Look at the anatomy carefully

There is so much variation in brow and eyelid surgery, as well as in a patient's normal anatomy, that it is hard to answer your question specifically. Most people's faces, and especially eyes, are asymmetric. Surgery itself is not an exact endeavor. If your original surgeon is reputable and skilled, you are almost always better off going back to him or her because the original surgeon always has a more complete fund of knowledge about what was done or not done. A new surgeon is always guessing or interpreting to some degree. However, if you have lost confidence, that would preclude you returning to your surgeon.

Revisional surgery can be a simple matter or a very complex one. Or it may not help at all if your anatomy dictated a certain imperfect result. The key is in the anatomical analysis and I would ask the surgeon you go to to explain in detail the anatomy and rationale of the problem and treatment. Every patient and every surgery is a little bit different. Good luck.

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Revisional eyelid surgery is complex and often requires canthal reconstructive, cheeklift or midfacial advancement techniques, which are highly specialized.

During your consultations to see if a revision is necessary or recommended, it is helpful to see if the doctor has published articles on these topics, and to see if his artistic style in before-after pictures meets your expectations.

As difficult as your decision to have your first surgery was, the decision to have revision surgery is even more difficult.

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Unfortunately, complications and unsatisfactory results are a part of cosmetic surgery, as much as we surgeons try diligently to avoid them.  Occasionally, this leads to a loss of confidence on the part of the patient towards the original surgeon, which is natural as well.  The subsequent treating surgeon takes on the burden not only of the more urgent expectations of the unhappy patient, but the difficulty of correcting a problem not of his making.  There is a high probability that the results will not be "perfect" under the best circumstances, and that there will be some lingering disappointment on the part of the patient.

In order to maximize the chances of a favorable secondary surgery, it is critically important that the patient clearly communicates the present details of what she finds unsatisfactory about the first surgery, and what are the goals she would like to achieve with the next surgery.  It is very helpful as well to obtain the pre-operative photographs and medical records, including the operative note, from the first surgeon.  This need not be done in a confrontational fashion, but simply as a request for information.

If the subsequent surgeon has confidence that he can improve your surgical outcome with a secondary procedure, careful planning is critical.  It is equally important that the surgeon communicates with the patient both the best-case and worst-case scenarios of what he expects to accomplish for the patient, since the patient and her problems now belong to the second surgeon.

Finally, there is a big difference between "botched" and "not a lot of improvement", and some asymmetry is not only normal, but is expected and natural, and may only now be more apparent to you.  Communication between surgeon and patient will go a long ways towards closing the gap between these two descriptions of the surgical outcome.

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