Brow Ptosis: Drooping Eyebrows, Foreheads and Brow Lifting

Brow Ptosis- What is it?

Changes in position and shape of the eyebrow are an integral part of facial expression and influence the way in which one's mood and personality are interpreted by others.

Although, there are a variety of eyebrow shapes, on average the female brow has a higher arch than the flatter male counterpart.

With age, the eyebrow starts to descend and become less prominent due to atrophy of the surrounding supporting tendons and deflation of the tissue through loss of fat of the scalp, forehead and temples.

The eyebrow also starts to alter shape and become less stable. A commonly seen feature is descent of the outer tail of the eyebrow with loss of the gently flared shape of youth to become 'comma' shaped. This is commonly referred to as 'clipping' of the eyebrow.

What Causes Brow Ptosis | Drooping Eyebrows

  • Normal AgeingMost patients do not notice nor complain of actual descent of the eyebrow at all but increased upper eyelid bags or hooding (dermatochalasis) due to increased redundancy of skin in the upper eyelid fold. For patients wishing to look younger, corrective eyelid surgery (blepharoplasty) will help a lot of these patients but a significant proportion of patients will also require surgery to stabilise or lift the eyebrow. since eyelid surgery alone may actually worsen the pull down further an already drooping eyebrow.
  • Certain IllnessesIn addition to normal ageing of the surrounding supporting structures of the eyebrow causing brow ptosis, some disease conditions can cause descent of the eyebrow e.g. facial nerve damage
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Before Before brow lifting surgery
After After brow lifting surgery

Before and immediately after combined brow lifting surgery combined with ptosis correction surgery. This lady's eyelids and eyebrows were so droopy that it compromised her vision and as such was therefore funded by the NHS for functional reasons.

How Does Brow Ptosis | Drooping Eyebrows Affect You?

  • CosmeticPatients complain that they look tired, stern and melancholic
  • Headachesfrom fatigue of the forehead muscles as patients try to constantly work to lift up their drooping eyebrows
  • Visual Field Compromisesometimes eyebrow descent results in marked redundancy of the below eyelid skin and vision obscuration
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Brow Ptosis Treatment

Depending on the patient's complaints and brow ptosis severity, various procedures may be performed to improve the stability and position of the eyebrow.

For the small proportion of patients whose symptoms and signs are very severe, these procedures may be offered for functional reasons and would therefore be available on the NHS and through private medical insurance.

However, for most patients who seek treatment for brow descent purely for cosmetic reasons, treatment falls into the realms of cosmetic surgery and is therefore only available privately via self funding.

There are several treatment methods that Mr Cheung offers for the treatment of brow descent/instability, all with a different role to play.
These range from:

  • default_titleSimple, non surgical methods e.g. muscle relaxing injections into the tail of the eyebrow using botulinum toxin (Botox®) or injection of dermal fillers into the eyebrow to alter brow shape/position
  • default_titleMinimally invasive techniques often used in conjunction with eyelid surgery e.g. transblepharoplasty brow lifting, internal browpexy, orbicularis depressor excision
  • default_titleConventional endoscopic and non endoscopic forehead lifting
  • default_titleExcisional techniques e.g. direct brow lifting, direct forehead lifting, pretrichial brow lifting, coronal forehead and eyebrow lifting
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These procedures vary in complexity, postoperative recovery time, procedure duration and permanence. Mr Cheung will be able to counsel you on what is most suitable for you based on what you want to achieve and your personal circumstances.

Brow lift surgery can be performed under:

  • default_titleLocal anaesthesia using just numbing injections usually performed by Mr Cheung
  • default_titleLocal anaesthesia with conscious sedation. An anaesthetist administers a trickle of sedating medication through the patient's vein to keep the patient relaxed, comfortable and often unaware of the the procedure.
  • default_titleGeneral anaesthesia
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Most brow lift operations are performed as a daycase procedure, that is, the patient goes home the same day. However, some patients prefer to stay overnight in the hospital or nearby hotel especially if they are from out of town.

There is a variety of brow lifting operations, all with different advantages and disadvantages. These will be discussed with you and the most appropriate one for you and your circumstances will be chosen. These include:

  • default_titleMinimally Invasive Brow Lifting Techniques
  • default_titleConventional Internal Brow Lifting Techniques
  • default_titleExcisional Brow Lifting Techniques
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Minimally Invasive Brow Lifting

Orbicularis depressor excision, internal browpexy and transblepharoplasty brow lifting
These are relatively simple procedures which are usually performed at the same time as upper eyelid cosmetic surgery (blepharoplasty). They have the advantage of being minimally invasive, using the same incision as the eyelid operation, hidden and invisible within the natural skin crease. Thus there are no additional scars and the recovery time is often very, very quick.

Orbicularis depressor excision involves removing a tiny strip of orbicularis muscle which attaches to the tail of the eyebrow causing it to depress. Removing this little strip weakens the depressor action of the orbicularis muscle, allowing the eyebrow tail to elevate slightly.

Internal browpexy involves elevating the eyebrow by releasing from the underlying tissue and securing it to the periosteum (lining of the bone) of the forehead using a suture. This is relatively quick to perform and is fairly inexpensive. Although an internal browpexy does not elevate the eyebrow substantially, it is often very useful in stabilising the eyebrow, allowing safe blepharoplasty surgery.

Endotine Transblepharoplasty Implants
Transblepharoplasty brow lift is similar to an internal browpexy but the instead of using a suture, a dissolving implant is used to help more securely elevate the brow.
Usually performed at the same time as a blepharoplasty operation, this procedure adds about 30-45 minutes of extra operating time.
The bone underlying the eyebrow is gently exposed and a tiny partial thickness hole is made in the outer layer of it. The implant is then engaged into this hole. Three hooks on the 'Endotine' transblepharoplasty implant engage the overlying soft tissue of the eyebrow and prop up the eyebrow. The implant the provides a secure convenient support for the eyebrow and overlying forehead tissues and slowly dissolves away over the next 3-4 months to become impalpable.
  • Before endotine transblepharoplasty brow lifting

    Bilateral lid hooding and brow ptosis: Before bilateral upper lid blepharoplasty and transblepharoplasty brow lifting. This lady was complaining of very heavy eyebrows, headaches and constriction of her peripheral vision.

  • after transblepharoplasty endotine brow lifting

    After bilateral upper lid blepharoplasty and transblepharoplasty brow lifting. Notice the improved eyebrow position and shape. Previously the outer tails of her eyebrows were droopy. With a combined brow lift and blepharoplasty, both her eyebrows and eyelids assume a better shape and no longer compromise her visual field. Blepharoplasty surgery alone would not have sufficed.

  • Stacks Image 9604

    This lady complained of upper lid hooding on both sides but with the right worse than the left. Note her right eyebrow is lower than her left

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    This lady complained of upper lid hooding on both sides but with the right worse than the left. Note her right eyebrow is lower than her left

  • Stacks Image 9614

    1 week following blepharoplasty surgery to both upper eyelids and elevation of her right eyebrow to match the other side using an endotine transblepharoplasty implant. Note the perfect symmetry of her eyebrows and eyelids again

  • Stacks Image 9619

    All incisons are hidden with the normal skin creases

  • Stacks Image 9624

    ….which have almost vanished at 6 weeks following surgery.

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    Before surgery again

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    After surgery again

  • before blepharoplasty and internal browpexy surgery

    Before Surgery: Upper lid hooding and Brow Ptosis. This lady complained of hooding of her upper lids. Her eyebrows were so unstable, that eyelid surgery on its own would have resulted in further descent of the eyebrow.

  • after internal browpexy surgery

    1 week following internal browpexy and blepharoplasty surgery. The eyebrow was therefore stabilised by using a suture to secure it to the underlying lining of the forehead bone (internal browpexy). Notice that even after only 1 week, much of the postoperative swelling has already disappeared.

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    This lady complained of marked hooding of her eyelids. Notice that her eyebrows are also quite low and rounded on the ends (brow ptosis). Unfortunately blepharoplasty surgery alone would likely cause further descent of the eyebrow and would be insufficient.

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    This lady complained of marked hooding of her eyelids. Notice that her eyebrows are also quite low and rounded on the ends (brow ptosis). Unfortunately blepharoplasty surgery alone would likely cause further descent of the eyebrow and would be insufficient.

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    1 week following bilateral upper lid extended blepharoplasty with internal browpexy. The internal browpexy stabilises the eyebrows and stops them from descending further. The blepharoplasty itself has had to be extended outwards into one of the lateral crow's feet to address the lateral hooding of the eyelids

  • after internal browpexy blepharoplasty

    1 week following bilateral upper lid extended blepharoplasty with internal browpexy. The internal browpexy stabilises the eyebrows and stops them from descending further. The blepharoplasty itself has had to be extended outwards into one of the lateral crow's feet to address the lateral hooding of the eyelids

  • Image

    1 week following bilateral upper lid extended blepharoplasty with internal browpexy. The internal browpexy stabilises the eyebrows and stops them from descending further. The blepharoplasty itself has had to be extended outwards into one of the lateral crow's feet to address the lateral hooding of the eyelids

  • after internal browpexy and blepharoplasty left 4

    6 weeks after surgery, most of the wounds have disappeared leaving a tiny degree of skin redness of the crow's feet which continue to fade away over the next 3 months

  • after internal browpexy right

    6 weeks after surgery, most of the wounds have disappeared leaving a tiny degree of skin redness of the crow's feet which continue to fade away over the next 3 months

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    6 weeks after surgery, most of the wounds have disappeared leaving a tiny degree of skin redness of the crow's feet which continue to fade away over the next 3 months

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    Before surgery again

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    After surgery again

Endoscopic and non endoscopic internal brow and forehead lifts

An internal brow lift is often used in middle aged patients with moderate amounts of brow ptosis. Although originally used in cosmetic surgery, internal forehead lifts with or without the aid of an endoscope has been used successfully in patients with mild functional brow ptosis due to certain diseases e.g. facial nerve palsy. Not only does it elevate the eyebrow, it also smooths out the forehead wrinkles. These internal brow and forehead lifts involve the release of the the descended forehead and eyebrow off the underlying bone of the forehead, sometimes with the aid of a rigid endoscope. Five small incisions behind the hairline are performed to allow release of the upper forehead to allow dissection of the retaining ligaments of the forehead soft tissues. These incisions heal to leave fine scars hidden within the hair. The tissues are then elevated and secured using a variety of fixation techniques. In addition to being able to release the retaining ligaments of the forehead and brow, an internal brow lift also allows for partial removal of some of the wrinkle and furrow causing muscles of the eyebrow and bridge of the nose.

Stacks Image 9657
Although commonly performed both in the UK and US, it does have certain recognised disadadvantages including relatively high cost, moderate permanence of effect and long procedure time. Compared to some of the newer less invasive procedures, full internal forehead and brow lifting is also associated with significantly longer recovery and greater postoperative discomfort. Increasingly, it is being recognised that the surgery associated with a full internal forehead lift e.g. a full forehead dissection is probably not necessary and that what is more important is the reliability of the fixation technique to secure the tissues in their elevated state.

Many surgeons are now recognising that the newer more reliable fixation techniques to elevate the eyebrow and forehead can also be employed e.g. endotine forehead fixation devices, without the cost and morbidity associated with performing a full internal forehead lift using an endoscope. In addition, many feel that the extreme amounts of lift associated with such extensive forehead dissection often result in an unnatural eyebrow giving a surprised, windswept look and that what is more important now is more subtle recontouring of the eyebrow shape instead i.e. less is more.

Overall Mr Cheung will tend to reserve this technique when there is generalised mild to moderate drooping of the eyebrow. For the more commonly seen temporal brow droop i.e. descent of the tail of the eyebrow, Mr Cheung prefers newer less invasive techniques e.g. transblepharoplasty brow lifting.
These operations are not suitable for patients with a high hairline due to scalp incisions. Patients can usually return back to normal activities 2 weeks following surgery.

Direct brow lift, temporal (pretrichial) lift, direct forehead lift and coronal brow lifts

Although these techniques of brow lift have been around the longest, they still have a significant role to play in modern surgery. They all have in common the fact that they are excisional techniques, where a strip of tissue above the eyebrow to be lifted is excised (removed). Because of this, they allow for significant amounts of brow lifting and are still considered to be the longest lasting of all the brow lifting techniques. The main disadvantage of excisional techniques is that a skin scar is created. However, the scar often becomes inconspicuous/ invisible.

For these reasons, excisional techniques have a major role to play in severely drooping eyebrows/foreheads often due to pathological conditions e.g. damage to the nerves supplying the facial muscles, where significant reliable amounts of lifting are commonly necessary.

  • default_titleDirect brow lift involves the removal of skin just above the eyebrow and is mainly used in older patients or patients with severe brow ptosis, commonly due to facial nerve damage. The incision scar will often look like normal forehead wrinkles in time or disappear outright. A direct brow lift not only has the advantage of being the most effective and predictable method of lifting a ptotic eyebrow, but also has the side effect of smoothing out the forehead furrows slightly by pulling it downwards towards the eye. This leads to an ironing out the forehead furrows and a pulling down of the hairline slightly, which is particularly useful in patients with a high hairline. Care is taken to try and hide the incision just above the eyebrow hairs.
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    Direct Brow Lifting: This patient has a drooping eyebrow due to paralysis of the facial nerve

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    Direct Brow Lifting involves removing a small slither of skin above the eyebrow. Here the required amount of skin has been marked out ready for removal.

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    Direct brow lifting: A fine scar may remain following surgery but for most patients this is cosmetically acceptable

  • default_titleA temporal (pretrichial) brow lift is useful for a patient who requires a moderate lift of the outer aspect of the eyebrow only. The incision is made in the temple just behind the hairline and involves the removal of a strip of hair-bearing skin.
  • default_titleDirect forehead lift involves removing a strip of forehead skin and muscle. Usually performed in men older than 50 due them commonly having pre-existing deep forehead furrows, the incisional scar is hidden within a forehead line. Although initially quite visible, the postoperative scar often fades away over time to resemble a normal forehead wrinkle.
  • default_titleThe coronal forehead and brow lift is the most invasive approach to brow lifting. This involves a large incision running across the scalp a few centimetres behind the hairline. Although considered outdated, this approach still has a significant role in patients with a marked brow ptosis. The disadvantages of this approach are the scar and potential permanent numbness of the scalp behind the scar which extends to the centre of the scalp.
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Postoperative Care
After brow lifting surgery, depending on the operation type, pressure dressings may be applied to minimise swelling. These are usually removed by the patient usually within 24 hour of the surgery and the patient is asked to apply ice compresses to reduce swelling further. If there are any stitches then these are usually removed at 7-14 days. Although 80-95% of the swelling has usually dissipated by 2 weeks, some minimal residual swelling may remain at 3-6 months. You may be asked to apply antibiotic ointment to the skin wounds and some ocular lubricants to the eyes, especially if a blepharoplasty operation has been performed as well.

Brow lifts performed for functional reasons are often available on the NHS or under private medical insurance.
Brow lifts performed for cosmetic rejuvenation reasons range in price from £250 to £5500 depending on procedural complexity, length of hospital stay, type of anaesthesia.

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 at West Midlands Hospital, Halesowen

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?
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  • default_titleIs he friendly?
  • default_titleCan I trust him?
  • default_titleCan I talk to him comfortably?
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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: