Have you ever wondered what a day in the life of an oculoplastic surgeon looks like? What about a plastic surgeon that specialises in the area around your eyes? These are doctors that are trained in plastic surgery in the eye area.

Dr Nick Koutroumanos is a London-based Oculoplastic Surgeon. Here is a quick look at what he treats and what his daily schedule may look like.

What an Oculoplastic Surgeon Treats

Dr Koutroumanos targets the area around your eyes. Plastic surgery is not just about how you look. This kind of surgery can be the solution for many medical ailments. Eye surgery can help treat teary eyes and blocked tear ducts. Sometimes eyelids can become misshapen because of other illnesses. Eyelid surgery may address these conditions. Oculoplastic surgeons can also treat cataracts and perform reconstructive surgeries around the eyes.

Dr Koutroumanos is a specialist in addressing cosmetic concerns. Some common cosmetic eye surgeries are brow lifts and eye bag removal. He is also trained to inject fillers and Anti-Wrinkle Injections around the eye area. Dr Koutroumanos has received praise from his patients for their quick recovery times and results from eye bag removal.

He will also spend some of his time meeting with patients and making plans for treatment. The other part of his time is spent in surgery. Dr Koutroumanos splits his time between his private practice clinic, London Ophthalmology and Ophthalmic Plastics, and working for the National Health Service.

Clinic Days

Pre-Op Consults

Before any kind of surgery can take place, Dr. Koutroumanos will get to know you and the reasons for your visit. He will ask about your medical history and any pre-existing conditions.

He’ll also ask about your desired outcome after surgery. The goal is that your ideas align with Dr Koutroumanos’s practices and that any concerns between both parties are addressed.

Before proceeding with any treatments, you’ll also receive a full eye exam. This is so Dr Koutroumanos can decide what procedures are best suited for your wishes and to rule out any reasons that surgery may not be suitable. You’ll have some clinical photos taken as a reference. Then you and Dr Koutroumanos will develop a plan for treatment.

Dr Koutroumanos’s private practice is based out of The Hospital of St John & St Elizabeth, and he sees his NHS patients at the Royal Free Hospital in Hampstead.

Minor Procedures

These surgeons can do minor procedures like Anti-Wrinkle Injections or filler placement. Typically these kinds of appointments will be set for a time that Dr Koutroumanos is in the clinic rather than the operating room.

Post-Op Appointments

Dr Koutroumanos also follows up with patients after their operation. He’ll remove sutures and bandages and check to see how patients are healing. He may ask how you’re feeling, how the healing process is going, and if any problems have come up since the surgery. Dr Koutroumanos takes special care to check in with parents of young children since one of his specialties is paediatric oculoplastic surgery. He will also check in at this stage to gauge your reaction to the procedure. This is another chance for you to ask any questions you still have about your surgery or recovery.

Operation Days

Each day spent in the surgery bay will look different depending on what procedures are scheduled. Dr Koutroumanos employs two secretaries full-time and works with other medical professionals on operation days. He regularly works with Dr. Camilla Davies as his anaesthetist.

Before each procedure, Dr Koutroumanos checks in with his patients. He’ll ask how you’re feeling and explain the procedure once more. He may also draw some pre-operative markings and go over his expectations for your surgery. On the day of surgery, Dr Koutroumanos will make sure you are comfortable and understand the procedure he’s about to perform.

Surgeries last for different amounts of time depending on how complex they are. Simple procedures might be done in under an hour. Complex procedures can take much longer. If it is safe and called for, it may be possible to combine several procedures into one session.

Dr Koutroumanos specialises in many areas of ophthalmologic surgery. He is an expert in complex tear-duct surgery for paediatric patients and is practiced in reconstructive eyelid and upper facial surgery. Dr Koutroumanos has also been praised for his skills in aesthetic rejuvenation and cosmetic eye surgeries.

Training Others

Dr Koutroumanos also trains other young professionals. He leads a fellowship program that trains surgeons from all over the world. These fellows observe under Dr Koutroumanos’ leadership to better understand this field. He is also a trainer and Royal College Examiner for ophthalmologic plastic surgery, cataract surgery, and general ophthalmology.

If you are in need of the services of Dr Koutroumanos or are interested in learning more about what a day in the life looks like for him, contact our office and set a time to meet.

Book Your Consultation

Ready to explore how eyelid surgery can enhance and rejuvenate? Book a consultation with Dr Nick Koutroumanos:

Blepharoplasty surgery is a common eyelid procedure that can help with the appearance of drooping eyes. The total cost of this surgery depends on the oculoplastic surgeon you choose, the hospital they work out of, and what kind of treatment you want. Here are the top things to know if you’re thinking about this kind of procedure.

Types of Blepharoplasty Surgery

As we age, the fine skin around our eyes stretches and becomes less elastic. This stretchy skin creates a hooded effect on our top eyelids and a sagging effect on the bottom eyelids. Hooded lids can impact your field of vision. Many people also find that sagging lids detract from the beauty of their eyes.

There are two types of blepharoplasty that target the top lid and bottom lid. You can also combine these surgeries and have them done at the same time. The surgeries only differ slightly from top lid to bottom lid. The upper eyelids are done with tiny incisions along the crease, and the lower eyelids are done with a completely invisible incision or less commonly one just under your lash line.

Fixed Price Surgery Costs

There are some general costs for all surgeries. This may include the cost of use of the operating room (theatre), the cost of anaesthesia, pharmacy costs, and the costs of post-op care.

Location is a large factor in the total cost. Urban hospitals treat more people and have a greater demand for their equipment. They also spend more on new technology and skillful staff. Expect to pay more if you seek treatment in London versus the provinces. The experience of your doctor may also influence the cost of your treatment. A tenured surgeon will come at a higher cost than a junior plastic surgeon.

Contracts differ from hospital to hospital. One hospital may include all follow-up appointments and pharmacy costs, others may only cover costs incurred within hospital walls. Make sure that you read the fine print to find out about any hidden fee-per-service charges.

Average Cost

The average cost varies hugely in the UK with promotional fees and very economical rates offered by non-specialist clinics. By and large, lid surgery carried out by oculoplastic surgeons tends to be somewhat pricier due to the expertise involved. Having both upper and lower eyelids done at the same time will be more expensive than just the top or bottom lid but one can usually expect a four eyelid blepharoplasty to cost them less that having the uppers and lowers done separately due to economies of scale.

Insurance Coverage and Private Pay

The NHS does not usually cover blepharoplasty surgery. It is considered a cosmetic procedure, and these are generally not covered. Exceptions may be made for drooping eyelids that significantly impact your vision or quality of life. You’ll need to work with a doctor to demonstrate this impact. Otherwise, expect to self-pay for this procedure.

Other Procedures

Some people use the chance while already under anesthesia to get multiple procedures. As long as this is approved by your doctor and tolerated by your health, there is no problem performing multiple procedures. Some treatments that people commonly combine with eyelid lifts are Anti-Wrinkle Injections and eyebrow lifts. Adding more procedures will increase the total cost of your surgery. However, this may be less than choosing to have a separate operation later and pay hospital fees again.

How to Decide on an Oculoplastic Surgeon

You have lots of freedom to choose your surgeon when paying privately for your operation. With Dr Koutroumanos, your experience starts with the first phone call to our office. You will feel warm and welcomed by our office staff when you call.

Dr Koutroumanos is a surgeon with the experience to back up his credentials. You can expect better results from a doctor with an excellent track record than one fresh from college. They may come at a higher cost, but you should not compromise on the quality of your oculoplastic surgeon. Dr Koutroumanos was awarded three scholarship fellowships all around the world before settling down in his London office.

Each surgery is unique to the person it is being performed on, so be wary of one size fits all treatment plans. Dr Koutroumanos believes that the best kind of cosmetic procedure is one that complements your natural features and is minimally invasive, saving you recovery time and preserving your natural beauty.

Book Your Consultation

Ready to explore how eyelid surgery can enhance and rejuvenate? Book a consultation with Dr Nick Koutroumanos:

Eyelid bumps can easily go away using home remedies. If the lump interferes with your vision, doesn’t respond to home treatment, or is too painful to bear, seek medical treatment. Understanding what causes eyelid bumps can also aid prevention and decision-making as some conditions may require eyelid surgery. Here’s an overview of eyelid bumps as well as the different types, symptoms, treatment, and prevention:

What Is An Eyelid Bump?

An eyelid bump is any painful lump at the edge of your upper or lower eyelid.

Some appear red and are located where the eyelash meets the eyelid. Bacteria and oil gland blockage are the common causes of most eyelid bumps, and the condition is generally harmless. You don’t necessarily require medical treatment as bumps can go away with basic home care. Other cases are severe and call for prompt medical care and diagnosis.

Types of Eyelid Bumps

Before considering treatment for your eyelid issue, you should know the type of bump. Understanding what kind it is and the underlying cause will determine your treatment options. All eyelid bumps can fall into these primary categories: styes, a chalazion, viral papilloma (warts), cysts (sebaceous and apocrine cysts), and xanthelasma.

  1. Styes: A stye occurs when bacteria penetrate the oil glands in your eyelids, Styes are common and round, with a red bump close to the eyelash. It can make you feel sore or itchy around the eyelid and increase sensitivity to light, resulting in teary eyes. A style requires a few days to form, and you can have more than one on the same eyelid.
  2. Chalazion: A chalazion is another common type of eyelid bump stemming from issues with the oil gland. It’s an inflammatory lesion that develops when your tear gland or oil-producing glands in the eyelids get blocked. A chalazion can grow to a bigger size than styes and is generally painless. The bump can, however, interfere with your vision, depending on its location and size.
  3. Viral Papilloma (Warts): Viral papilloma generally occurs in middle-aged or elderly adults. It is benign and painless and appears as a simple skin tag on the eyelid. Standard removal of this eye bump includes excision, where the doctor will surgically remove the wart from the eyelid.
  4. Sebaceous Cysts and Apocrine Cysts: Apocrine cysts are rare but benign cystic tumors of the apocrine sweat glands. These nodules may appear along the eyelid margin. Sebaceous cysts are also benign. Visit your doctor to assess the condition of your eyelid. They will determine whether you have eyelid cysts or a different kind of bump.
  5. Xanthelasma: This eyelid bump stems from fat buildup under the skin. Xanthelasma is generally harmless, yellowish, and occurs more in older people. Such eyelid bumps can also indicate high cholesterol levels. If xanthelasma interferes with your vision or becomes painful, consider medical treatment as this may suggest other issues, such as bacterial infection (stye).

Symptoms of Eyelid Bumps

Eyelid bumps manifest in different symptoms depending on the type. Most lumps are either red or the color of your skin and appear along the edge of the eyelid.

The bump may be tender or firm, and others result in watery eyes, gritty, scratchy sensations, and light sensitivity. Eyelid bumps can be mild or harmless, but you should seek medical attention if you experience the following:

  • Your eyes become teary/watery
  • There’s discharge from your eye
  • The white part of your eye changes color
  • The bump causes trouble seeing
  • Your eyes hurt in low lighting
  • The bump grows or gets extremely painful
  • You experience eyelid blistering and bleeding in the eyelid bump
  • Your eyelid becomes scaly, crusty, or reddish

What Causes Bumps on Eyelid?

Stye eyelid bumps occur when bacteria enter the oil glands in your eyelid, causing inflammation. Those with blepharitis and other eyelid inflammation conditions are more likely to get stye bumps. Chalazion bumps can form when the eyelid oil glands and tear glands are blocked. A style that fails to drain can become a chalazion. Xanthelasma bumps appear when fat collects below the skin surface and may indicate an underlying condition.

Preventing Eyelid Bumps

You can do various things to prevent developing eyelid bumps. Practicing good hygiene is essential in stopping the spread of bacteria and preventing stye eyelid bumps. Make sure you don’t touch your eyes until you’ve washed your hands. If you have blepharitis, rinse your eyelids at least once a day and use a warm compress as soon as you feel irritation. You can also keep xanthelasma bumps at bay by controlling cholesterol levels and eating healthy.

Eyelid Bumps Treatment

Not all eyelid bumps are avoidable or resolved without treatment. If you’re concerned about a stye or chalazion bump becoming bigger or more painful, consult a professional immediately. Some bumps resolve with common home remedies, but others may require advanced procedures like eyelid surgery to restore normal function. Here’s a look at popular treatment options for eyelid bumps:

Home Care
A warm compress is a popular home care treatment for eyelid bumps. Holding a warm compress for about ten minutes up to four times a day can help loosen and drain blockages in the glands. Heat and compression can also aid healing, but these homecare practices aren’t required for xanthelasma.

Medical Care
If the eyelid bump doesn’t respond to warm compress and routine hygiene, you should involve a medic. The eye is a delicate organ and requires experienced ophthalmologists and eye surgeons to correct. Your doctor will determine whether the bump needs puncturing, draining, antibiotic cream and drops, or eyelid surgery.

Do I Need Eyelid Surgery?

Bumps, such as a large chalazion that doesn’t go away on its own, may require surgery. Eyelid surgery will remove the bump and treat the wound to protect your eye from infection. Surgery can also correct fluid drainage and blockage issues. Dr Nick Koutroumanos specialises in the eyelid, eye socket, and peri-ocular surgery.

Book Your Consultation

Concerned about your eye health? Book a consultation with Dr Nick Koutroumanos:

Plastic and oculoplastic surgeons are closely related but have some distinctions worth mentioning. Oculoplastic surgery mainly deals with the eyelids and structures around the eye, while standard plastic surgery covers the entire body. Here’s an overview of the main differences between oculoplastic (eyelid) surgery and general plastic surgery.

Plastic and oculoplastic surgeons are closely related but have some distinctions worth mentioning. Oculoplastic surgery mainly deals with the eyelids and structures around the eye, while standard plastic surgery covers the entire body. Here’s an overview of the main differences between oculoplastic (eyelid) surgery and general plastic surgery.

Plastic and Oculoplastic Surgeon Education

An oculoplastic surgeon must complete training and internship and needs more extensive training than general plastic surgeons. The Oculoplastic surgeon must graduate from medical school and complete nine years of internship and residency in ophthalmic surgery.

Candidates must also complete two years of additional fellowship training. They’ll undergo scientific research and oral/written examinations. Oculoplastic surgeons must also perform 500 surgeries before they begin specialised training in ophthalmology.

Plastic surgeons need to graduate from medical school and complete several hours of training and internship. A plastic surgeon will begin a residency in general surgery immediately after completing medical school. The training focuses on general treatment for various body parts.

Candidates training to become plastic surgeons will also complete fellowship training in plastic surgery. The training involves treating and operating on all parts of the body. On average, plastic surgeons will complete at least 150 surgeries before specialised training.

Oculoplastic Surgeries and Treatments

Oculoplastic surgery focuses on the eyelids, eye sockets and facial structures around the eye area. It’s a highly specialised surgical procedure combining ophthalmology and plastic surgery. The surgeries are also delicate and involve operating on incredibly fine structures.

The procedure also comes by other names, including oculofacial surgery, ophthalmic plastic surgery and ophthalmic reconstructive surgery. Oculoplastic surgery can be cosmetic or reconstructive or both.

Certified surgeons can treat conditions affecting these structures, including watery eyes, injuries, drooping eyelids, skin cancers and thyroid eye disease. Popular oculoplastic surgeries include blepharoplasty and ptosis repair:

  • Blepharoplasty – refers to a type of eyelid surgery used to treat patients with excess upper eyelid skin that folds over the eyelashes or lower eyelid wrinkling, bags or dark circles.
  • Ptosis Repair – involves correcting an upper eyelid that droops over the pupil because the eyelid lifting muscle is weak or slipped.

Oculoplastic surgeons can also offer non-surgical procedures for patients with cosmetic and functional issues. Other treatments include skin care to enhance the appearance of facial skin. The surgery combines microsurgical skills and aesthetic and soft-tissue skills.

Microsurgical operations are part of an ophthalmologist’s work. The aesthetic and soft-tissue operations are from general plastic surgery. Oculoplastic surgeons may specialise in specific procedures, such as peri-ocular surgery or eyelid surgery.

Plastic Surgeon Operations and Treatments

Plastic surgery involves restoration, reconstruction or alteration of the skin and musculoskeletal tissues. A plastic surgeon can perform the procedure on all parts and extremities of the body, including the head and face, neck, chest, abdomen and back.

Anti-Wrinkle Injections, Juvederm, Xeomin and Volbella are typical plastic surgeries for addressing wrinkles, fine lines, ageing and more. Plastic surgery falls into two primary categories: cosmetic and reconstructive/functional.

  • Cosmetic Surgery – Focuses on enhancing appearance. It is the most commonly sought plastic surgery and suits those looking to reverse ageing or alter appearance.
  • Reconstructive Surgery – Also known as functional surgery, reconstructive surgery focuses on restoring or improving function. It suits people who have an injury or condition requiring reconstruction to regain normal function.

Popular plastic surgeries are further grouped into different categories based on the body part. Popular types include head, face and eyes, mouth and teeth, breast, abdomen, hand and upper limb and skin. Here are examples under each category:

  1. Head/Face Surgeries: Includes facelift, forehead/brow lift, eyelid lift, ear reshaping, hair replacement, nasal surgery and nose reshaping. Chin, cheek and jaw reshaping, lip augmentation, cleft lip/palate and craniosynostosis are also standard head plastic surgeries.
  2. Mouth and Teeth Surgeries: Maxillofacial and oral surgeries are the two famous mouth and teeth plastic surgeries. They involve reconstructing and enhancing the teeth, jaws and mouth.
  3. Breast and Abdomen Surgeries: Breast surgery includes breast augmentation, reconstruction and reduction (for Gynecomastia) and breast lift. Abdomen surgeries include a tummy tuck (abdominoplasty) and liposuction.
  4. Hand and Limb Surgeries: Chase hand and limb centre are the standard procedures under this category. They mainly involve cosmetic enhancements but may also suit functional reconstructions.
  5. Skin Plastic Surgeries: You’ll encounter several skin surgeries, including chemical peel, Anti-Wrinkle Injections, dermabrasion and injectable collagen fillers. Other examples include glycolic and laser peels, vein removal, scar revision and tattoo removal.

Other Key Differences Between Plastic and Oculoplastic Surgeons

Oculoplastic surgeons begin with fine touch obtained from ophthalmology training. The surgeons focus solely on the eyes and facial regions and are specialists in such operations.

Plastic surgeons begin with large touch, big body and bowel manipulations obtained from general surgery training. A plastic surgeon will cover many body parts, including the head, neck, arms/limbs, chest, abdomen and more.

You’ll encounter fantastic plastic and oculoplastic surgeons, but the latter has a slight edge when it comes to aesthetic facial surgery. Plastic surgeons are big sculptors specialised in chipping away unwanted parts to produce beautiful results.

Oculoplastic surgeons use delicate, small and precise movements to produce the most beautiful outcome. They will learn precision and finesse in ophthalmology and oculoplastic fellowships.

Oculoplastic surgeons suit eyelid and facial plastic surgery where attention to detail is vital for better surgical and aesthetic outcomes. Some plastic surgeons can still achieve a great job performing eyelid surgeries but won’t be nearly as good as oculoplastic surgeons.

Who Should I Visit for Eyelid Surgery: Plastic or Oculoplastic Surgeon?

Oculoplastic surgeons are arguably plastic surgeons, albeit specialised in the eyelid, eye socket and facial structures surrounding the eye area. If you need eyelid surgery, peri-ocular surgery, ptosis repair or general ophthalmologic services, you should visit an oculoplastic surgeon.

General plastic surgeons can handle various procedures to treat different areas. An oculoplastic surgeon can only operate on the eye and facial area, while plastic surgeons work on all body parts. You can visit a plastic surgeon for head, neck, chest, arm and abdomen surgeries.

Since oculoplastic surgery is plastic surgery, experienced plastic surgeons can perform eyelid operations and other facial procedures. Patients should review each surgeon keenly to choose the right professional for their needs.

Oculoplastic surgeons offer better precision and finesse for delicate eye surgeries and ophthalmological procedures.

Eyelid Surgery with Dr Nick Koutroumanos: Your Solution to Rejuvenated Eyes

London Ophthalmic and Oculoplastic surgeon Dr Nick Koutroumanos is an expert in ophthalmic plastic and reconstructive eyelid surgery including upper and lower blepharoplasty.

Book Your Consultation

Ready to explore how eyelid surgery can enhance and rejuvenate? Book a consultation with Dr Nick Koutroumanos:


Eyelid surgery is a big undertaking, and there are many questions to ask your oculoplastic surgeon during consultation. The best approach is to prepare a list of questions about everything you need to know about the procedure. After consultation, you should feel ready and adequately informed to decide. Here are four sets of questions to ask during your oculoplastic consultation:

1. Questions About the Oculoplastic Surgeon

Oculoplastic surgeons specialise in performing functional and cosmetic eyelid and facial area surgeries. The eyelid, eye socket and surrounding structures are very delicate and require precision. You need a reputable, trustworthy surgeon with the proper training, experience and skill for the procedure. Ask these questions during the first consultation:

  • Which institution did you attend for medical school, residency training and fellowship training program?
  • Do you perform specific eyelid surgeries (blepharoplasty, peri-ocular surgeries, ophthalmologic services, upper/lower eyelid)?
  • How long have you performed surgeries, and how many procedures have you completed?
  • Do you have a license from the state to perform eyelid surgeries? Are you board certified?
  • Does your surgical facility have a verifiable accreditation from a national/state-recognised accrediting agency?
  • Do you have verifiable references and testimonials from your past eyelid surgeries?
  •  What is your success rate with patients like me?

Asking questions about the surgeon will help you identify skilled, experienced professionals with a license and board certification. It also helps to build trust between you and the surgeon to focus on getting ready for the procedure. The goal is to find top eyelid surgeons and clinics in your area.

2. Questions About the Surgical Procedure

Undergoing a surgical operation comes with concerns, and you also have specific objectives you want to achieve with the procedure. The consultation offers the best opportunity to learn the ins and outs of the operation, including whether you are the right candidate. Here are some questions to ask your oculoplastic surgeon about the procedure:

  • Am I a good candidate for eyelid surgery?
  • What does surgery accomplish? Are my goals reasonable?
  • Where will the surgery take place?
  • Which anesthesia is used in the procedure?
  • What steps are involved/what happens during the surgery? How long will it take?
  • Are there any side effects, risks or complications? How do you handle such situations?
  • How long until I’m discharged from the hospital/clinic?
  • Will I have scarring? How long will it take to heal?
  • What can I do to enhance the results of the procedure?
  • What options do I have if the outcomes don’t meet my expectations?

Questions about the procedure will provide informative answers to determine if you want to follow through or find other solutions. It’s crucial to ask everything you need to know to be comfortable. These questions will also help you understand the limitations and set realistic goals.

3. Questions About Required Preparations

Your surgeon will recommend a few changes in your lifestyle and daily activities to prepare for the procedure. It’s vital to follow all instructions for pre and post-surgery to enhance the outcome and speed healing. You should ask the surgeon all kinds of questions to help you get ready for the operation. Here are some top inquiries:

  • For how long should I stop smoking before the procedure?
  • What medications, supplements or vitamins should I stop taking? How long in advance do I stop taking them?
  • Can I eat, drink and take a shower on the morning of my surgery? Are there any specific outfits I should avoid or wear to the clinic?
  • How do I prepare for the day of my surgery? At what time should I arrive at the clinic?

You shouldn’t rush oculoplastic surgeries. A consultation will help you plan for the day of surgery and adjust your lifestyle to be in the best shape and health for the procedure. Good preparation is critical for successful eyelid operation and faster recovery. You should be open and honest with the surgeon about your lifestyle and daily activities.

4. Questions About Post-Procedure Recovery

Plastic and oculoplastic surgeries can leave you incapable of performing your daily activities. In the case of eyelid surgery, you’ll experience discomfort, swelling, double vision and other symptoms. Arranging for someone to pick you from the surgery facility and stay with you for the night of the procedure is vital.

You need to review the following questions in advance to plan for your operation:

  • When do I go home after the procedure?
  • How will I feel immediately after surgery?
  • How long will my recovery take?
  • Do I need special medication for recovery?
  • Will I need prescribed painkillers?
  • How soon can I resume regular activities (washing my face, wearing makeup, going out in public, exercising, driving or going to work)?
  • Do I need special gear like an eye patch or glasses?
  • When should I come back for a follow-up visit?
  • How do I minimise the chances of a complication or scarring?
  • Who do I contact in case of a complication or emergency?
  • What limitations should I be aware of during recovery?
  • Can I maintain long-term results? How?

Eyelid Surgery with Dr Nick Koutroumanos: Your Solution to Rejuvenated Eyes

London Ophthalmic and Oculoplastic surgeon Dr Nick Koutroumanos is an expert in ophthalmic plastic and reconstructive eyelid surgery including upper and lower blepharoplasty.

Book Your Oculoplastic Consultation

Ready to explore how eyelid surgery can enhance and rejuvenate? Book a consultation with Dr Nick Koutroumanos:


Oculoplastics in the News: What is eyelid ptosis? What is a droopy eyelid and what can be done to correct this in London?

Published: 04/08/2021

The clinical nuances involved in recognising ptosis are very important when it comes to considering the condition, how it’s caused and options regarding repair.

Leading ophthalmic and oculoplastic surgeon, Dr Nick Koutroumanos speaks to Top Doctors about these issues as well as the difference between ptosis and hooded eyes, and the management of ptosis in children.

What is ptosis?

When people refer to droopy eyelids, they may be describing a number of different things which, in clinical practice, actually vary. They vary both in terms of what causes them and more importantly, how they ought to be repaired.

Eyelid ptosis or blepharoptosis, is in a sense a true eyelid droop, and it refers to the condition when one or both upper eyelids sit in a position lower than normal, whatever this normal might be for every different person. By eyelid, here we refer to the curved edge of the upper lid where the lashes are found and the area which wipes the eye’s surface every time we blink.

What causes ptosis?

The causes of ptosis form a long list and a vital part of the assessment with an oculoplastic specialist is working out which of these actually causes someone’s droopy eyelid. Individuals can be born with a droopy eyelid on one or both eyes. In these cases of congenital ptosis, it is actually quite common for both eyes to be affected but to a different degree.

If you are not born with eyelid ptosis but have instead developed it later in life, chances are you have what we refer to as aponeurotic (or involutional) ptosis, which in effect refers to the gradual stretching and slipping of the little muscle which controls the eyelid position. This is common and is easily addressed by day case surgery. Correction is proven again and again to be associated with significant improvement in people’s quality of life. A droopy eyelid can of course affect one’s vision if severe enough but even in milder cases, headaches may develop due to the constant eyebrow lifting and of course, confidence is frequently affected.

A very small proportion of individuals will develop eyelid ptosis due to an underlying medical condition or injury and though these cases are uncommon, it is vital that they are identified and, when necessary, managed promptly.

What is the difference between ptosis and hooded eyes?

This is a good question because this distinction is very important to make. Hooded eyes, or dermatochalasis, is when the upper lid’s curved edge, (lash line) is sitting on an appropriate and symmetric position in front of the eye but the skin above it, is excessive. This can have many appearances, from skin hooding, hiding part of or the whole eyelid, to a bulging, bulky swelling giving a swollen eyelid appearance and so on. People describe puffy, hooded, droopy or fatty eyelids. Much like with eyelid ptosis, hooding can be distressing and disfiguring. Individuals are often thought of as being tired and can appear more aged than they feel.

When more severe, dermatochalasis or hooding can cause headaches or reduction of peripheral vision. Upper eyelid blepharoplasty surgery, when carried out by eyelid specialists is safe and rapid, a day case or sometimes in-office procedure which can dramatically improve one’s youthfulness and appearance.

What is the best treatment option for ptosis?

As mentioned previously, the first and most vital bit here is making an appropriate diagnosis. Ptosis can be missed during your average non-specialist aesthetic assessment and this sometimes leads to blepharoplasty surgery being carried out inappropriately with disappointing results.

When eyelid ptosis is picked up, certain measurements carried out will define the suitability and need for surgery but also the ideal technique. If not all, the vast majority of eyelid ptosis carried out in my practice is done via a hidden incision or no incision at all, meaning that no scar is visible after surgery. An assessment of the eyeball and the eye surface will decide how safe ptosis surgery is. The need for one or both eye surgery will be assessed so that symmetry can be optimised.

Though any surgeon’s main focus will be the safety of the eye and its function, detailed attention should be given to restoring and improving symmetry and youthfulness.

What are the complications of ptosis surgery?

When ptosis and its causes are suitably worked out and the correct management plan is offered, ptosis repair surgery is a very safe procedure. Most often, it is carried out under local anaesthesia with an administration of a relaxant to ensure that the procedure is pleasant. Down time is usually about a week.

A very small proportion of patients, in the range of 5 to 10 per cent, may be offered some adjustment for refinement of the symmetry or the resulting eyelid position. Dry-eye sensation can be encountered for a number of days or weeks after surgery and a very small proportion of cases may experience longer periods of dryness. This, however, is very uncommon.

How is ptosis managed in children?

Ptosis repair in children can be both more challenging but also often more beneficial.

Depending on the severity of the droopy eyelid, the effect it causes on the child’s vision, head posture and psychosocial wellbeing, surgical correction can be offered. Congenital ptosis repair is an area of medicine of particular interest to me, given not only the technical precision required to deliver a precise result but also the incredible effect this intervention can have on a child’s quality of life and development.

A variety of surgical techniques are available all of which are carried out under general anaesthetic. The choice of technique is based on the child’s age, severity of ptosis and the strength of the eyelid muscle. Maintaining the safety of the eyes and providing a lasting natural and functional outcome is kept central to any treatment carried out.

Book Your Consultation

Concerned about your eye health? Book a consultation with Dr Nick Koutroumanos:

National Eye Health Week – Podcast

Episode 1: How the eyelid helps in protecting the eyes with Dr Nick Koutroumanos

In celebration of the National Eye Health Awareness week, we’ve invited Dr Nick Koutroumanos, Consultant Ophthalmologist from Royal Free Hospital, who helped us answer some of the most important questions on how critical it is to look after our eyes to prevent any issues in the future.

Dry eye is a condition most common to people living in a city like London and during the pandemic. Dr Koutroumanos explained the role of eyelids in protecting our eyes and gave some practical tips to protect them.



London oculoplastic surgeon and eyelid expert Dr Nick Koutroumanos featured in the Daily Telegraph.