Tear Trough Rejuvenation Under Eye Dark Circles & Hollows Tear trough fillers

The Tear Trough Deformity


• The tear trough is the groove at the junction between where the lower eyelid and the cheek.
• As we age, one of the changes which is commonly noticed and commented on is the appearance and gradual worsening of dark circles under the eyelids. This occurs due to the thinning of the overlying skin and soft tissue over the bony orbital rim. A band of tethering fibrous tissue called the orbitomalar ligament binds the skin underneath the lower eyelid to the underlying bony rim of the eye socket.
• In youth, due to the surrounding plump fat, thicker overlying skin and soft tissue surrounding this structure, this ligament is usually invisible.
• However, with age atrophy of the adjacent tissues and thinning of the skin occurs, leading to increased visibility of this deep attachment between the skin and orbital rim-the so called tear trough deformity.

Treatment Options

Various treatment options for the disguising the tear trough deformity exist but all of them are based around two principles.
Either to:

  • default_titlePlump up the tissue around the ligament (leaving the ligament intact) e.g. using filler or fat injections or to
  • default_titleDisrupt the ligament altogether and then to filler the concavity i.e. using surgery (lower eyelid blepharoplasty/lower eyelid bag removal) and/ or restoration of the midface fat to the area (midface lift)
  • Show More

Both treatment principles have their advantages and disadvantages and the suitability of each treatment option varies from patient to patient. For example, some patients benefit from a combination of both surgery and filler injections. Mr Cheung offers multiple treatment options and will be able to advise on the best option for each individual patient.

Injectable filler (Restylane) for tear trough rejuvenation Tear Trough Filler Treatment

• An increasingly popular treatment is the use of injectable implant fillers, especially in patients in their late 30's to 40's, to essentially fill out the trough.
• Commonly in this age group, the loss of volume at the junction between the upper cheek and lower eyelid, i.e. a worsening tear trough deformity, is the only obvious sign of ageing. Therefore simple replacement of this lost volume without the need for surgery can lead to dramatic improvement.
• In the past, various injectable implants e.g. the patients own harvested fat cells have been used with varying patient acceptability and success. Over the past decade though, injectable fillers such as Restylane & Perlane, which are based on hyalauronic acid- a natural tissue component produced by the body, have been used with excellent safety and effectiveness.
• The aim of the treatment is to place the filler deep below the skin and soft tissue around orbitomalar ligament, thereby lifting up the these tissues, making the tear trough appear shallower.
• In most patients there is an almost immediate improvement with a reduction in the depth and width of the tear trough itself. Dark circles which are often due to shadowing within the trough itself similarly improve. In some patients though, there may remain some residual dark circles due to actual longstanding skin pigmentation built up over many years. In these patients they often notice an enhanced effect from using makeup to mask these lines.

Before Restylane Tear Trough Filler Before Restylane Tear trough filler
After Restylane Tear Trough Filler After Restylane Tear Trough Filler

Non Permanent
As with all safe hyalauronic acid based fillers, there is very slow absorption of the injected material over time and these injections can quite safely be repeated if necessary. As one's face slowly changes with time, cosmetic doctors have now recognised that non-permanent treatments are advantageous since they allow them to maintain harmony rest of the patients face. A permanent implanted material such as silicone given to a patient in their 30's may not look as good or harmonious if it still present when the patient is 80. For this reason, patients and their surgeons are seeking non-permanent absorbable injectable implants since they allow for retreatments in the future customised for that patient.

Another major advantage of these hyalauronic acid based fillers is that they can quickly reversed if the patient so desires. In the rare situation where the patient is not content with the treatment, a small injection of Hyalase (hyalauronidase) into the injected implant, an enzyme drug commonly used during cataract surgery for over 20 years, can be used to quickly dissolve the implant.

No Surgery Required

  • On the whole, the treatments are very well tolerated, being virtually painless with only a small amount of skin numbing local anaesthetic cream necessary applied to the skin just prior to injection. Patients can feel some mild pressure during the procedure itself.
  • The procedure is usually performed within the outpatient clinic and takes about 5-10 minutes per side.
  • Most patients go back to work immediately following treatment. Bruises and lumps can occur and if so last typically 3-7 days. They can often be covered up using makeup.
  • The recovery time is very quick and although patients do notice some mild swelling over the first post procedure week, most of this would have disappeared within 10 days. As the mild trauma associated with the injection can cause some minimal swelling and lumpiness, it is advised that patients be aware of this and be reassured that it is often normal for the treated area to look swollen and slightly lumpy during this period.
  • After 1-2 weeks though the injection trauma swelling should have largely settled down. Any lumpiness may uncommonly therefore be due to irregular distribution of filler material. The material is still mouldable under the skin over the forthcoming weeks to months and this characteristic is very often useful as patients can often self mould the implant to their own liking e.g. to smooth out any tiny visible lumps.
  • Mr Cheung uses a combination of standard injection using needles and also subdermal fanning techniques using microcannula depending on the area to be treated. The use of a microcannula has greatly improved the safety, comfort and reliability of treatment recently. Minor bruising is uncommon with this procedure and usually disappears over 10 days. Most bruising is superficial and light and is easily concealed with makeup.
  • Mr Cheung’s filler of choice for tear trough filler is Restylane.
  • Although Perlane has been used in the past by Mr Cheung with the added advantage of Perlane lasting longer than Restylane, Restylane gives more consistent results when using a cannula injection technique.
  • A first course of treatment consists of an outpatient clinic visit for treatment, then a follow up clinic review usually two to four weeks later to reassess and top up if necessary.
  • For medicolegal reasons in the UK and because we wish our patients to be fully informed about their procedure and risks, Mr Cheung cannot offer same day initial consultation and treatments.
  • Patients may undergo a repeat course of top up retreatment if desired to replace any filler which has slowly dissolved over time, sometimes 12-18 months later.

There are risks associated with any medical procedure and doing nothing is always the safest option in comparison to cosmetic treatments. However the risks associated with tear trough filler treatment are rare. Despite this, Mr Cheung tries to be as comprehensive as possible when it comes to informing patients of risks so that they can make a fully informed choice.

  • Infection- As with any type of filler treatment there is a tiny risk that the patient develops a skin infection from the injection. This risk is quite rare and is greatly reduced by the use of aseptic injection techniques.
  • Reactions including allergy- very rarely patients are allergic to the filler substance. This may range from low grade local chronic allergic type reactions to full blown acute anaphylactic shock reactions. Mr Cheung would not recommend tear trough filler treatment in any patient who has had any unexplained reaction to dermal fillers or to local anaesthetics such as lidocaine. Uncommonly patients may need dissolution of hyalauronic acid filler using an enzyme (hyalauronidase) mixture if it is suspected that they are suffering from a low grade allergic inflammatory reaction against the filler. Patients who have had previous allergy to hyalauronidase enzyme (often used in local anaesthetic injections) should therefore not undergo tear trough hyalauronic acid filler injection treatments. Patients who have certain allergies e.g. to eggs or bee stings have a higher risk of being allergic to hyalauronidase enzyme too and therefore should similarly avoid hyalauronic acid filler injections.
  • Visibility - Uncommonly filler treatment can appear to cause blue discolouration of the skin in bright light. This is more common in patients with very thin skin injected with the higher viscosity fillers such as Perlane. This can be avoided though by careful filler type choice and accurate placement of the filler itself into the deeper layer. For the technically minded, Mr Cheung tends to inject in a fan type configuration under the muscles specifically to avoid this potential problem.
  • Migration - there have been reports of late movement of the filler away from its originally injected area. This is quite uncommon especially with the use of low pressure cannula injection techniques but can usually be easily treated.
  • Vision loss and double vision - Due to the way that the blood vessels of the face interconnect with the blood vessels of the eye, there is a very rare risk of blockage of the blood vessels of the eye leading to blindness. So for example, fillers which are commonly injected into the lips or forehead have a risk of causing obstruction of the blood vessels of the eye resulting in loss of vision. This risk is incredibly rare and most of the case reports have been with the use of injected fat (liposculpture) but can theoretically occur with any type of injected substance anywhere on the face where there is interconnection with the blood supply of the eye. Indeed any clinician practising facial filler work should therefore inform their patients of this risk at the consent process. There are sparse case reports of this happening with hyalauronate based fillers injected elsewhere in the face but taking into context how many facial filler injections are administered worldwide and the number of reports, one can see that it is incredibly rare. As of 2015 there have not been any reports of embolic central retinal artery occlusion secondary to tear trough filler injection but it can theoretically happen. The risk of this complication is theoretically much reduced with oculoplastic surgeons performing this procedure as they have intimate knowledge of the major blood vessels around the eye and therefore can avoid them better. In addition the use of blunt cannula techniques should reduce this already minuscule risk even further.
  • Need for hyalauronidase dissolution - Occasionally hyaluronic acid fillers need to be dissolved when the aesthetic treatment has not produced the desired outcome or there is a possibility of vascular occlusion or impending necrosis (tissue death) which could lead to compromise of healthy tissue. Hyalase® (hyaluronidase 1500 units) has an off-license use in aesthetic medicine and except in the case of emergency administration requires the patient to undergo a skin patch test at least twenty minutes prior to the procedure being undertaken. The skin patch test is carried out by injecting Hyalase® into the subcutaneous tissue of the forearm and observed for signs of reaction (i.e. hives or wheals). If a positive patch test result is observed, treatment with Hyalase® cannot be carried out. Erythema or redness and slight vasodilation may be expected. Hyalase® is an enzyme which breaks down hyaluronic acid fillers, but it can also break down naturally occurring hyaluronic acid present in the body therefore this may lead to loss of volume and there can be some skin laxity. Hyalase is safe to use around the eye and has been used for over 20 years off license during eye surgery. While many single treatments have been successful, there is no guarantee that the dermal filler will be dispersed fully after one treatment and may require further treatments. Hyalase® administration can result in a severe allergic reaction and so conservative treatment options or leaving the dermal filler to break down naturally which may take several months. After hyalauronidase treatment some other common injection-related reactions might occur including redness, swelling, pain, itching, bruising and tenderness at the injection site. They have generally been described as mild to moderate and typically resolve spontaneously a few days after injection. Bruising may occasionally be more significant. Infection can rarely occur as with any infection. Allergic reactions and severe anaphylaxis reactions have rarely been reported and can occur.
  • Need for surgery - Very very rarely patients may need surgery with possible additional costs to the patient to deal with complications related to tear trough filler treatments.
  • Risks of Injection - Trauma during the procedure is caused by needles and cannulas passing through tissue and can include bleeding, bruising, haematoma (i.e. a larger collection of blood in the skin, outside of blood vessels), damage to underlying structures including beings, arteries, nerves, salivary glands, lymph nodes, bone, muscle and other soft tissues structures are possible. In rare cases this could cause continuous problems in appearance, sensation or function and may require medical intervention to treat or may be permanent. Most traumatic injuries heal completely on their own.
  • Permanent volume changes - Hyalauronic acid fillers in most patients will slowly dissolve away leaving no evidence of their previous injection. In most patients therefore undergoing tear trough filler injections, they will therefore require a top up treatment 12-18 months later. However occasionally some patients notice that their tear trough filler treatments appear to last much longer than anticipated. Rarely the patient’s skin may react to the tear trough filler treatment causing collagen deposition leading to the injected area becoming plumper and fuller. Rarely the patient’s tissues may react against the filler leading to the filler become entrapped long term preventing or slowing down its gradual natural dissolution (filler encystment). For most patients this is actually a welcome phenomenon meaning that they won’t need to have a top up but this may rarely be troublesome for some patients.
  • Patients should not have this treatment if they are breastfeeding or pregnant.
  • Patients should not have this treatment if they have an active infection of their eyelids.
  • Disappointment - Rarely patients may be disappointed with the results of treatment despite Mr Cheung’s and the Westbourne Centre’s best efforts. Indeed rarely patients may request dissolution of any injected hyalauronic acid filler because the outcome outcome does not meet the patient’s expections. e.g. the filler may look lumpy or cause a tissue reaction due to its presence. Unfortunately these poor outcomes are often not predictable and may not be discovered until after treatment and the usage of consumables, facility usage, etc with their associated costs. Before embarking on this course of treatment, you must therefore be aware that the Westbourne Centre and Mr Cheung therefore may not be able to offer any refund in the event of patient disappointment and any refunds (whether partial or full) of procedure fees in the event of patient disappointment are wholly discretionary.

Restylane Tear Trough Filler Gallery

  • Stacks Image 7819

    Tear trough deformity in a 30 year old lady. She complained that she looked tired.

  • Stacks Image 7824

    Notice that she has some hollowing under her eyes (tear trough deformity) and a mild bulging of a fat bag

  • Stacks Image 7829

    She complained that she had looked tired even in her teens and that this had worsened as she got older.

  • Stacks Image 7834

    Immediately following injection of Restylane. Only a tiny volume was necessary on each side

  • Stacks Image 7839

    Notice the single injection points when using a microcannula technique

  • Stacks Image 7844

    There was minimal bruising and the patient can return to work the following day

  • Stacks Image 7849

    Two weeks Restylane injection for tear trough deformity.

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    All the bruising has disappeared. The Restylane filler not only fills up the under eye hollowing but also helps disguise the mild bulging from the small fat bag

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    Before treatment again

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    After treatment again

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    This lady in her early 40s complained of looking tired.

  • Stacks Image 7877

    She had moderate under eye hollowing/ tear trough deformities with minimal fat bulging her HER RIGHT and moderate fat bulging on HER LEFT.

  • Stacks Image 7882

    She was keen to avoid surgical debulking of her fat pads as this was her first cosmetic treatment. Mr Cheung advised her that although tear trough fillers may help matters, there would still likely be minimal bulging of particularly prominent fat bags.

  • Stacks Image 7887

    Immediately following injection of Restylane for the tear trough deformities. Notice the single injection point when using a microcannula technique

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    Immediately following injection of Restylane for the tear trough deformities. Notice the single injection point when using a microcannula technique

  • Stacks Image 7897

    Two weeks following injection. Notice the result looks very natural. All the swelling has dissipated. She has still has a slightly prominent fat bag on HER LEFT but it has completely been camouflaged on HER RIGHT

  • Stacks Image 7902

    Two weeks following injection. Notice the result looks very natural. All the swelling has dissipated. She has still has a slightly prominent fat bag on HER LEFT but it has completely been camouflaged on HER RIGHT

  • Stacks Image 7907

    Two weeks following injection. Notice the result looks very natural. All the swelling has dissipated. She has still has a slightly prominent fat bag on HER LEFT but it has completely been camouflaged on HER RIGHT

  • Stacks Image 7912

    Before treatment again

  • Stacks Image 7917

    After treatment again

  • Tear trough deformity in a lady in her late 20s. This lady complained that her eyes looked tired.

    Tear trough deformity in a lady in her late 20s. This lady complained that her eyes looked tired.

  • Tear trough deformity in a lady in her late 20s. This lady complained that her eyes looked tired.

    Tear trough deformity in a lady in her late 20s. This lady complained that her eyes looked tired.

  • 2 weeks after injection of Restylane in to the tear trough. Notice the increased fullness to the tear trough. The filler helps camouflage the bulge of the lower lid caused by prolapsing fat pads. One can see why this procedure is sometimes termed a ‘non-surgical blepharoplasty’

    2 weeks after injection of Restylane in to the tear trough. Notice the increased fullness to the tear trough. The filler helps camouflage the bulge of the lower lid caused by prolapsing fat pads. One can see why this procedure is sometimes termed a ‘non-surgical blepharoplasty’

  • 2 weeks after injection of Restylane in to the tear trough. Notice the increased fullness to the tear trough. The filler helps camouflage the bulge of the lower lid caused by prolapsing fat pads. One can see why this procedure is sometimes termed a ‘non-surgical blepharoplasty’

    2 weeks after injection of Restylane in to the tear trough. Notice the increased fullness to the tear trough. The filler helps camouflage the bulge of the lower lid caused by prolapsing fat pads. One can see why this procedure is sometimes termed a ‘non-surgical blepharoplasty’

Pricing for Restylane Tear Trough Filler Treatment

The typical cost for a course tear trough rejuvenation with injectable fillers by Mr Cheung is around £990 (£100 for initial consultation and £890 for a course of tear trough filler treatment with Restylane at the Westbourne Centre).

• Tear trough filler treatment is performed personally by Mr Cheung at The Westbourne Centre, Birmingham.
• Following an initial consultation (consultation fee £100) which can take place at any of the clinics where Mr Cheung consults, tear trough filler treatment may be recommended. Mr Cheung will supply information to allow you to make an informed choice about whether they wish to proceed. If you are still happy to proceed, please then contact Mr Cheung or his PA directly, who will ask Westbourne Centre to liaise with the patient to arrange a convenient date of treatment and collect payment in advance of the procedure. From March 2021, the treatment charge for this treatment is £890 and includes procedure fee, facility fees, consumables and necessary review appointments.
• Most patients require a 1ml vial of hyalauronic acid filler for their treatment. However for patients who have excessively deep troughs, larger volumes of filler may be necessary which the Westbourne centre may need to bill for.
• For patients undergoing their initial treatment course, it is recommended that they attend clinic again 2-4 weeks following their treatment to be reviewed in person Mr Cheung. However if the patient is comfortable and has no problems, they may decide to forgo this review appointment and keep in contact with Mr Cheung via email.

I had been thinking about tear trough filler for years but was always too scared as I had heard it could cause blindness. I did a lot of research and read that the risk was minimum if you chose an experienced doctor. I Googled eye surgeons in Birmingham and Dr David Cheung came up who had a clinic local to me. He has a lot of experience and of course he is an expert in the anatomy of the eyes so I chose to go for a consultation. He put me at ease immediately and I was impressed with his honesty and knowledge. He suggested tear trough filler would be a good option and informed me of all the risks. I decided to go ahead and booked an appointment. The consultation fee by the way cost £100. So the appointment arrived and I was nervous but again Dr Cheung was wonderful. Really friendly and pleasant. He actually uses anesthetic to numb the area (which stung) but wasn't too bad and then uses a microcannula to inject the filler. He decided upon restylane for me because I have very thin under eye skin and he needed to inject deeply. He said if he'd used perlane it might have left blueish tint under eyes. I couldn't feel a thing due to the anesthetic so the whole procedure was fine and I'd worried needlessly! I have sensitive skin so after I had visible redness and needle marks and a little immediate bruising. Dr Cheung talked through my after care and said I would bruise a bit in the says to come and have swelling, especially as he'd had to inject so deep. As he warned I did suffer from bruising and swelling but used ice to help along with arnica. I had it done on Saturday and was back at work on Monday but I think my glasses helped to hide it! I'd say it had settled within a week and I was really happy with the results and glad I had done it. Before I could not hide the bags and darkness with makeup and constantly got told how tired I looked. Now I feel I look refreshed - not tired and I don't need to pile on concealer! I can even leave the house WITHOUT concealer!!! At my follow up I wanted to have some more filler injected but Dr Cheung did advise against it and said because of where he has to inject the filler he'd only be able to marjinally improve upon the results and to save my money. I was happy with his honesty and respected his professional opinion. Therefore I will, after about 12 months time look at going to see Dr Cheung again for some more!
Esva: Restylane Tear trough microcannula injection - BMI Edgbaston Hospital - Review from RealSelf.com

Patient Feedback and Reviews

It is understandable to be anxious about what to expect when meeting a new doctor.

Common questions asked by patients seeing a new doctor include:

  • default_titleWhat is the standard of his surgery?
  • default_titleShould I be nervous about surgery?
  • default_titleWill he be easily contactable for my concerns?
  • Show More
  • default_titleIs he friendly?
  • default_titleCan I trust him?
  • default_titleCan I talk to him comfortably?
  • Show More

Here is a small selection of patient testimonials kindly offered by some of Mr Cheung’s previous and current patients, which give some insight into what to expect. All the patients involved have kindly given their consent to the publication on this website. To protect patient confidentiality, any identifying elements have been removed.

"As a senior nurse, I was very discerning in my choice of surgeon , and undertook significant research before deciding to have surgery. I am delighted that I chose David Cheung. From my very first email enquiry, through to discharge, David's communication was excellent. He gave me full explanations and information. My initial consultation was friendly and thorough and by the end I felt fully informed about what to expect, I had ample opportunity to ask questions and was very involved in agreeing with David the outcome we were planning to achieve. The actual surgical experience was positive and I only experienced minimal discomfort. I am delighted with the result of the surgery which has achieved the outcome David and I agreed resulting in a more youthful but natural look."
Dame Catherine Elcoat DBE

Dear David, I just wanted to thank you for your extreme dedication and professionalism in coming in specially to perform expert restorative surgery on this young girl on Tuesday morning. I saw her post-op yesterday and the difference compared to pre-op was remarkable and I’m sure will make a huge difference to her in the future. The mother and the girl herself are immensely grateful for your expertise and recognise the vast improvement they can already see…."
Mr JS Barry, Consultant Ophthalmologist, Dudley Group of Hospitals NHS Trust.

" Dear David, we just wanted to say that we are incredibly happy with the final result following our surgery. It has given us so much confidence and has really made such a difference to our lives. We would have loved to see you again but hope you'll understand that we'd rather just send a selfie. Either way they look amazing and we are just so happy with them. Thank you so much for taking the time with us, making sure we were always in the loop and your intricate surgical skills. Thanks so much…."
Miss CC and SC, Glasgow. Surgery performed: Double eyelid surgery/ Oriental Blepharoplasty with medial epicanthoplasty under local anaesthetic at the BMI Edgbaston Hospital.

“ Dear Mr Cheung, Oh what a surprise! How absolutely amazing-I am sitting on cloud 9-admiring myself! On the way home last Wednesday my great friend informed me that I looked like a panda, but she did at least buy me a big bag of frozen peas on the way! I was a little anxious at the thought of looking in a mirror but anticipation too over from fear! What I saw in the mirror was absolutely incredible. I was looking at a person whom I knew very well, but had not seen for many years. This was an absolutely amazing experience. My friends and I all agree. We are absolutely thrilled with the results of my meeting with you and your surgery. We can hardly believe what we are seeing! And now I don’t know how to thank you- for words aren’t adequate. But I will say, “Thank you, thank you, thank you!”-again and again for I am over the moon! I am thrilled beyond words and am looking forward to seeing you again to say “Thank You!’”
Dr JB (retired consultant anaesthetist, Worcestershire). Surgery performed: Combined bilateral upper eyelid ptosis correction with blepharoplasty under local anaesthetic at the West Midlands Hospital, Halesowen

”Dear Sir, thank you very much indeed for the surgery you performed on me, although it was it was recommend to improve comfort it has, how can I put it, benefitted my vision…I believe that the the eyelashes were scratching the lens so following the surgery when this scratching ceased the lens allowed what sight I still have to work better. Before the operation to my right lower lid, I was down to just the left eye for clarity and that is without significant peripheral vision; the right eye was just shapes and colour- in many circumstances the right eye was detracting from the vision in the left eye and often I found it better to cover my right eye. Since the operation I can see again in my right eye. At 60 years old, my GP had told me that I would eventually go blind. Last week though my wife and I went to the photography show at the NEC and I bought a new digital camera. With the wonders of this new technology I can see the results on my new television. For the first time in a long time, I felt confident enough in the future and with my vision to buy this new camera. For the first time in a long time I have felt optimistic enough to buy something like this. Thank you so much. At the age of 87, I am living for the now and the near future, not morosely managing decline. The world is full of people who complain but few notice the good things such as your exceptional service provided…”
Mr GR. Surgery performed: Right lower lid entropion correction at the Russells Hall Hospital, Dudley

" ..Dear Paula Clark, in today’s society people are very quick at making complaints but don’t voice gratitude and acknowledge outstanding professional care. Hence the following letter: I had the privilege of being referred to Mr Cheung a few years ago following the removal of an acoustic neuroma in 1999. I have had continued problems with my left eye since that date. Although it has not probable that I have been his greatest challenge, for me it is a significant irritation when dealing with all of my other medical conditions. I feel it important to mention from the beginning I had an emergency operation in Manchester, which left me with great anxieties re: any further treatment with my eyes. I cannot state this strongly enough. My first meeting with Mr Cheung was amazing. For the very first time in many years, I met a friendly professional who LISTENED. He took my history and talked to me about my concerns and issues that arose. He remained very professional throughout examinations and explained at a level of communication that suited me, exactly what he was doing and talked to me throughout. I don’t feel he understands exactly how good he is with using his holistic skills in communication. He is open and easy to communicate with, which immediately builds a trust between patient and professional. This in turn allows a patient to build confidence and trust. He is open and transparent in his working methods, which again builds trust. I have never felt excluded from my treatment, which I have felt so many times before, which promotes a sense of mistrust. He is a shining example to so many other staff in how to relate to patients and equally I’ve seen him communicate with other professionals and teach students in such a professional and dignified manner. (I hope the students realise how privileged they are.) He is very calming and will explain at a level suitable to the recipient about what is going to happen. Mr Cheung will give useful handouts thus allowing you to take the resources home to enforce all the verbal information given in appointments. His skills in theatre again are professional, calming and promotional to a patient’s holistic needs being met. As previously stated my mistrust with any procedures was a hurdle for me to overcome beyond belief. My first meeting with Mr Cheung restored my trust and allowed me to receive treatment with confidence in his capable professional care. Obviously patients talk in waiting rooms and I can honestly say I have never heard anything but positive feedback. He treats everyone with respect, his friendly persona and open, transparent method of working builds trust.... Please pass on my thanks to Mr Cheung. I hope he is as valued by the health authority as he is valued by the patients he treats….."
Miss SD. Letter to Chief Executive of Dudley Group of Hospitals NHS Trust

"....Hi, thank you so much for the photos [of my eyelids before and after the operation]. As you say, you can really tell the difference and I do feel more confident within myself and the headaches have lessened.I do appreciate your help and the friendly way in which you take care of your patients. Again, thank you so much..."
Mrs JC (Birmingham). Procedures performed: blepharoplasty of all 4 eyelids at the West Midlands Hospital, Halesowen

“........I underwent a blepharoplasty operation performed by Dr. Cheung.  I would just like to say how professional and reassuring Dr. Cheung was throughout the whole procedure, leading up to, during and after the operation. Although only a minor operation I did have doubts about having it done because obviously if anything went wrong it would show!  I am pleased to say that I am thrilled with the results, it's really improved the quality of my eyesight, put an end to the headaches and tiredness I was experiencing and even made me look a little younger! I am so pleased that I am considering having more surgery. I would recommend Dr. Cheung’s services to anyone in a similar situation.”
Mrs LB (Worcester). Surgery performed: Bilateral upper lid blepharoplasty with orbital fat sculpting at the Edgbaston Hospital, Birmingham

“...For many years I had a runny eye, having been told by a lady ophthalmologist to “live with it”. After two infections, my GP referred me to your department for September. However in June, it was infected, very inflamed with a pus discharge. Immediately, my husband took me to the eye clinic. A very kind nurse explained I had to go to eye casualty first and took us there. After examination by the casualty officer sent me to see you as an emergency. Being late afternoon, I was surprised to be able to see you so soon. I do appreciate your care and kindness. Antibiotics were prescribed which cleared the infection up. A date was booked for my operation.
I came in at 12.30pm, when all my details and BP were recorded. I also spoke to a lady anaesthetist and prepared for my op. They had trouble finding a pulse and I was told that the needle ( for the general anaesthetic) would hurt- it did! But the next thing I awoke and it was all over.
Back in bed, a drink with food and a visit from you who told me I could go home. Thank you and all your nurses and staff. All of them were so caring, friendly and kind. I couldn’t fault you. I had a bit of trouble breathing, but Olbas Oil on my pillow helped put me to sleep.
Since then I’ve seen you twice and had the tube (lacrimal stent) removed. After a few twinges out it came. You were very pleased with the healing of the scar and took some photos. Many thanks to you all for the hard work you do in making me look better. Good luck in your career, may you succeed and become very successful!”

Mrs JS (Aged 80). Surgery performed: External dacryocystorhinostomy with lacrimal intubation (tear drainage surgery) under general anaesthetic.

“.... At all stages of my treatment from initial consultation to my final review, I was made to feel at ease. I was nervous about the operation and what was going to be undertaken but the care of your staff reassured me. Your care and work was excellent too and I am very happy with the result..Grateful thanks to everyone!”
Mrs JB (Bromsgrove). Surgery performed: Bilateral upper lid blepharoplasty and unilateral upper lid ptosis correction under local anaesthetic at the Edgbaston Hospital, Birmingham

“... I can only commend the service and care I was given before and during my surgery. Prior to my surgery, I was given information about the operation. As I am 86 years of age, my daughter and grandson came along to the hospital with me, and not only did you explain the operation to me, but also to them. I was very pleased about this as I think it is important for your family to understand exactly what will happen during surgery.
I found your team very kind and caring both at Dudley Guest and Sandwell before and after surgery. I felt at ease and confident during my operation and was quite surprised when surgery was completed... Thank you once again!”

Mrs IH. Surgery performed: Excision of eyelid tumour followed by reconstruction after histological confirmation of clearance under local anaesthetic.

"..... thank you so much for giving me my new eyes!!  What a difference it has made to me, not just the fact that I can see more now than I could before, but I also have eyelids, a fact that my daughter keeps commenting on.  She says that she has never seen me with eyelids before and she’s is almost 30!!  People at work have commented that I look younger and fresher, without looking startled which is just what we wanted to achieve.  I can’t believe that on the day of surgery I was so calm, I am usually quite an anxious person, particularly where hospitals and treatment is concerned, but your chats beforehand and on the morning of the surgery put me completely at my ease.  I really can’t remember anything of what went on even though you told me that I was talking the whole way through.  Please thank your theatre team for their care too...."
Mrs AJ (Gibraltar). Surgery performed: bilateral upper eyelid blepharoplasty under local anaesthesia with twilight sedation as an outpatient procedure at the Edgbaston Hospital

"....if I had known about you guys before [oculoplastic surgeons], I wouldn't have gone to a general plastic surgeon and been in such a dreadful state when I first saw you. Thank you so much for giving me back my eyes. I wished I'd come to you in the first place! Please pass on my thanks to your wonderful caring team..."
Mrs TT (London). Surgery performed: revisional lower eyelid blepharoplasty and tear trough restylane performed at the Edgbaston Hospital.

"...Hello David, Thanks very much for the photos.  And yes, they are a HUGE improvement!  It has totally transformed my face..... I just want to say Thank you so much!  My eyes literally pop when I have my war paint on! Lots of best wishes"
Mrs SC (Edinburgh). Surgery performed: Bilateral upper Oriental Blepharoplasty/ Double Eyelid surgery at the Edgbaston Hospital, Birmingham

“... I was referred to Mr Cheung by my doctor. He told me what I needed doing, which was that my top and bottom eye lids need to be tightened up and tear ducts washed out (nip and tuck). It involved injections around the eyes. I was rather nervous but need not have worried. He has done a lovely job. I have not had any problems since. I wish to thank Mr Cheung for the excellent job he and his team did.”
Mrs CD (Birmingham). Surgery performed: bilateral upper lid blepharoplasty, bilateral lower lid tightening and ectropion correction.

"...My eyelids look so lovely! I'm so thrilled! Thank you oh so much. Swelling has almost completely disappeared already. You just can't see the scars. My husband passes on his thanks too. He said I look like I did when he first met me 20 years ago. Thank you. Thank you. Thank you..."
Mrs KG (London). Procedures performed: bilateral upper lid blepharoplasty, bilateral lower lid blepharoplasty, tear trough rejuvenation with Restylane and wrinkle relaxing injections with Botulinum Toxin A injections under local anaesthesia at the West Midlands Hospital, Halesowen

“…Before having my tear trough treatment I was naturally a little apprehensive. David gave me all the facts and his friendly and knowledgeable manner put me at ease and made me feel confident that he knows exactly what he is doing.I didn't need to worry however as he did a fantastic job and I had no problems whatsoever. What strikes me most about Mr Cheung is his skill and knowledge, as each case is individual, but he knows what to do to get the best result possible for you. I also felt assured that he would correct any problems, I actually emailed him for advice and he replied promptly and answered my query. It is clear to me that he is a principled and conscientious practitioner, who wants to achieve the best results possible for his patients. On top of that he has a friendly helpful manner and is generally a top guy!....
Mr SH (London). Tear trough filler treatment for under eye dark circles and hollowness at the Edgbaston Hospital, Birmingham

"....One of the best pieces of news that I ever received in my life today when you told me that I was cleared of my eyelid cancer. My husband says that he can't see where you've actually removed the tumour. I was so worried at the time but you calmed down and instilled me with confidence. I'm so indebted to you and your team. Merry Christmas and carry on with the good work!..."
Mrs EH (Birmingham) Surgery performed: Skin cancer (BCC) removal from lower eyelid (Moh's micrographic surgery) with reconstruction as a day case under local anaesthesia at Sandwell Hospital, Birmingham

"....Finally my eyes are dry! The incision has disappeared altogether and after 10 years of embarrassment, I can finally play a round of golf with my friends asking why I'm crying! I should have had this surgery done years ago. Thank you so much again for you professionalism, skills and expertise. From the first time we met, you took the time to explain what was going on and what surgery entailed without resorting to jargon such that I knew what was going to happen. I knew I would be in competent hands. Thank you so much...."
Mr FT. Surgery performed: Dacryocystorhinostomy (tear duct bypass surgery for blocked tear ducts) to treating watering eyes under local anaesthesia with twilight sedation as a day case procedure at the West Midlands Hospital, Halesowen

.....It's been just over 3 weeks since I had the op, and I wanted to write to say a big thank you.  As the swelling has settled down some more, I am really happy with the results.  The whole experience from the moment I first contacted you has been a very positive one.  You have been very informative throughout, always quick to reply to emails and have always put me at ease. A big thank you for the "freebie" on the day too, and the professional care you and your team provided at the time...."
Miss LL (Manchester). Surgery performed: bilateral upper eyelid Asian/ Oriental blepharoplasty combined with ptosis correction under local anaesthesia at the Edgbaston Hospital, Birmingham

".....Thank you so much for operating on my eyes recently for the removal of skin on the upper eyelids. The in how I look and therefore feel is remarkable in only three weeks. I can now work and carry on with my creative work without getting 'tired' and heavy eyes. I can also wear make-up again (very important to us women!). Thank you again for such a marvellous outcome...."
Mrs CP (London). Surgery performed: bilateral upper eyelid blepharoplasty under local anaesthesia as an outpatient procedure at the West Midlands Hospital, Halesowen

"Dear Mr Cheung, I just wanted to say thank you so much for looking after my mom and removing her eyelid cancer. We were so worried but you always put our minds at ease and we can't even see where the original lump was now. You were so busy and everyone kept coming to ask for your advice when we saw you. We had to wait a while to see you each time because you were so busy with so many patients but you always made my mom feel special and safe. The NHS needs stars like you so please don't ever just leave our hospital"
Mrs RC. Daughter of a patient treated at Russells Hall Hospital, Dudley for Basal Cell Carcinoma of the eyelid

“The consultation with Mr Cheung was both informative and relaxed. He put me at ease about the surgery and explained the procedure. The operation itself went very smoothly and I had the best possible care at West Midlands Hospital. The recovery period was as I expected and I took 12 days annual leave from work. The bruising and swelling had disappeared by the time I went back to my job as a flight attendant. The recovery was pain free, just a little itching as the stitches were healing. So many people have commented on how fresh faced I look since the surgery. My work colleagues have been asking me if I've been on holiday as I look so well rested. I can honestly say that I had total confidence in Mr Cheung and had a very good experience in his care. My confidence in my appearance has improved and I feel 10 years younger...”

Miss KL (Cheltenham, Gloucestershire). Surgery performed: Bilateral lower lid blepharoplasty under local anaesthetic with twilight anaesthesia at the West Midlands Hospital, Halesowen

“....Oh David, I don’t want to big up your head too much but what others say about you is true! You are where medicine, art, science and habit meet. As you can tell I’m so damn happy with what you’ve done with my eyes. Thank you so so much....”
Miss MS (Manchester, Lancashire). Surgery performed: Bilateral lower lid blepharoplasty under local anaesthetic with twilight anaesthesia at the West Midlands Hospital, Halesowen

“...David, if only you really knew how much you’ve altered my life for the better! I can’t thank you enough. I can see again, everything looks so much brighter. Lovely lashes! Thanks so much for all the pictures of my eyelids but I don’t really want to look at them again. They remind me of how old I used to look. Thank you, thank you, thank you, thank you....”
Miss JC (Oxford). Surgery performed: Four eyelid blepharoplasty with twilight anaesthesia at the BMI Edgbaston Hospital, Birmingham

“...Now I understand why there’s a waiting time to see you and for surgery! You were so worth the wait though. I bit more expensive than my local plastic surgeon but so much more thorough. The plastic surgeon I saw before I saw you didn’t do half the tests that you did. I had total confidence in your care. Now to save up for my lowers! Thanks so much David”
Miss MB (Bristol). Surgery performed: Bilateral upper eyelid blepharoplasty with ptosis correction under local anaesthetic at the BMI Edgbaston Hospital, Birmingham
“ I would like to take this opportunity to thank you and your team for the friendly care and attention you gave me on my recent DCR operation which went very well, I’m glad to say. You and your team really did a first class job. You especially Mr Cheung!
I’m very grateful that it was you who personally performed the operation as you really are top class. I have to have further treatment later on but I have every confidence in your ability. You and your team have put me at ease and looked after me very well. I’m very happy with your system of patient care. Many thanks”

Mr DQ. Surgery performed: Unilateral dacryocystorhinostomy and retrointubation for lower canalicular obstruction (complex tear drainage surgery) under general anaesthetic.

"....Thank you again for your excellent care. For the first time in 15 years, I can finally say that I'm happy with my eyes. Thank you for giving them back to me! My husband is very, very happy and sends you his best regards. Please pass on my thanks to your excellent team and to all the nurses who looked after me. Your service is an example of clinical excellence and professionalism in the NHS."
Mrs GT. Surgery performed: Four eyelid blepharoplasty eyelid lowering with orbital fat debulking & repositioning for thyroid eye disease.

“...First and foremost, I would like to say that I have recovered very well from the surgery to my left eye. I did not experience any pain or bruising during recovery and I returned to work within a few days. My eye looks better than ever and I have not experienced any of the explained risks i.e. double vision or dry eye.
In considering relative comments about my experience, I have to say that initially I was concerned about the prospect of undergoing invasive eye surgery, which I feel is only natural. However on speaking to you about the procedure all my fears disappeared. You instil confidence in your patients and put them at ease, I feel this is of great importance for their well being. After consulting with you, I actually looked forward to the operation. Your bedside manner and professionalism is a credit to the Trust.
We must also mention the staff and your team at the ophthalmology unit. I thank them for all the care they provided before and after the operation. Every member was so helpful and courteous- a credit to the unit. This also speeds recovery and makes patients feel better. The way the ophthalmology is run is reminiscent of the way hospitals used to be: small is beautiful. Many thanks...”

Mr AP. Surgery performed: Debulking of prolapsed orbital fat under general anaesthetic.

“ I have had a thyroid problem for years, but the past 4 years or so it’s affected my eyes. They thought there was something behind my eye, pushing it forward, it was so bad. I had a CT scan and everything was clear. I was then referred to an ophthalmologist who said that my eyes did need minor surgery, so he referred me to Dr Cheung. I was so self conscious about my eyes when I was talking to anyone. I stopped using makeup. I had no eyelid at all in my left eye. When I first met Dr Cheung, he said that there was a minor operation he could do. I was so pleased that someone could help but on the other hand I was very very nervous, but he really put me at ease. When Dr Cheung told me I would be awake for the operation, this made me more nervous, but I thought just do it. I did have the operation and I’m so glad I did. I didn’t feel a thing. I now can look people in the eye, when I’m talking to them. I would like to thank Dr Cheung and I would recommend this operation to anyone who has a similar condition to mine. Thank you again Dr Cheung!”
Mrs RG. Surgery performed: Unilateral upper eyelid lowering for lid retraction due to thyroid eye disease.

“...I just wanted to say thank you once again for doing such a great job on my eyes last year. I'm so pleased with the results. I also thought you were a really nice and caring person as well as highly professional. Thank you so much Mr Cheung!”
Miss JA (London). Surgery performed: Bilateral upper eyelid revisional blepharoplasty under local anaesthetic at the BMI Edgbaston Hospital

“….Just wanted to say how thrilled I am with my new eyelids. From my consultation with Mr Cheung through to my operation, Mr Cheung was very professional and reassuring. I didn’t feel any pain when having my left and right eyelids done. In fact I would do it all over again! Before the operation, Mr Cheung said that it would be “better than going to the dentist and the operation is a bit like having your hair done” and he was right! The results are truly amazing. Thank so very much Mr Cheung!..”
Mrs RA (Walsall, West Midlands). Surgery performed: Bilateral Upper Eyelid Blepharoplasty/ Upper Eyelid Lift as an outpatient under local anaesthetic at the West Midlands Hospital, Halesowen

“....Dear David, thanks a billion for your photos, I will keep them for life as this is a very special memory of mine and I am very satisfied with the results, thanks for your amazing professionalism and constant reassurance! ...Many thanks for your incredible skills and consideration....”
Miss KIL (London). Surgery performed: Bilateral Upper Eyelid Oriental Blepharoplasty (Double Eyelid surgery) and Single Anchor Point Medial Epicanthoplasty under local anaesthetic at the BMI Edgbaston Hospital, Birmingham

" David. Thanks so much for looking after me. I'm made up with the result! I just wanted to say thank you for all your skills, your patience and always being there for me. Most of all thank you for looking after me as an individual. I know you're busy but I could never tell it from your consultation style, emails, telephone calls…Good luck with the future and I may see you again for my uppers in a few years…"
Mrs VP, Worcester. Surgery performed: Anterior approach lower lid fat draping blepharoplasty

“....Hi David, Thank you so much for the pics, but thank you more for the fantastic, skilled surgery and the complete overall experience, I couldn't be happier with the results....”
Mrs AP (Stourbridge, West Midlands). Surgery performed: Bilateral upper eyelid blepharoplasty and transblepharoplasty brow lifting with Endotine

“....Hi Mr Cheung. Photos look great on website. Thanks again for doing an amazing job on my eyes....”
Miss MU (Stourbridge, West Midlands). Surgery performed: Complex lower lid blepharoplasty

“ Hi David, thank you for the pics. It was good to see you too. So glad my eyes have improved so much, thanks to your expertise....Lastly thank you so much for taking care of me, no need to worry about me going to anyone else. I have found the best and will stay with the best!....”
RL (Coventry, East Midlands) Surgery performed: Bilateral lower eyelid transconjunctival blepharoplasty under twilight sedation

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Forthcoming clinics for Mr Cheung

Frequently Asked Questions

Probably about 70% of Mr Cheung’s patients live outside the West Midlands area. Indeed about 20% live abroad.
Mr Cheung often sees patients with quite complex eyelid problems e.g. patients requesting revisional eyelid surgery, patients wanting bespoke cosmetic eyelid surgery. Thus many patients come quite a distance to see him, rather than a general ophthalmologist or general plastic surgeon.

Mr Cheung normally runs regular clinics for consultation on:
Wednesday (8.30am-2.30pm) at the Edgbaston Eye Consultants clinic in central Birmingham. Telephone: 0121 456 3444
Thursday mornings (8.30am -12.00pm) at the West Midlands Hospital in Halesowen, B63 2AH and Stourside Hospital in Stourbridge DY8 1UX. Telephone: 01384 632607 and 07384 253011
Saturday mornings (8.30am - 12.30pm) at the Westbourne Centre in central Birmingham 0121 456 0880

Due to these hospitals partaking in the national NHS resilience scheme (where private hospitals have offered their services for usage by the NHS), unfortunately some of these clinics have had to temporarily close or reduce in frequency.

Most patients living outside Birmingham prefer to see Mr Cheung at one of the central Birmingham locations. These are all approximately 10mins by taxi from Birmingham New Street Train station and 45 minutes taxi from Birmingham International Airport.
Currently 30% of Mr Cheung’s patients are from London: many of whom commute for their morning appointments by train, to arrive back home just around lunchtime.
Patients attending for eyelid problems rarely need to have dilating drops instilled during their consultation and are therefore usually fine to drive.

  • Look at the calendar above to check when a clinic is being held.

From October 2020, Mr Cheung normally runs clinics for consultation on:
  • Wednesdays (8.30am- 3pm) at Edgbaston Eye Consultants in central Birmingham. Telephone 0121 667 3927 Website
  • Saturday mornings (8.30am- 12.30pm) at the Westbourne Centre, Birmingham. Telephone 0121 456 0880 Website

  • Unfortunately neither Mr Cheung nor his PA have access to the hospital outpatient diary systems. These are run solely by them. Please kindly ring the clinic on the phone numbers above to arrange the appointment to suit you. You may be asked to leave a voicemail message since the clinics can be very busy.
  • Please bear in mind that rush hour traffic congestion can be severe especially during school term time in central Birmingham and if necessary allocate additional travelling time for this.
  • If you have any difficulty booking an appointment, then please feel free to email Mr Cheung directly:

Mr Cheung’s operating lists are usually in the morning. Patients commonly arrive for 7.45- 8am, undergo their surgery and are going home by lunchtime. Most patients are usually back home by mid afternoon.
Less commonly patients book a hotel nearby for the night before and night of the actual operation. This is usually for convenience’s sake so that the commute is less rushed but Mr Cheung is quite happy for patients to commute back and forth on the day of their surgery.

Local Anaesthetic Surgery
Most patients undergo their surgery under local anaesthetic due to its lower costs and convenience. Patients often commute by public transport or are driven to the hospital by friends or family. For some smaller procedures Mr Cheung is happy for the patient themselves to drive and attend accompanied.

Twilight Sedation Surgery
Patients can request for an anaesthetist at extra cost to be present during the operation to administer sedation. Following intravenous sedation though, patients may have slightly slower reactions and are therefore advised not to drive nor operate machinery for 24 hours afterwards. They should attend hospital for their operation accompanied by a friend or family and can commute by public transport or be driven by car.

Due to medicolegal constraints affecting the entire healthcare industry now, Mr Cheung is no longer able to offer same day consultation and procedures.
Like most reputable hospital facilities, the hospitals at which Mr Cheung operates insist on a ‘cool down’ period of at least 14 days to allow the patient to fully consider the consequences, risks and benefits of any discussed surgery. If you do have a specific date in mind for your consultation and surgery, then please feel free to email Mr Cheung directly to discuss further.
An initial consultation with Mr Cheung typically takes about an hour because multiple steps need to performed to ensure patient safety including ocular surface examination, eyelid function, ocular motility, orbital examination, ocular fundoscopy, clinical photography, patient discussion and surgery planning. Following this there is a 3 stage consent process to ensure the patient is completely happy prior to proceeding towards their requested treatment plan.

Skype/ FaceTIme/ Webex/ Zoom compromises the consultation process too much to be truly useful unfortunately for the initial consultation. However with the advent of COVID 19 these platforms have been useful for remote consultations in the patient's care pathway.

Similarly patients can if they so wish correspond via email with Mr Cheung sending good quality 'selfies' of their eyelids

Patients may if they so wish perform an audio recording of their consultation for their own records. For medicolegal and medical chaperone purposes, all consultations are continually audio recorded and then encrypted and archived respecting patient confidentiality and data protection.
  • Patients undergoing minor procedures sometimes do not need to be seen again following their procedure.
  • However most patients undergoing more extensive operations e.g. double eyelid surgery, blepharoplasty surgery, cosmetic eyelid surgery, are usually seen at 1-2 weeks afterwards. Stitches are often removed at the appointment.
  • Most patients are then seen again at 3-6 months following their procedure just as a final check up. However many patients from outside the West Midlands are quite happy to cancel this final outpatient appointment and email Mr Cheung to reassure that everything is fine or conduct these late consultations remotely e.g. via Zoom, Webex, Microsoft Teams

Mr Cheung's PA for private patients
Mrs Elizabeth Carter
Tel: 01384 632636

For technical questions relating to surgery and advice, Mr Cheung would be grateful if you would kindly direct any queries via email to him directly via: