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Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

asked 1 year ago by 2426anon in NJ
Latest answer by Debra M. Kroll, MD
Question viewed 1,126 times
Tags: female, fat reduction, hanging, options

I had lower bleph and too much fat was removed, so the left lower eyelid hangs 1 mm too low with scleral show. I went through 2 failed canthopexy revisions with my PS to attempt to tighten the eyelid. Then I went to an oculoplastic surgeon who performed another canthopexy and said I didn’t need a graft, but this didn’t work. Tightening won’t raise the lower eyelid, as it does not have enough fat to support it. Taping it hasn’t helped. Should I try AlloDerm, fat graft, or Restylane?

19 answers to Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

Biomatrix grafting a new approach for orbit deficiency

Over the past several years I have had very nice results with the use of biomatrix which stimulates new tissue regeneration especially in areas of the orbit where tissue deficit is noted. In march a publication of many such patients will be in print. Biomatrix lift is a procedure that combines established tissue repositioning surgeries with strategic tissue regeneration. HA fillers can give you a temporary benefit wheras biomatrix approach is more long lasting.

Julian Henley, MD
New Haven Facial Plastic Surgeon

Too much surgery for the lower lid in a young patient

I never take the lower lid lightly as it is prone to complications and if you are too aggressive with it, the lid will pull down or look "different" from canthal tightening. That being said, you need to quit having any more surgery and back off to a little Restylane. Please, for your sake, don't have another operation if you can help it.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Not bad... less is more

When you are smiling in the right-most photo the scleral show is not visible. In the photos on the left, there is about 1mm of scleral show. You could try gentle upward massage of the lower eyelid to try to lengthen the tissues. I would recommend conservative Restylane in the periocular hollows to revolumize and Botox for dynamic wrinkles by an Oculoplastic surgeon or someone experienced with injectables in this area. I would only use a... more

Debra M. Kroll, MD
New York Oculoplastic Surgeon

Too much fat removed

I have a feeling that the bulge you have in the preop photo was not fat but actually for orbital rim (bone) visible with a blue hue that mimics shadow from a fat bulge. it then follows that fat removal further exposed the bony rim leading to a worsening of the "bag". your scleral show is generally not related to fat removal except when it creates scarring in the middle layer or lamellae. at this point surgery is not the answer and may lead to a worse result. without a proper exam... more

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Canthoplasty and tightenings can work

When too much fat is removed during a lower blepharoplasty, canthoplasty and tightenings can work. But often fillers such as Restylane can be helpful and give support to the lower lid and revolumize that area. You should check with the doctor who did the procedure. Often we will use fillers.

Joseph A. Eviatar, MD
Bronx Oculoplastic Surgeon

www.ChelseaEye.com

Loosening the orbicularis with fat grafting can raise the lid

Based on some studies with trans malar repositioning of the orbicularis we notice improvement in lower lid position with a "undermining" of the orbicularis occulis during a microfat grafting procedures. This will release the attachments of the lid and allow it to be raised by inflation. This works well in patients with more scleral show than you manifest. I agree canthoplasty surgery will probably not be high on the list of choices.

Richard Gentile, MD
Cleveland Facial Plastic Surgeon

www.facialplastics.org

Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

Regarding: "Too Much Fat Removed During Lower Bleph - What Options Do I Have Now? I had lower bleph and too much fat was removed, so the left lower eyelid hangs 1 mm too low with scleral show. I went through 2 failed canthopexy revisions with my PS to attempt to tighten the eyelid. Then I went to an oculoplastic surgeon who performed another canthopexy and said I didn’t need a graft, but this didn’t work. Tightening won’t raise the lower eyelid, as it does not... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

A well performed Injectable Filler treatment may be employed to restore lower eyelid volume after lower blepharoplasty surgery.

I read your concerns and reviewed your photos. You look better than you think. Your "scleral show" on your left is barely perceptible. And your lower lids do not have a hollow, operated appearance. If I had to guess, you're either using Latisse, or you're blessed with long, thick eyelashes. I don't think you should consider any further eyelid surgery. You appear to have typical lower eyelid grooves which could be improved by a well performed Injectable Filler... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

Eyelid Asymmetry after Lower Blepharoplasty and Fat removal

Hi 2426anon in NJ, Thank you for the question and providing photographs. First, it's very difficult to provide more specific answers without a comprehensive in-person evaluation. Generally, facial asymmetry is very common, in fact considered normal. Based on your photographs, your brow, upper eyelid, eyeball, and inner eye asymmetry suggests that the lower eyelid may have been asymmetric at baseline. In addition, plastic surgery treatment cannot reliably improve these... more

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon

www.potomacplasticsurgery.com

Lower lid problem

You made a couple of comments that require some clarification for other readers. 1. Putting fat back into the lid will not make a malpositioned lower lid go back up. 2. Lid malposition & scleral show is not caused by taking the fat out. It is caused by a shortening (usually from scar) of one of the 3 layers ("lamella") of the lower lid. Correction of this problem gets complicated and technical- more than this forum can do. Your... more

Thomas Fiala, MD
Altamonte Springs Plastic Surgeon

Blepharoplasty

Removng fat does not lead to scleral show. This usually happens with scarring or poor tone. I would avoid further surgery.

Steven Wallach, MD
Manhattan Plastic Surgeon

Too much eyelid surgery

First of all, I agree that you should not have another surgical procedure. If anything, have an HA (Resytlane or Juvederm) injected - and only small amounts. Second of all, it is impossible to evaluate your before and after since you are unanimated in the before pictures and smiling in the after pictures. When you smile, your cheek is naturally going to raise and cause some wrinkling in your lower lids. Good Luck.

David Shafer, MD
New York Plastic Surgeon

Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

STOP! the surgery merry go round! Try a filler to slightly improve but my best advise is NO more of anything. Your expectations seem unrealistic, there I said it. Be happy you didn't have a real issue. From MIAMI Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon

Please do not become an eyelid surgery cripple.

Dear Anon From the before photo, you most likely could have avoided surgery by having hyaluronic acid filler for the under eyes. In the after photos you are smiling not doubt to demonstrate how your lower eyelid heaps now that you have had eyelid surgery. I think you need to take steps that are less likely to get you into trouble. Fillers with a very experienced injector is recommended. I would definitely stay away from alloderm or fat grafting. While... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Post-blepharoplasty asymmetry

Although you notice and are bothered by the 1 mm. scleral show and the asymmetry, it is too small of a difference for surgery or other treatments to reliably correct. The margin of error in most treatments is going to be as great or even greater than your problem. It is also impossible to fully evaluate your anatomy based on only a frontal view.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Scleral Show after Blepharoplasty

You had a total of 4 surgeries on your lower lids with only minimal result from the three canthopexies. This tells me that your lower lids do not respond to modest surgical tightening but would require a formal canthoplasty for additional repositioning and change. You will need to make the decision whether this is really worth it to you but I definitely would not just "try" something - especially when it comes to the delicate lower eyelid! Often, a conservate approach (watchful... more

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon

Avoid another surgery

Another surgical procedure should be avoided at this stage.Try Restylane & if you like the effect, fat grafting can be done later on.

Anup Dhir, MD
India Plastic Surgeon

Take A Break From Revisional Blepharoplasty Surgery

Scleral show after a blepharoplasty is not the result of too much fat removal. It may be from too much skin removal or scarring/contracture of the orbicularis muscle. After three failed revisions to achieve your goal, I think it is time to take a break from doing anything to the lower eyelids for now. Give them plenty of time to recover and the tissues to return to a more normal quality...like at least a year. You are on a revisional merry-go-round and are not getting anywhere. You may be sea more

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon

Too much fat removal and scleral show after multiple blepharoplasties.

Too much fat removal and scleral show after multiple blepharoplasties. You will do better by seeing a good eye surgeon for only Restalyne at this point--no more surgery.