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Persistent Puffy Eyes After Blepharoplasty, TCA Peel and Tightening

I had upper and lower Blepharoplasty a year ago with a lot of complications. I have very sensitive skin. The stitches did not dissolve and I had a hard time healing from the TCA chemical peel done afterwards.

It has been a year since the surgery and my one eye looks as if I did not even have anything done to it. The lower lids are very puffy again. My plastic surgeon has been trying many things to get the skin to tighten but so far nothing has worked. I am considering having him do a revision and this time removing some extra skin. I paid for something and I am still waiting for the results.

He does not want to do another TCA because it took so long to heal the first time. He has been doing some kind of skin tightening now for over 5 months with no results yet. I am having my last one done on Wednesday then we go back to the drawing table. What do I do as a patient? Is there something I should be asking from my surgeon? I am dark skinned Hispanic and I freckle and scar easily.

Asked 35 months ago by zzn2323 in ferndale washington usa

Tags:

lower eyelids upper eyelids female complication extra skin puffy eyes side effects skin

Here's the answer

I find it interesting how many are willing to not answer this question. Okay, first your brows are fine, no brow lift is needed. Yes, your upper lids still have a little extra skin that could be removed. The real problem is at the lid cheek junction. Another physician addressed this but not, in my opinion, the correct procedure. Your problem is that the cheek fat/tissue is falling due to age and gravity. This causes the deformity that you have now. Removing skin of the lower lid... more

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

Look at a lateral photo

Sometimes the answer to your problems is in analyzing your eyelids from a lateral photo. This is because you cannot tell what sort of support you have from the frontal view. The presence of "bags" after a lower blepharoplasty and the rounding of the lower lid suggests that you might have a situation of "negative vector" where there is a lack of support for you lower lids. Here, your lid and your skin and fat of the lower lid is "hanging over a cliff" sort of like a tight belt below a beer... more

Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon

ASPS

Persistent swelling after eyelid surgery

It is hard for me to say from your pictures but there are potentially reasons why eyes may not look different after the surgery. The first is that the surgeon was conservative in the removal of skin and fat as to avoid potential complications like ectropion or scleral show, or hollowness that are hard to fix. it is always better to go back and do a bit more than to do too much the first go round. Also, there can be issues of a festoon rather than a lower eyelid fat pad, and the festoon is... more

Doctor's Website

Julio Garcia, MD

Las Vegas Plastic Surgeon

ASAPS ASPS

Complications post blepharoplasty

It is important to return to the original physician as long as the patient has confidence the surgeon can correct any complications. If the lower lids are very puffy again after the blepharoplasty, there may not have been enough fat removed from the lower lids. Extra skin can be conservatively removed if there is excess present, but one has to be very careful as not to change the shape of the eyelids. It is probably not advisable to have another TCA peel on the lower lid because of the... more

Doctor's Website

William Portuese, MD

Seattle Facial Plastic Surgeon

Volume loss in lowers gives "tired look"

We prefer to combine a minmimally invasive "orbicularis lift" with superiosteal fat or filler injection. This will benefit the 'tired look' that volume depletion gives the lower lids and also avoids complications of open mid face lifts.

Doctor's Website

Richard Gentile, MD

Cleveland Facial Plastic Surgeon

I would check into a second opinion

At this point, you may want to check into a second opinion. You may also want to be better informed about what "treatments" you are receiving. You want to be very careful around the eye. Also, a little patience may help. It takes a long time for swelling around the eye to resolve and for the tissues to settle. You may see positive results, but it will take time.

David Shafer, MD

New York Plastic Surgeon

ASPS

A second opinion is always a good idea

I cannot begin to give advice from one photo, physical exam, and no preoperative ones as well. if you have been undergoing several "tightening" procedures without effect, I think it is wise for you too see another surgeon with a great amount of experience with eyelid surgery. An occuloplastic surgeon is an excellent option.

Michael S. Beckenstein, MD

Birmingham Plastic Surgeon

ASAPS ASPS

Blepharoplasty complications

Many things to do or no things to do? What is right? I have read the suggestions below and would be a little confused if I were you. But to sort out the problems here is the way I see it. 1. You have had many different things done within the last year -- a brief period of time after surgery. 2. You are hispanic with a darker skin type, which puts you at risk for peels and laser procedures. 3. Your upper lids and brow looks a little heavy, but so does the rest of your face. Ethnically,... more

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

I think it is time for a second opinion with a Plastic Surgeon

From a less than ideal photo, and not enough views or perspectives, I will hazard an analysis of what I see. The upper lid position appears good. You have redundancy and heaviness of the upper lids. I also see ptosis (drooping)of the brow with transverse forehead and "11" wrinkles between the eyes (frontalis and corrogators/glabella. It looks like there are some transverse wrinkle at the root of the nose. Based on these observations, You should at least consider a brow lift, and revision... more

Scott E. Kasden, MD

Dallas Plastic Surgeon

ASAPS ASPS

Lower blepharoplasty and lid-cheek junction

It is difficult to give you specific advice without more close-up photographs of your eyes. That being said, I believe you have a common problem after lower blepharoplasty. I see that you have asymmetric mid-face cheek fat descent - which is not uncommon. I believe that even though your plastic surgeon probably removed the same amount of orbital fat from both sides, the deficient SOOF and cheek fat at the right lid-cheek junction enhances the right lower lid bag. I don't think that skin... more

Daniel Reichner, MD

Newport Beach Plastic Surgeon

ASPS

Repeat lower lid surgery could be dangerous

Repeat surgery on the lower lids could be dangerous. Sometimes, it could be easier to get a filler injected carefully along the eye lid cheek junction. If one day you would attempt a revision, inform your surgeon of all the previous treatment and the difficulty with getting a result that you like.

Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

ASPS

Balance your risks vs benefits carefully

It sounds like your doctor is trying dilligently to get you to a happy outcome. Be very careful with repeated treatments to your lower eyelids as these are quite prone to complications which are very hard to fix. Maybe you have reached the point where your result is as good as it is going to get and you are going to have to consider lowering your expectations. Your upper lids look fine and you seem more worried about your lower lids than you probably should be.