I had a lower bleph 2 years ago and some fat was left in the corner of my eye. I had the first op by an incision made just under the eyelashes. My surgeon is happy to see me with the possibility of doing a revision. Should I have this done from inside the eye? I just want to know the risks involved in a second procedure and want to know what can go wrong?This surgeon is a general plastic surgeon or should I go to a specialised oculoplastic surgeon for this type of procedure?
Is a Second Blepharoplasty Risky?
Doctor Answers 6
Is a Second Blepharoplasty Risky?
Yes, the fat can likely be removed from inside the eye. The term general applied to plastic surgeons can be a bit misleading. Plastic surgeons who have gone through integrated training programs represent the top % of all medical doctors in terms of talent and intellect. This is the most competitive residency pathway by an overwhelming margin. In addition, the training involves 6 or more years after medical school with these very talented surgeons. Finally, some plastic surgeons like myself do hundreds of eyelid and facial surgeries in addition to hundreds of body surgeries each year.
Kenneth Hughes, MD Los Angeles, CA
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Secondary eyelid surgery is always riskier than primary.
If there is a small amount of redundant that after lower lid blepharoplasty trans conjunctival approach might be the preferred route. Any secondary operation is riskier than the primary.
If you just need fat removal, a transconjunctival approach may be satisfactory to remove the excess fat.
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Risks with revising a lower blepharoplasty.....
Revising a prior lower bleph to remove more fat is a challenging procedure but the risks of weakening the lower eyelid muscle are lower approaching it via a transconjunctival approach. That said, lower blepharoplasty is one of the most technically challenging of facial plastic procedures and the experience of the surgeon is an important factor. Have the consult and discuss your options with your surgeon and obtain a second opinion if not convinced.
Revision of the lower eyelid after a blepharoplasty
A blepharoplasty is a technically challenging procedure and there are many methods used to perform the procedure. Every method has its risk and benefits. If only fat is to be removed then the transconjunctival approach is an excellent method especially for revision procedures where not enough fat was removed from one of the three pockets of the lower eyelid. There is no substitute for skill and experience with these operations.
Unfortunately, the particular specialty of your surgeon does not protect you from complications.
Having said that, general plastic surgeons are less likely to use the transconjunctival approach to the lower eyelid. The plastic surgery literature underplays the risk of making an incision under the eye lashes to remove lower eyelid fat. The majority of lower eyelid complications arise from the use of this incision. Removal of the lateral fat pocket is tricky business because when you lay flat on the operating room table, this knuckle of fat is hard to locate.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.