Sleep surgery · London
Uvulopalatopharyngoplasty, selectively, and honestly.
A palate and tonsil operation for CPAP-intolerant sleep apnoea and severe snoring. Done by a sleep-trained ENT consultant, only after DISE confirms palatal-level obstruction, and only where a modern alternative like Inspire is not a better fit.
Why patients choose us
- 01
A sleep-trained ENT surgeon, not a general list
A BAO-HNS-registered consultant with a dedicated sleep-surgery practice, DISE-driven case selection and honest response-rate quoting.
- 02
UPPP only when it truly fits
Classic UPPP is superseded for most OSA. We check whether Inspire, MAD, CPAP re-titration or a modern pharyngoplasty is a better call before you consent.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private UPPP costs in London.
Indicative ranges across our partner units. Send your sleep study and we quote firm figures across two or three options.
In short
Classic UPPP with tonsillectomy: £4,500 to £7,500, one overnight stay.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation, DISE mapping and case selection | £1,200–£2,200 | 60 min + 30 min DISE | 48 hours |
| Classic Fujita UPPP with tonsillectomy | £4,500–£7,500 | 60–90 min | Overnight stay |
| Expansion sphincter pharyngoplasty (ESP, Pang) | £5,500–£8,500 | 75–100 min | Overnight stay |
| Z-palatoplasty or lateral pharyngoplasty (Cahali) | £6,000–£9,000 | 90–120 min | Overnight stay |
| Multi-level surgery (palate + tongue base) | £8,500–£14,000 | 2–3 hours | 1–2 nights |
| Second-opinion review of sleep study and DISE | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by surgeon, by whether tongue-base work is added, and by length of stay. We come back with a firm quote within one working day.
The journey
From sleep study to repeat polysomnography.
One team from the first message through DISE, surgery and the response study at 3 to 6 months.
- 01
Before
You send us your sleep study and history
A short confidential form. AHI on polysomnography, CPAP history, Epworth score, Mallampati and Friedman grade if you know them, and any prior sleep surgery.
- 02
Before
We come back with a recommendation
Within one working day: whether UPPP fits, or whether Inspire, MAD, positional therapy or a soft-palate procedure is the better call. Indicative price.
- 03
Before
DISE and clinic review
Drug-induced sleep endoscopy maps the actual obstruction site. Without a palatal-level VOTE pattern, UPPP is not offered.
- 04
On the day
Arrival and general anaesthetic
Admission, consent, anaesthetic review. GA with nasotracheal or oral intubation and a shoulder roll to open the pharynx.
- 05
On the day
The UPPP itself
60 to 90 minutes. Tonsillectomy, uvular resection, trimming and tightening of the soft palate, posterior-pillar advancement, mucosa preserved for healing, absorbable sutures.
- 06
On the day
Overnight airway monitoring
An overnight or 24-hour stay with saturation monitoring. CPAP available at the bedside for the first night if you use it.
- 07
After
Recovery and follow-up sleep study
Significant throat pain 10 to 14 days on soft diet and opiate analgesia. Repeat polysomnography at 3 to 6 months confirms response.
When it helps
When UPPP is the right step - and when it is not.
Response rates depend on getting the patient right. Palatal-dominant collapse, favourable anatomy and a BMI under 30 are what predict success.
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CPAP intolerance after a fair trial
You tried mask fittings, humidification and pressure re-titration for 3 months and still cannot use CPAP.
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Palatal-level VOTE obstruction on DISE
Drug-induced sleep endoscopy shows retropalatal collapse as the dominant pattern. Without this, UPPP has no target.
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Friedman grade I to II with tonsillar hypertrophy
Large tonsils and a favourable palate profile predict the best response rates - historically 60 to 80 per cent in this subgroup.
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Severe socially disruptive snoring
Primary snoring unresponsive to weight loss, positional therapy and minimally invasive palatal procedures.
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Selected mild to moderate OSA
AHI 15 to 30 with palatal-dominant obstruction, BMI under 30, and no significant tongue-base or hypopharyngeal collapse.
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BMI over 32 or predominantly tongue-base collapse
UPPP responds poorly. We steer toward Inspire hypoglossal stimulation, weight management or CPAP re-engagement instead.
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Central sleep apnoea or complex apnoea
UPPP does not address non-obstructive events. A sleep-medicine review is needed before any surgery is discussed.
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Red flag: severe OSA (AHI over 30) untreated
Untreated severe OSA carries real cardiovascular risk. CPAP or Inspire remain first line - UPPP is not a substitute.
Procedure options
UPPP is a family of techniques - and Inspire sits beside it.
Classic Fujita UPPP has been largely superseded by modern pharyngoplasty variations and, for many CPAP-intolerant patients, by hypoglossal nerve stimulation.
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Classic Fujita UPPP
The original technique. Tonsils, uvula and a rim of soft palate are resected, and the posterior pillars are sutured forward. Historically first-line, now selective.
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Expansion sphincter pharyngoplasty
Pang and Woodson’s technique. The palatopharyngeus is transposed to expand the lateral velopharyngeal wall - better OSA outcomes than classic UPPP in modern series.
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Z-palatoplasty
Two opposing Z-plasty flaps in the soft palate widen the retropalatal airway anteroposteriorly. Useful when previous tonsillectomy limits lateral options.
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Lateral pharyngoplasty (Cahali)
Targets the superior pharyngeal constrictor to open the lateral wall. Longer recovery, but the strongest evidence for lateral-wall collapse patterns.
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Multi-level surgery
UPPP combined with tongue-base radiofrequency, midline glossectomy or hyoid suspension when DISE shows more than one obstruction level.
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Inspire hypoglossal stimulation
The best modern alternative for CPAP-intolerant moderate to severe OSA in selected patients. See our own page for candidacy.
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Soft-palate stiffening (pillar, RF)
Minimally invasive options for snoring and very mild OSA. Lower morbidity, more modest effect. See the snoring surgery page.
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Second-opinion review
A specialist review of your sleep study, DISE video and prior surgical notes - sometimes the answer is not another operation.
Our vetted London network
A small panel of sleep-trained ENT surgeons, we picked them.
Consultants at the Royal National Throat Nose and Ear, HCA The Portland, Chelsea and Westminster Private and the London Sleep Centre. Introductions are made privately.
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BAO-HNS-registered ENT consultants with a dedicated sleep-surgery practice
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DISE-led case selection with VOTE scoring, not tonsil size alone
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Access to sleep medicine, CPAP re-titration and Inspire pathways in the same unit
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Anaesthetists experienced in the difficult airway of the OSA patient
Safety and recovery
What to expect afterwards - honestly.
UPPP has real morbidity. Plan for two weeks of significant throat pain, a soft diet, and a repeat sleep study to confirm you actually responded.
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Significant throat pain for 10 to 14 days
Worse than a tonsillectomy in adults. Regular paracetamol, ibuprofen where safe, opiate cover for the first week, and a soft or liquid diet.
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Velopharyngeal insufficiency
Nasal air escape and nasal regurgitation of fluids is common in the first weeks. Persistent VPI in around 5 per cent of cases - discussed before consent.
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Taste change and foreign-body sensation
A metallic or altered taste and a lasting sense of something in the throat can persist for months. Usually settles, occasionally does not.
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Post-operative bleeding
Primary or secondary bleeding in 2 to 5 per cent, most between days 5 and 10. A clear 24/7 contact plan and same-day return route matter.
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Airway obstruction on the first night
Post-operative swelling can worsen OSA acutely. Overnight saturation monitoring is standard and CPAP is available at the bedside.
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Dehydration from poor oral intake
Pain limits swallowing. Sip little and often, and call the unit if you are producing very little urine or feel light-headed.
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Revision or adjunctive therapy
Around 40 to 50 per cent of patients still meet OSA criteria after UPPP. A repeat sleep study at 3 to 6 months guides CPAP, MAD or Inspire adjuncts.
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Return to work and exercise
Desk work at 2 weeks, non-contact exercise at 3 to 4 weeks. No heavy lifting or contact sport for 4 weeks.
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Red flags after discharge
Any bright red bleeding, worsening breathing, high fever, or inability to swallow saliva - call the unit or go to A&E the same day.
Reading your surgical notes
Your UPPP notes in four parts. Read the last one first.
Whichever variation was used, the notes and follow-up plan keep to the same shape.
- 01 Assessment
Sleep study, Mallampati and Friedman grade
Baseline AHI, oxygen nadir, Epworth score, Mallampati class, Friedman tongue and tonsil grades, and BMI.
- 02 DISE
VOTE score and obstruction map
Velum, oropharynx (lateral walls), tongue base and epiglottis scored for degree and pattern. Palatal-dominant collapse is what UPPP treats.
- 03 Procedure
Technique, resection extent, closure
Which variation was used, tonsillectomy en-bloc, uvular preservation, posterior-pillar sutures and any adjunctive tongue-base work.
- 04 Outcome
Response criteria and next steps
Read this first: post-op sleep study at 3 to 6 months, Sher criteria for response, and whether CPAP, MAD or Inspire is now added.
Send us your sleep study
Not sure if UPPP, Inspire or a better CPAP set-up is right for you?
Send your polysomnography and a short CPAP history. We come back within one working day with an honest read on whether surgery fits, or whether the answer sits elsewhere.
Recognised by major UK insurers
Cover for UPPP varies by insurer. Usually funded for documented OSA with CPAP intolerance. We confirm cover before booking.
Frequently asked
Everything we get asked about UPPP.
Response rates, recovery, Inspire versus UPPP, and what happens if you still snore afterwards.
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How effective is UPPP for obstructive sleep apnoea?
Honestly, response rates are modest. Sher’s meta-analysis and later series put OSA cure by strict criteria at around 40 to 50 per cent, with higher figures (60 to 80 per cent) only in the Friedman I to II subgroup with large tonsils and a favourable palate. Snoring is reduced in 70 to 85 per cent of cases. CPAP remains the gold standard and Inspire hypoglossal stimulation is the best modern alternative for many CPAP-intolerant patients.
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How is UPPP different from Inspire hypoglossal stimulation?
UPPP is a resection operation on the palate and tonsils that enlarges the retropalatal airway. Inspire is an implanted stimulator that advances the tongue in time with breathing and treats obstruction at multiple levels. For CPAP-intolerant moderate to severe OSA in selected patients (AHI 15 to 65, BMI under 32, no complete concentric collapse on DISE), Inspire has better published response rates than classic UPPP and preserves anatomy.
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What does the recovery from UPPP actually feel like?
Worse than an adult tonsillectomy. Severe throat pain for 10 to 14 days, a soft or liquid diet, opiate analgesia for the first week, and temporary nasal regurgitation of fluids. Most people return to desk work at 2 weeks and non-contact exercise at 3 to 4 weeks. Taste change and a foreign-body sensation in the throat can last months.
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Do I have to have my tonsils out at the same time?
Yes, if they are still in. Tonsillectomy is an integral part of UPPP and is included in the surgical fee. If your tonsils were removed in childhood, the operation is a palatoplasty and posterior-pillar advancement only, which is usually less painful but with a different response profile.
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How much does UPPP cost privately in London?
Classic UPPP with tonsillectomy is roughly £4,500 to £7,500 all-in. Modern variations like expansion sphincter pharyngoplasty are £5,500 to £8,500. Multi-level surgery combined with tongue-base procedures runs £8,500 to £14,000. Consultation with DISE mapping is £1,200 to £2,200 and we quote a firm figure within one working day.
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Which London units do you use for UPPP?
Our panel includes sleep-trained ENT consultants at the Royal National Throat Nose and Ear (private list), HCA The Portland ENT, Chelsea and Westminster Private ENT, and the London Sleep Centre. Introductions are made privately once we understand your DISE findings and CPAP history.
Related treatments
Looking for something else?
-
Inspire hypoglossal stimulator
The best modern alternative for many CPAP-intolerant patients.
Learn more -
Snoring surgery (soft palate)
Pillar and radiofrequency options for snoring and very mild OSA.
Learn more -
Mandibular advancement device
Custom MAD fitting for mild to moderate OSA and snoring.
Learn more -
CPAP titration and fitting clinic
Re-titration and mask review before any surgery is considered.
Learn more -
Positional therapy for OSA
Supine-avoidance devices for positional sleep apnoea.
Learn more -
Adenoidectomy
Adenoid removal, occasionally combined with palatal surgery.
Learn more -
Sleep apnoea condition guide
The condition, causes, testing and full treatment options.
Learn more -
Send Enquiry
Send your sleep study and we come back within a working day.
Learn more