Upper Blepharoplasty

Over time, the delicate tissues surrounding our eyes change, impacting functionality and aesthetic appeal. An upper blepharoplasty addresses concerns related to the contour of the upper eyelids. This procedure becomes particularly relevant as the skin loses elasticity and tissues experience volume loss due to factors such as ageing, sun exposure or smoking.


The upper eyelid, a complex structure responsible for eye protection, undergoes natural changes as we age. As well as acting as a shutter to keep out foreign bodies, it is also essential for adequate tear film distribution across the eye.

The cumulative effects of blinking, environmental factors, and lifestyle choices contribute to issues like hooding, sagging, and heaviness. By the age of 60, the upper eyelids, having blinked millions of times, may exhibit signs of dermatochalasis or hooding, which can be aesthetically distressing and potentially hinder the field of vision and causing discomfort.

An upper blepharoplasty is a transformative procedure that addresses the ageing process as it affects the upper eyelids, offering functional and aesthetic benefits. Understanding the details, potential complications, and post-operative care is essential for individuals considering this rejuvenating surgery. Consultation with a qualified surgeon is crucial to achieving the desired outcomes while managing expectations and potential risks.

Dr Nick Koutroumanos is a Consultant Ophthalmologist at the Royal Free Hospital in London, serving as head of the NHS Oculoplastic service. He also has a private practice for general Ophthalmology and Oculoplastic surgery at the Hospital of St John & St Elizabeth based in St John’s Wood.

He has undergone extensive training in eye health and eyelid surgery. As an Ophthalmic and Oculoplastic surgeon, Dr Koutroumanos has completed a seven-year training program in Ophthalmology, primarily at the esteemed Moorfields Eye Hospital. He then received additional scholarship-funded Oculoplastic fellowships in London, Vancouver, New York, and San Francisco.

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

Sagging eyes treatment

Procedure at a Glance

Procedure time
1-1.5 hours

Local or General

Length of Stay
Day case

Up & Mobile
Same day

1 week

Back to Work
Up to a week

5 days

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

Upper Blepharoplasty FAQs

Both upper and lower blepharoplasty can be conducted under various anaesthesia options, and incisions are meticulously designed for discreet healing, hidden in the natural crease of the upper lid. Dr Koutroumanos will carefully remove any unwanted tissue through this incision and tighten the muscle if required.

If there is any upper eyelid hollowness, he will reposition the tissues to fill the hollows and sculpt the upper eyelid. After surgery, the incisions are sutured with delicate stitches removed after six to ten days.

At the end of the procedure, antibiotic cream is applied over this area, and you will be asked to use this ointment three times a day for five to seven days post-operatively.

Bandages or padding are very rarely used. If required, they will usually be applied for a short period after your operation and removed before you return home.

The recovery period for upper lid blepharoplasty is generally shorter than a lower lid blepharoplasty, ranging from one to two weeks, with minimal downtime.

You will be encouraged to get up and move on the evening of the operation. Discomfort is minimal after this procedure, and it is easily controlled with over-the-counter painkillers. The amount of swelling and bruising varies between patients, but using cold compresses and sleeping upright can speed up recovery.

Patients are advised against driving or operating machinery for a specified period after anaesthesia. Wound care is straightforward, with gentle washing initiated after 48 hours and make-up application avoided for the first ten to 14 days.

Most patients find that after the second postoperative week, it is not detectable that they have undergone surgery. The healing scar may be visible for up to six weeks, but after that time, it is extremely unlikely to be noticeable.

While blepharoplasty is generally safe, there are potential complications, including scarring, bleeding, infection, changes in sensation, asymmetry, eyelid position issues, unsatisfactory results, and long-term changes over time.


Incisions are made in the natural fold of the eye and become virtually invisible once entirely faded and flattened. In rare instances, keloid scarring can occur, and you may need surgery to improve scarring.


A small amount of bloody discharge or blood-stained tears is typical in the immediate post-recovery period, but bleeding into the eye socket is a very rare but serious complication that can cause vision loss. A sudden increase in blood pressure is usually the reason for any substantial bleeding after surgery.


This is a rare complication after a blepharoplasty. It can be treated with antibiotics, but you may require a further operation, or it can affect the aesthetic outcome.

Change in sensation

After surgery, the skin can become more or less sensitive, but this should be temporary as the nerves heal. In very rare cases, a change in sensation can be permanent.

Symmetry issues

Although everyone has a mild degree of asymmetry between their eyes, this can become a concern after eyelid surgery. Often, this is temporary as the eyes typically heal at different rates, and once all swelling has subsided, there is no cause for concern.

Eyelid position

If too much skin is removed, it can affect your blink function, and you may not be able to close your eye properly. This results in the eye’s surface drying out and, in severe cases, you may require a small skin graft.

Allergic reaction

This is a rare occurrence and occurs due to the tape or stitches used.

Change over time

Dr Koutroumanos aims to rejuvenate the upper eyelid which can last for five to ten years and even longer for some patients. Although it can reset the ageing clock, a blepharoplasty will not stop the ageing process, and you may wish to undergo a second blepharoplasty in the future to maintain your results.

Unsatisfactory result

Dr Koutroumanos often treats patients who have undergone a blepharoplasty elsewhere and are dissatisfied with the results of the upper eyelid lift. To avoid this potential complication in his own practice, he offers a comprehensive consultation to ensure that he and the patient have established clear communication about the outcome. Before your procedure, he will also take precise measurements under high magnification, with patients sitting upright and lying down, to consider the patient’s individual anatomy.

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.