fantastic.
It wasn’t something to cut corners on, of course. I also met someone who’d gone abroad for cut-price blepharoplasty that had gone wrong, which made me especially vigilant about finding a top London surgeon I could really trust.
As it turned out, I found not one, but two: Dr Murthy and Dr Roos at Face Restoration. They perform blepharoplasty in a totally unique way, operating side by side, working on one eye each. They also do it under local anaesthetic, so yes – you’re awake throughout.
That idea was nerve-wracking but they were so reassuring about every part of the procedure. As they explained, doing the op under local anaesthetic removes the risks of going under general, and I’d be given anti-anxiety drugs to ensure I felt calm and comfortable throughout.
We talked about the benefits to my appearance – I’d look more awake, more refreshed – but we spoke far more about the health side. My brain, I learned, was constantly aware of the eyelids half-covering my vision, and was “telling” me to open my eyes wider, which was causing the headaches. For years, my husband had been asking, “Why are you always staring at things with your eyes so wide?” and I had no idea what he was talking about. Now it all made sense.
Dr Murthy and Dr Roos couldn't have done more to prepare me for the operation, but I was still a bag of nerves when I sat in the clinic, waiting for the anti-anxiety pill to take effect. Thankfully, by the time I was on the operating table and had taken a second diazepam, I felt incredibly relaxed.
The exact details are slightly hazy, but I was aware of everything that was going on. The doctors were talking to each other and I was talking to them, asking, “What’s happening now?” but in a totally calm way. Because of the drugs, I wasn’t scared at all, just curious!
My eyes had been completely numbed, so there was just a mild sensation of something happening, but not a trace of pain, and I definitely didn’t see a blade coming towards my eyes! The doctors both have such a lovely manner and were hugely reassuring throughout.
With the two of them working together, it was all over quickly. It took about 35 mins to do my eyelids, and also remove a benign growth from my cheek, which I’d had for years.
I went home in dark sunglasses, not because I looked particularly bad but because I was being picked up by my very squeamish sister. I had blue ink marks over my face and I could see I had stitches right across my eyelids, but it wasn’t gory or gruesome. The next day, the skin was swollen and beginning to bruise, but I honestly wasn’t in pain.
I was probably a very annoying patient because over the next few days I’d be constantly sending photos to the doctors, asking, “Is this right?” They were so kind and would reassure me that everything I was seeing was totally normal. Two weeks later, I went to have the stitches out, and that was probably more uncomfortable than the actual operation. My eyelids were still swollen, but I’d already been working from home for a week and nobody on Teams had recoiled and said, “What have you had done?”
It’s not something I’ve kept a secret. While I was healing, I’d just say, “I look like this because I’ve just had eyelid surgery.” The typical reaction from women my age was, “Really? I've been thinking about having that done – tell me everything!” And now you can see the final results, I’ve given out Face Restoration’s phone number more times than I can count.
I’d say it took four months until the swelling was completely gone, but that’s just me, knowing my own face. By four weeks, I looked totally normal to anyone else. There’s a thin scar where the loose skin was removed, but it’s mostly hidden away in the eye crease. The one tiny bit you can see is hardly visible, and it’ll fade away even more over time.
The difference has been incredible. Firstly, the headaches have completely vanished, which feels life-changing. I also look far more rested, and a lot of people have complimented me on that. I just feel so much more confident, not looking like I’m knackered and over the hill. Even my husband, who was worried I’d look like the Bride of Wildenstein, has said, “It looks great – I can understand why you’ve done it.”
It’s the little things, too. I can wear eye makeup again if I want to, after years when there was just no point bothering because my eyelids just swallowed it up. It’s lovely seeing myself wearing eyeliner in photos again, and thinking, “Oh my God! Beth’s back.”
And that’s the point, really. It’s not a transformation; it’s a restoration to how my eyes used to be. I still look and feel completely like myself, only better and less tired. My headaches are gone, my eyelids are back and, best of all, so is my self-confidence. I’m so happy I had it done.’
Blepharoplasty: need to know
What is blepharoplasty?
It’s an operation to rejuvenate the eyes by removing or redistributing excess skin and fat around the lids. It can be done on both upper and lower eye contours. ‘With age, the delicate tissues around the eyes can become heavy, puffy or sagging. By refining these contours, we restore natural definition and can transform a tired look,’ says Dr Jonathan Roos. ‘This procedure is also ideal for those whose vision is affected by drooping upper lids.’
How long is the recovery?
Most patients return to normal activities within a few days of upper lid surgery, around a week for lower lids, and about two weeks if combined with cold-ablative laser resurfacing, says Dr Roos. ‘Bruising and swelling are mild, and makeup or light skincare can usually resume soon after.’ The full results are seen once swelling completely subsides and skin has healed. ‘Final results are to be expected at three months – often faster,’ says Dr Roos.
‘For upper lid surgery, there should be no visible final scarring as the incision is mostly hidden in the crease, though for the outer parts of the incision mark, the healing take a little while longer to fade,' adds Dr Roos.
What are the benefits of using local anaesthetic?
‘Local anaesthetic avoids the systemic risks associated with general anaesthesia – particularly important for older patients or those with health concerns,’ says Dr Roos. ‘Recovery is faster; patients typically go home the same day, with less grogginess and a quicker return to normal life.’
Results are more precise, he adds. ‘Because patients are awake, surgeons can refine adjustments in real time to ensure the most natural, balanced aesthetic outcome. This is especially beneficial for those who have naturally droopy eyelids. It’s also safer for lower lid surgery, as you can check that the eye muscles aren’t affected, and for upper lid that the eye still closes and opens.’
What if patients are nervous?
‘We always reassure patients that it’s completely natural to feel that way,’ says Dr Murthy. ‘We have a pre-op call the night before and a three-way WhatsApp group with every surgical patient for 24/7 availability.’
If a patient doesn’t want local anaesthetic with diazepam, ‘We can do sedation or general, but for patients it’s safest and best to have it under local,’ says Dr Roos.
How common is blepharoplasty?
According to the latest stats from the British Association of Aesthetic Plastic Surgeons, its members performed 3,138 blepharoplasty procedures in the UK (2024, BAAPS). That’s a 13% year on year growth, making it the third most popular cosmetic surgery operation.
What are the potential risks?
While a good clinic will do everything to minimise potential complications, no operation is without potential risks. According to BAAPS, potential complications and risks of blepharoplasty include bleeding during surgery, infection, a haematoma in the eyelid, suboptimal scarring, asymmetry, skin discolouration and delayed healing.
This is a highly-skilled procedure and should only be carried out in expert hands. Having it under local anaesthetic avoids the general risks of general sedation, but as Dr Murtha stresses, 'It takes an experienced surgeon to be able to do this procedure with local whilst also keeping the patient completely at ease'.
*Upper lid blepharoplasty costs £7,950 at Face Restoration
