Cosmetic Eyelid Surgery

Ptosis Repair

Ptosis of the eyelids is a common condition we treat in our London eye surgery clinic. It involves drooping of the upper eyelid, reducing the size of one or both eyes. Various factors contribute to eyelid ptosis, with the most prevalent cause being the gradual wear-and-tear of the muscle responsible for lifting the eyelid.


In most cases, correcting eyelid ptosis is a routine day surgery with minimal downtime of approximately a week. If a surgical incision is required, a small hidden incision is almost always employed by Dr Koutroumanos, meaning no scar will remain visible.

When performed by a specialist oculoplastic surgeon, ptosis repair is typically a very safe procedure that has shown substantial quality of life improvement in numerous clinical studies.

An oculoplastic surgeon focuses only on the eyelids, eye sockets and facial structures around the eye area. It’s a highly specialised surgical procedure combining ophthalmology and plastic surgery.

Factors such as a prolonged history of contact lens use, prior eye surgeries, or trauma can result in a droopy eyelid condition known as blepharoptosis. Individuals are sometimes born with drooping eyelids, and correction at a younger age may be recommended to support proper eyesight development. More rarely, a descended eyelid could indicate an underlying medical condition, warranting further diagnostic tests.

It’s essential to distinguish ptosis from upper lid hooding or bagginess caused by excess skin or fatty tissue, as these conditions necessitate different treatment approaches, such as blepharoplasty. Some patients may require ptosis correction combined with a blepharoplasty to achieve more open, youthful, and symmetric eyes. This is one of the main reasons that blephoraplasty surgery is best carried out by an eyelid specialist.

Sagging eyes treatment

Procedure at a Glance

Procedure time
45 mins-1.5 hours

Local or Sedation

Length of Stay
Day case

Up & Mobile
Same day

1 week

Back to Work
1 week

1 week

Post-op Care
Ice pack for first 2 days

On back, sleeping upright for 1 week

Resume Exercise
2 weeks

Full Recovery
4-6 weeks

Final Results
3 months

Ptosis Repair FAQs

The surgical correction of upper eyelid ptosis involves tightening the levator muscle to lift the drooping eyelid. Various techniques, such as levator resection, may be employed based on the type and severity of ptosis, muscle strength, and previous cosmetic eyelid procedures.

The repair can be achieved through a posterior eyelid approach with internal incisions, known as a mullerectomy, for a scar-less treatment. Alternatively, an external approach is employed, with hidden incisions along the upper eyelid crease. This is the same incision used in a standard upper blepharoplasty.

In cases of congenital blepharoptosis or weak levator muscle tendons, a frontalis sling technique may be utilised, linking the upper eyelid to the forehead muscle for support.

Depending on the patient’s preference and safety considerations, the procedure can be conducted under local anaesthesia, intravenous sedation, or general anaesthesia. Performing the surgery while the patient is awake allows for better adjustment of the final eyelid height.

In the case of external approach ptosis repair, a fine incision is strategically designed along the natural fold of the eyelids, hidden in the skin creases. The levator muscle is identified, shortened, and meticulously sutured with tiny stitches. These are removed six to ten days after surgery.

Antibiotic cream is applied post-operatively, and an ice pack is usually used immediately afterward. Dr Koutroumanos will provide comprehensive aftercare advice, and you will be asked to apply the antibiotic cream three times a day for up to a week after your operation.

Bandages or padding are seldom used. If they are required, this is usually just for a short period after your operation and will be removed before you return home.

Recovery after upper lid ptosis repair involves one to two weeks of variable amounts of swelling and potential bruising of the eyelids. Depending on the nature of your job and lifestyle, Dr Koutroumanos will advise anywhere between one to two weeks of downtime, but most patients find they can resume most normal activities within just a few days.

Pain is minimal and easily managed with over-the-counter painkillers. We advise you to rest for 48 hours, and although you should wait for three weeks before resuming exercise, you should be safe to go for a brisk walk after day three. Movement boosts blood circulation, which aids in the healing process.

Post-surgery care includes using cold compresses to alleviate bruising and swelling, with gentle washing after the initial 48 hours. Make-up is recommended to be avoided for the first ten to 14 days. Within three to four weeks, eyelid swelling should subside, revealing the positive outcomes of the corrective procedure.

Remember, individual recovery experiences may vary, but adherence to post-surgery care guidelines contributes to a smoother recovery.

Eyelid surgery expert
Oculoplastic surgeon London


Dr Nick Koutroumanos

Dr Nick Koutroumanos is a London-based Ophthalmic & Oculoplastic surgeon, with particular subspecialty expertise in ophthalmic plastic & reconstructive eyelid, orbital and lacrimal surgery.

His private practice, based at The Hospital of St John & St Elizabeth in St John’s Wood complements his work in charge of a large NHS oculoplastics practice at the Royal Free Hospital in Hampstead.

A qualified senior trainer and Royal College Examiner in ophthalmic plastic surgery, cataract surgery and general ophthalmology, he runs an Oculoplastics Fellowship training programme that is highly sought-after by both UK and international candidates.

Kind Words from Our Patients


A true perfectionist

Words are not enough to express my sincere gratitude for the care and dedication Dr Koutroumanos put into my journey. I felt safe and secure in his hands. This is someone who truly cares about outcome and ethics of practice. A true perfectionist. I would not hesitate to wholeheartedly recommend him.

100% worth it

I had surgery a few days ago with Dr Koutroumanos for congenital ptosis. It’s early days but I don’t think it’s too early to say the results will be life changing for me in terms of confidence levels. I struggled at school due to the condition and have learnt to live with it – that is until I saw the doctor who was reassuring from the start and has just done the best job. 100% worth it and amazing to know I was in such safe hands. I can’t thank him enough.

I’m really happy with my results

I’ve recently had a brow lift and blepharoplasty with Mr N Koutroumanos. The whole process from start to finish was handled professionally and each process was very informative. I’m still at the recovery stage, so far I’m really happy with my results. Highly recommend using Mr N Koutroumanos services.