Functional Oculoplastics Gallery

Here are a small selection of our before and afters. During your consultation with Dr Nick Koutroumanos, you will be shown more before and afters.

Bilateral transconjunctival upper eyelid recession

Upper eyelid retraction is caused by scarring and the permanent contraction of the muscle responsible for opening the eyelid.

The unnaturally and permanently wide-open eye leads to severe dry eye with a risk to the eyesight and an angry, seemingly threatening appearance.

The most common cause is Thyroid Eye Disease, and the preferred treatment approach is internal eyelid lowering.

Here is a patient following a bilateral transconjunctival upper eyelid recession under local anaesthesia and prior to undergoing upper blepharoplasty.


Thyroid eye disease

No cases demonstrate the role of specialist ophthalmic plastic surgery more than those with Thyroid Eye Disease.

These patients feature complex and asymmetric periocular tissue expansion, bags, eye bulging (proptosis) and eyelid retraction and should be looked after by surgeons with exclusive expertise in the eye area anatomy.

A huge thank you to our patient for sharing her journey involving orbital decompression, upper eyelid retraction repair and blepharoplasty.


Upper & lower eyelid lift plus treatment for watery eyes

The majority of our male patients express one main surgical wish: Subtlety.

Technically, this means a few things, but mostly it ‘s about:

  • Completely scarless surgery
  • Staying true to age
  • Avoiding feminisation of the brows

For this reason, brow lifting is often not desirable unless the position is very low.

Here is an example of natural upper and lower blepharoplasty, before surgery and at the one-week review.

Our patient also suffered watery eyes due to lower eyelid laxity and this was simultaneously addressed with lateral canthal tightening leading to full resolution of these symptoms.

Over the following couple of weeks, any residual bruising and swelling will also settle.


Eyelid Lumps + Growths

Removal of eyebrow tumour

This is a progressively enlarging eyebrow tumour. Growths of such size (in this case a Pilomatrixoma) require specialised techniques to ensure that the patients’ facial structures and characteristics are not altered following removal.

Our patient here photographed on the day of surgery and six weeks later shows absolutely no permanent scar or deformity of his eyelid or eyebrow. Tissue analysis of the removed growth showed complete removal therefore posing no risk of recurrence.

As a rule, the sooner individuals who notice upper face lumps present to a specialist, the more straightforward treatment can be expected to will be.


Removal of eyelid cysts

The eyelid area is rich in glands and as a result a common area for cysts to develop. Lumps and bumps such as these multiple sweat gland cysts on this patient of ours can be removed by simple in office surgery with minimal downtime and discomfort.

Most importantly, growths in the eyelid area ought to be assessed by a specialist prior to any such treatment, to ensure an appropriate plan is set in place. This will very often require analysis (biopsy) of the tissue to rule out sinister causes for the growths.


Removal of skin tumour

Skin tumours are very uncommon in young people and this is a fortunate thing for facial reconstructive surgeons who rely on laxity of tissues – like the kind which comes with ageing – to seamlessly reconstruct defects following tumour excision. In youth, there is very little tissue ‘give’ or wrinkles making procedures much less forgiving.

This young man suffered a recurrent aggressive pilomatrixoma, unusually requiring wide excision by the dermatologists. The challenge here was to repair the defect without any traction on the lower eyelid and this was achieved by a sliding island flap.

The outcome was both functionally and aesthetically successful and the patient totally free of his tumour. We thank him so much for sharing the images.

Please beware of stubborn growths on your skin and consult an appropriately trained physician when concerned.


Reconstructive Eyelid Surgery

Removal of extensive Basal Cell Carcinoma

Large neglected malignant tumours of the eyelid result in big surgical excisions which require creating new eyelids from nothing.

This practice is called periocular reconstruction and is carried out by oculoplastic surgeons.

Here is an example of an extensive basal cell carcinoma. Its removal meant the loss of most of the eyelids.

Reconstruction of a new lower eyelid and part of the upper lid has ensured the protection of the eye and acceptable cosmesis and symmetry.

The ‘after’ picture is at six weeks, and any residual scarring will fade away over the next few months.

Technique: Free tarsal graft, periosteal flap, modified cheek flap.


Removal of Basal Cell Carcinoma

Basal Cell Carcinoma is considered a non-aggressive skin tumour given its slow growth and extremely low metastasis rate. Tumours however which grow on areas with limited skin excess, such as around the eyes, can leave large gaps of no skin cover requiring reconstruction.

Periocular reconstruction needs to first ensure the safety of the eye by creating a normally functioning eyelid and then to deliver an as good as possible cosmesis. Such cases are best managed by oculoplastic surgeons working with dermatologists specialising in Mohs tumour removal.

Thank you to our patient for sharing his journey: A poorly defined (morpheaform) Basal Cell Carcinoma, identified late given its faint skin changes, leading to a large tissue defect addressed by cheek advancement.


Removal of Basal Cell Carcinoma

Small lumps, nodules or non-healing ulcers can represent slowly-growing malignancies, most commonly Basal Cell Carcinomas (BCC), and the skin around the eyes, being thin and regularly exposed to UV radiation, is one of the commonest areas to develop these.

Thank you to our patient agreeing to share her images showing her BCC, the skin defect following Mohs Micrographic removal and the final reconstructed appearance.

The earlier these lesions are identified and treated, the easier it is to achieve an excellent cosmetic result.


Removal of Basal Cell Carcinoma in tear ducts

Here is an unusual case of a teary eye, in this patient of ours presenting with a blocked, scarred tear duct in the inner aspect of her lower eye lid (image 1).

Close inspection of the area showed changes suspicious of a tumour and a biopsy confirmed a basal cell carcinoma.

She underwent Mohs micrographic tumour excision by our dermatologists (image 2) and a lower eyelid and tear duct reconstruction (image 3) resulting in a complete cure from the cancer, a satisfactory aesthetic and functional outcome and a full resolution of her watery eye.

Beware of any growths on the eyelids and seek a specialist opinion if concerned about recent changes.


Removal of Basal Cell Carcinoma

Basal Cell carcinoma grows slowly and for that reason, it is often considered a not so aggressive tumour.

Patients in the UK usually present reasonably early, meaning that tumours are often small when removed and thus, easy to reconstruct what is left behind.

This is particularly important in the eyes area given that it is the least forgiving one in the human body; any slight scar contraction can put the eyes at risk.

Seemingly small, less well-defined skin tumours can result in substantial skin loss when microscopically removed.

Our patient was keen for her case to be shared to raise awareness on this fact, and we sincerely thank her for this.