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Crepey Skin and Hollow Eyes After Blepharoplasty

asked 3 years ago by Va9503 in Vienna,Va.
Latest answer by Todd C. Miller, MD
Question viewed 22,301 times
Tags: crepey skin, hollow

I am 62, and have had lower Blepharoplasty 10 years ago. Now, my under eyes are sunken and the skin has a crepey appearance? What can be done for these?

22 answers to Crepey Skin and Hollow Eyes After Blepharoplasty

+5

Correcting Hollow eyes post over aggressive blepharoplaty

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around... more
Michael Law, MD

Raleigh-Durham Plastic Surgeon

michaellawmd.com

+5

Composite fat grafting to plump the hollow eye and fractional laser resurfacing to remove wrinkles

Dear Va9503, The hollowness or sunken area occurs because fat was removed during your blepharoplasty and during the past 10 years, the cheek fat pad has descended lower in the face. As our faces age, depressions and a hollow look below the eyes is very common. The crepiness of the skin is caused by skin aging, which thins the skin and repeated motion of the eyelid muscle beneath the skin, which causes the eyelid skin to form wrinkles. Excellent results and improvement in the sunken look or... more
Brooke R. Seckel, MD

Boston Plastic Surgeon

www.drseckel.com

+3

Lower blepharoplasty usually causes sunken appearance

Lower eyelid blepharoplasty entails fat removal and skin removal from the lower eyelids. This is part of the reductive philosophy that has dominated surgeons, and plastic surgeons. An analogy is that of a grape when it loses its volume and turns into a raisin. Based on traditional approaches, a plastic surgeon would take that raisin and remove the skin of the raisin to make it into really just a smaller grape. But based on this analogy, the smaller grape would not look like the grape that... more
Philip Young, MD

Bellevue Facial Plastic Surgeon
+2

Crepey Skin and Hollow Eyes After Blepharoplasty

Plastic surgery, like all science, evolves over time. It was once thought that removing more skin and fat was better. We now know that we lose tissue volume as we age, so it is imperative to create an aesthetic change while preserving volume. Modern blepharoplasty techniques try to reposition fat or minimize tissue resection so that the result is longlasting. Having said that, we cannot reverse the aging process (yet!). So even after surgery, you will continue to age, bu... more
Anand D. Patel, MD

Austin Facial Plastic Surgeon
+2

Crepy eyelid skin after lower blepharoplasty

Crepy eyelid skin after lower blepharoplasty can occur many years after a primary blepharoplasty procedure. This is often the result in the loss of elasticity in the lower eyelid skin with the aging process exacerbated by a previous surgery. Often a chemical peel or CO2 laser can improve that appearance. I would not recommend any additional lower eyelid skin removal since it can result in a pulled down eyelid appearance or create rounding to the lower eyelid area. As far as the hollowed... more
Scott Trimas, MD

Jacksonville Facial Plastic Surgeon
+2

Removing a small amount of skin and fat injections

The crepey skin on the lower lids can be excised through a subciliary incision and a small amount of skin can be pinched and removed so as to conservatively help with the wrinkles. This is usually glued with Histocryl tissue adhesive. Any hollowing under the eyes can be addressed with fat injections into the orbit to give more fullness.
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+2

Crepey skin and volume loss after Blepharoplasty

There are so many factors that contribute to the appearance you describe but generally they are associated with loss of facial fat and skin elasticity with time and environmental damage. HOLLOW EYES: You may want to contemplate using injectable fillers to "try out" the appearance of a fuller lower eyelid. If you like them, you could consider a long term solution such as fat injection, open fat repositioning/grafting, or cheek lift with SOOF or malar fat pad suspension. CREPEY... more
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

Lower Blepharoplasty volume loss

There have been changes in the way surgeons perform lower blepharoplasty. The general trend in lower blepharoplasty is toward conservation of the lower eyelid skin, preservation of lower orbital fat, avoiding tension on the lower lid, performing a canthopexy or canthoplasty, and filling the tear-trough depression. It sounds like your surgeon removed too much orbital fat, which along with the normal volume loss with age has contributed to the depression below your eyes. I would recommend a... more
Daniel Reichner, MD

Newport Beach Plastic Surgeon
+2

Time for another repair or maintenance procedure

Ten years ago, the standard blepharoplasty involved elevating the skin and muscle layer of the lower eyelids and removing the excess fat. At that point it was considered the correct operation. With the passage of time and improved understanding of the aging process we have come to believe that the fat of the face is a precious commodity and should not be removed in all cases. It can look good initially but with time and aging, the upper face and orbital areas become skeletonized. There... more
Jeffrey Zwiren, MD

Atlanta Plastic Surgeon
+2

Adding volume is an option

What most likely has happened is that during the first procedure, too much of the fat was removed, leaving a hollow, sunken look over time. Loose skin has also developed. A non-surgical option would be to treat the crepey skin with a laser, such as the Fraxel repair, and add volume to the hollow rim with either fat or a filler such as Juvederm. This would spare you an additional surgical procedure that risks lower eyelid rounding.
Min S. Ahn, MD

Westborough Facial Plastic Surgeon
+2

We have become much better at doing lower eyelid surgery

To Va9503, Hi! The result that you describe is quite common after old fashioned lower blepharoplasty. You will benefit by the PROPER revisional surgery. The results are very dependent on precise individual technique. Here are some suggestions. 1) You had too much fat removed. The remaining fat can be repositioned outward or the missing volume can be replaced with fat injections. 2) More skin probably needs to be removed. This can be done safely ONLY if you also tighten the corner of... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+2

A light skin peel combined with filler will do

The crepey appearance of the skin can be improved with a light skin peel, Obagi Blue Peel, or laser treatment. This will tighten the skin and improve its texture. The volume issue must be addressed with some type of filler. Fat grafting using your own fat would probably be the best answer since it would be a permanent solution. A clear gel filler like Restylane or Juvederm could be used but this would only be a temporary 3-9 month fix.
Arthur Foley, MD

Olympia Plastic Surgeon
+2

Crepey Skin: Customized Approach

Crepey skin from lower lid blepharoplasty is not uncommon. Your surgeon has to distinguish crepy skin from excessive skin. Excessive lower eyelid skin can be contoured with a subciliary approach. It is critical with any subciliary approach that your surgeon understand lower eyelid anatomy and the structures which maintain the position of your lower eyelid. Crepey skin itself can be improved with resurfacing procedure such as a TCA peel or LASER. Hollowing of eyes requires either structural... more
Anil R. Shah, MD

Chicago Facial Plastic Surgeon
+1

Hollow eyes at 62

During the aging process the skin loses its elasticity which can create a crepy appearance. This can be exacerbated by sun exposure which can create fine lines in the lower eyelid skin. In addition, as you age, the fat in the mid face region will both shrink and sag which contributes to the hollow appearance. A lower eyelid blepharoplasty is great for reducing the bulging, baggy appearance in the lower eyelids. However, removing this fat will not address the hollowness that is... more
Todd C. Miller, MD

Orange County Facial Plastic Surgeon
+1

Crepy Skin/Hollow Eyes After Blepharoplasty

It is not uncommon to see hollowed, sunken eyes or crepy skin after a bleharoplasty that was done years ago because in the past many times excess fat was removed which we now know actually accentuated aging. Therefore, one can actually inject fat or fillers into the upper eyelid area. Both are good alternatives. Hyaluronic acid fillers work well in this area to give a more youthful, less hollowed out look and can be done in the office. Fat injections would require being done in the operating... more
Rod J. Rohrich, MD

Dallas Plastic Surgeon
+1

Hollow Eyes After Blepharoplasty

Blepharoplasty of the lower eyelids entails surgical removal of fat. In more recent years, the surgical resection of fat is more conservative, to preserve the volume of the lower eyelid. The problem of hollow eyelids and crepey skin is common after blepharoplasty. It reflects the quality of your skin and the amount of fat removed during surgery. To address these issues, the most effective strategy is fat grafting to add volume to the lower eyelids and topical retinoids to improve... more
Raffy Karamanoukian, MD

Los Angeles Plastic Surgeon
+1

Difficult problems to correct after Blepharoplasty

Treatment of the lower eyelid has, in recent years, become much more conservative. Overzealous excision of fat and/or skin often results in a hollowed-out appearance that accetuates the aged look. Excision of too much skin may deform the lower lid, and will give you a 'sad' appearance. I feel that the best method of correcting your problem would be placement of fat grafts in the area beneath the crepey skin. This not only will fill the hollow, but often gives the skin a rejuvenated... more
Wilfred Brown, MD

Fairfield Plastic Surgeon
+1

Laser is a temporary fix for crepey skin and hollowness

Fat grafting is a must to correct the hollowed look. The best way to treat the crepey skin is with surgery. The treatment can remove the eye skin alone or in combination with tightening of the muscle and ligament to maintain a beautiful eyelid shape.
Robert M. Freund, MD

New York Plastic Surgeon
+1

A classic story in blepharoplasty

Va, Your story is consistent with the history of blepharoplasty. In years past, the surgical dogma for eyelid surgery was to remove as much fat as possible. Over the last 10-15 years we, as a surgical community of plastic surgeons, have revolutionized our thinking processes, primarily as a result of observing the long term effects of blepharoplasty. Newer blepharoplasty techniques rely on redistributing, rather than removing eyelid fat to avoid the hollowing that you describe. See your... more
Kenneth R. Francis, MD

Manhattan Plastic Surgeon
+1

Lower lid skin laxity

Lower lid skin laxity after a preivous blepharoplasty can be treated by skin exicision.  If you feel that you are hollow, this can sometimes be treated with facial fillers as well.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Secondary lower lid surgery or non surgical

What you describe is a combination of skin excess and fat atrophy. The simple answer to this could be a revision of the lower lid surgery with a conservative excision of the lower lid skin in additio to redraping of the fat pockets or microfat grafting. A non surgical option will be laser for skin and filler injection
Hisham Seify, MD, PhD

Los Angeles Plastic Surgeon

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