Your journey starts with a conversation between you and your surgeon: the pre-operative consultation, which is crucial to the operation's success. Patients interested in surgery with Kensington Medical have multiple consultations with the surgeon. This is because we want our patients to be completely informed before they decide whether to proceed with surgery. In most cases, our patients have two pre-operative consultations.

The first preoperative consultation is generally face-to-face. Its purpose is:

• For you to explain to your surgeon your concerns and what you want to achieve with surgery.
• For the surgeon to examine you.
• For the surgeon to demonstrate what they can achieve by showing you before-and-after
  photographs of their patients.
• For you and the surgeon to discuss a treatment plan.

After the first consultation, the surgeon will write to you summarising your discussion with them. We will issue you with a quotation based on the treatment plan that you have discussed at the consultation. We will also send you extensive information about the procedure you are considering, including the risks it involves and the steps you should take pre-operatively and post-operatively in order to get the best possible outcome from your surgery.

A second pre-operative appointment is frequently required. This is because:

• You will have additional questions for the surgeon after the first consultation and after reading
  the information provided to you.
• Several treatment options are sometimes discussed at the first consultation, so further
  discussions are sometimes necessary to decide which one suits you best.
• The surgeon wants to ensure you have a good understanding of the risks of surgery and of
  what to expect from surgery.

The second consultation takes place by video call or in person.

Once you've decided to proceed with surgery, we will schedule your procedure at one of our specialist cosmetic surgery hospitals.

If you undergo an upper and lower blepharoplasty, or a lower blepharoplasty, your procedure is likely to be carried out under general anaesthesia. You will be asked to fill out a health questionnaire ahead of surgery. Your anaesthetist will evaluate this and may call you to go over aspects of your medical history. You may need to visit the hospital for blood tests. One of our medical staff members will go through this with you before your planned appointment. An Upper Blepharoplasty is generally carried out under local anaesthesia, in which case no anaesthetist will be involved.

We will also issue you with preoperative instructions. In particular:

• You should discontinue smoking for several weeks before your facelift, as smoking can
  increase the risk of complications during the healing process.
• You should refrain from taking blood thinning drugs (such as aspirin) for 10 days before your
  procedure.
• If your operation involves a general anaesthesia, you should not eat six hours before surgery;
  you should not drink two hours before surgery.

If your surgery is under general anaesthesia, you will be asked to arrive at the hospital at least an hour before your operation. The hospital's nursing staff will check your blood pressure, temperature and pulse. You will then meet your anaesthetist for a final check and your surgeon for a mark-up. For a local anaesthesia procedure, you will arrive around 30 minutes before the scheduled time and meet only the surgeon and nursing staff.

For an upper blepharoplasty, or upper lid surgery, the surgeon makes a cut following the eyelid fold, then trims away unwanted skin, muscle and fat to finally stitch up the wound. The operation generally lasts 45 to 60 minutes.

For a lower blepharoplasty (also known as lower lid surgery or eye bag removal), the surgeon cuts inside the lower lid or in the natural crease on the lower lid, below the lashes. The surgeon trims or repositions unwanted muscle, fat and loose skin. The wound is then stitched up. The operation lasts 60 to 75 minutes.

When both sets of eye lids are involved (upper and lower blepharoplasty), the operation lasts 75 to 90
minutes.

Following an operation under general anaesthesia, you will be transferred to the hospital’s recovery room. There, the nursing team will look after you and monitor you. Depending on the surgery and your reaction to it, you should spend two to four hours in the recovery room. If the operation is under local anaesthesia, the recovery period is quicker and sometimes takes place in the operating theatre. You will leave the hospital with a friend or a family member after the nursing staff is confident that you are in a fit condition to return home. You should make plans for someone to spend the first night after surgery with you. Although post-operative discomfort is typically not severe, you will be given painkillers just in case.

The quality of the postoperative care following a blepharoplasty is crucial to ensure a good outcome to the surgery.

Our nursing staff will be on call around the clock after you leave the hospital to make sure your recovery is comfortable and to answer any questions you may have.

In the weeks following your operation, your surgeon and / or our nursing team will see you in
consultation several times to assist you and check on the facial skin and scars:

• The surgeon will inspect the wounds and dressings on the next day following surgery.
• There will be another consultation one week after surgery, and the surgeon might decide to remove the sutures then, based on your healing progress.
• At around two weeks post surgery, all sutures that are still in place will be removed and the surgeon will monitor your progress.
• At six weeks, a final post-operative visit is scheduled. At that point, if the surgeon is happy with the outcome of your operation, he will discharge you from his care.

Following a blepharoplasty, bruising and swelling may persist for one month to six weeks.

You will be given aftercare recommendations by our medical staff specific to the operation you have undergone and taking into account your medical profile. The advice will cover a number of subjects, including: when it is safe for you to resume your daily activities, exercise, make-up, travelling, looking after your dressing; washing, diet, etc. It is crucial that you follow these directions carefully in order to reduce the likelihood of postoperative complications.

The sun can cause scarring, discolouration, and other undesirable side effects. It is therefore essential that you protect your face by wearing a hat (or using an umbrella) and applying sunscreen when going outside.

Regarding exercise, sport, strenuous movements or activities involving much facial movement, please wait until our medical team at Kensington Medical has given you the all-clear.

A healthy lifestyle that includes enough rest, a balanced diet and plenty of hydration is also a key contributing factor to ensure a good recovery and surgical outcome. This being the case, it is advisable not to smoke or consume alcohol before the operation and throughout the healing process.

The time it takes to get back to a normal daily routine and work after a blepharoplasty varies from one patient to the next. Several factors are at play: the actual speed of the recovery and each patient’s perception of how they look.

In the first 7 to 10 days post surgery, there can be some swelling and bruising. In addition, the scars will be more visible until the stitches come out. Some patients are happy to return to work or to their normal routine during that phase, while others prefer to take time off.

Generally, in the second week post surgery, patients are able to put concealant on their lids and most of them are happy to return to work or to their daily routine. After three or four weeks, the healing will be advanced, the swelling and bruising should have gone and you will start to look very good indeed.

You should enjoy the full results from your surgery six to seven weeks after surgery.