Dr Nick Koutroumanos

This post is about early healing and identity preservation.
It’s also about patient expectations for conservative surgery.
Remembering that eyes and faces belong to individuals with very individual ideas and expectations about the change they hope to see.
We ll get to talk more about this as our case recovers further but for now, a point about malar oedema:
Pre-existing malar fluid does not typically improve with transconjunctival surgery. In certain, typically more serious cases, other surgical steps will be added which can help improve it.
Those extra surgical steps are not to be employed in mild cases such as this one. Other non surgical procedures may help, after surgical healing is complete. There’s lots more healing to come.
Fluid will temporary be worse and that’s important to explain to patients: just as a freshly operated ankle will lead to more ankle swelling on a long haul flight than the same ankle might have swollen before surgery.

✅ Upper blepharoplasty + lower blepharoplasty
📞 +44 (0)20 4531 6760
📮 [email protected]
🌎 www.koutroumanos.com
🏥 60 Grove End Rd, St John’s Wood, London NW8 9NH
📣 Individual results vary based on anatomy and expectations
📷 Photography published with the patient’s consent
👩 Actual patient of Dr Koutroumanos pictured

Some eye shapes make blepharoplasty considerably more difficult than it appears.
To the untrained eye, the anatomy looks straightforward, but combining a prominent supraorbital ridge with a deep-set eye and a heavy outer brow creates a real surgical challenge for blepharoplasty.
This case had an additional constraint, in that intravenous sedation and general anaesthesia both needed to be avoided.
We therefore carried out a combination of upper blepharoplasty and direct brow lift under local anaesthesia alone.
A super cool and interesting person, and what a pleasure it has been to look after her.
I only wish I could show here the full picture, as it’s on those full face pics that the real magic of a well designed blepharolasty shows its true effect.

✅ Upper blepharoplasty + direct brow lift
📞 +44 (0)20 4531 6760
📮 [email protected]
🌎 www.koutroumanos.com
🏥 60 Grove End Rd, St John’s Wood, London NW8 9NH
📣 Individual results vary based on anatomy and expectations
📷 Photography published with the patient’s consent
👩 Actual patient of Dr Koutroumanos pictured

Under eye bags can be a sign of aging and they do always -like most other things - get worse with ageing.
But a large proportion of my practice consists of younger individuals with prominent eye bags due to a relative anatomic weakness of the septum, a mesh like structure supposed to keep our eyesocket fat pads inside. This can be the case from a very young age.
Surgery in most cases is carried out via a hidden incision is very safe and predictable and the results can be life changing for those who are fed up with looking tired and without sleep every day of their life.

I am so pleased that you are so happy and sending you a huge thank you for trusting me with your eyes.

✅ Transconjunctival lower blepharoplasty
📞 +44 (0)20 4531 6760
📮 [email protected]
🌎 www.koutroumanos.com
🏥 60 Grove End Rd, St John’s Wood, London NW8 9NH
📣 Individual results vary based on anatomy and expectations
📷 Photography published with the patient’s consent
👩 Actual patient of Dr Koutroumanos pictured

Two months post upper and lower blepharoplasty with a temporal brow lift: these are actually still early results. In the next 4-6 weeks the scars will have vanished and so will the redness from that stye.

Patients with constitutionally heavy or full eyelids like this one present a particular surgical challenge. The tissues are more resistant to lifting, symmetry is harder to maintain, and there is a real risk of either under- or over-correcting. Aggressive surgery changes a person’s appearance in ways that can be difficult to reverse.
The op involves not only removing tissue but sculpting and suspending.
The focus always being in identity preservation just can’t be overstated. If it can’t look natural then don’t do it.
At two months, the result is still settling. I will post updated images as the recovery continues.

I am so pleased that you are so happy and sending you a huge thank you for trusting me with your eyes.

✅ Upper & lower blepharoplasty, temporal brow lift
📞 +44 (0)20 4531 6760
📮 [email protected]
🌎 www.koutroumanos.com
🏥 60 Grove End Rd, St John’s Wood, London NW8 9NH
📣 Individual results vary based on anatomy and expectations
📷 Photography published with the patient’s consent
👩 Actual patient of Dr Koutroumanos pictured