Revisional Eyelid Surgery

Eyelid surgery, or blepharoplasty, is one of the most sought-after cosmetic procedures in the UK. While blepharoplasty is generally well-tolerated and yields high patient satisfaction when conducted by a skilled surgeon, like any cosmetic procedure, it is not entirely devoid of potential complications or less-than-ideal aesthetic outcomes. In such cases, revision eyelid surgery is necessary.


Revision eyelid surgery becomes essential if a blepharoplasty procedure results in an unsatisfactory aesthetic appearance or functional complications. Revision blepharoplasty is often more complex than the initial procedure, and several techniques may be required to address issues, such as lower lid retraction or hollowing of the eyelids.

Dr Nick Koutroumanos, an Ophthalmologist and triple-fellowship trained Oculoplastic Surgeon, possesses dual expertise in ophthalmology and plastic surgery, making him exceptionally qualified for the intricacies of revision eyelid surgery.

Various factors can lead to dissatisfaction, including inappropriate patient selection, communication gaps between surgeon and patient, unrealistic expectations, surgical inexperience, aggressive techniques, and unexpected healing issues.

Dr Koutroumanos often performs revision eyelid surgery for patients who have undergone unsatisfactory primary blepharoplasty procedures elsewhere.

Choosing the right surgeon is pivotal for the success of any cosmetic surgery, both in terms of their surgical expertise and establishing a foundation of trust and effective communication to ensure your expectations can be met.

Dr Koutroumanos is a Consultant Ophthalmologist at the Royal Free Hospital in Hampstead, London, serving as head of the NHS Oculoplastic service. He has undergone extensive training in eye health and eyelid surgery.

This comprehensive training has given him a wide range of expertise in various eyelid surgery techniques, allowing him to achieve natural-looking results for his patients consistently.

Sagging eyes treatment

Procedure at a Glance

Procedure time
2-3 hours

Local or General

Length of Stay
Day case

Up & Mobile
Same day

1 week

Back to Work
2 weeks

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
2-3 months

Revision Eyelid Surgery FAQs

Revisional eyelid surgery is a nuanced and bespoke procedure addressing specific issues based on their type and severity. It poses increased challenges compared to the initial operation, given scar formation and anatomical changes, leading to heightened patient anxiety and a higher risk of complications.

Reasons for considering revision eyelid surgery include:

Excessive removal of upper eyelid skin

If too little skin has been removed from the upper eyelid, this can be addressed quite easily. However, if too much has been removed, it can result in difficulty closing the eyes, possibly requiring a skin graft. This can leave noticeable scarring.

Hollow upper eyelid

Removing too much fat can age the patient, necessitating an autologous fat graft.

Brow ptosis

Failure to address sagging brow tissues can impact the aesthetic outcome of a blepharoplasty.

Residual fat under the eye

Insufficient fat removal during a lower blepharoplasty may necessitate further intervention.

Deep tear trough

A common aesthetic concern is the indentation at the lid-cheek junction, known as the tear trough, whether due to the ageing process or genetics or ageing. Challenging to treat with lower eyelid lift alone, the tear trough may require additional intervention.

Lower lid malposition

After a lower blepharoplasty, one potential complication is the lid becoming everted, pulled down or pulled away from the eye. Lower lid malposition can be challenging to treat. It may require corrective surgery such as a canthoplasty, or a midface lift which addresses the corner of the eye, or a graft to strengthen the lower eyelid.


The eyes often look asymmetrical during the healing process because one eye will heal at a different rate. This is usually temporary, but once the swelling has disappeared and the incisions have healed, Dr Nick Koutroumanos can assess symmetry if you are concerned and advise whether further surgery could improve aesthetic outcomes.

To minimise risks, Dr Koutroumanos emphasises meticulous pre-operative planning, involving precise measurements under high magnification in various positions to account for individual anatomical variations.

Patients contemplating revisional eyelid surgery should exercise patience, allowing for the resolution of swelling and complete scar maturation, which may take up to a year. Dr Koutroumanos guides patients through a comprehensive consultation, explaining risks and expected outcomes, empowering them to make informed decisions regarding corrective surgery.

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.