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 have enough fat to support it. Taping it hasn’t helped. Should I try AlloDerm, fat graft, or Restylane?

Doctor Answers (19)

Biomatrix grafting a new approach for orbit deficiency

+2

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.


Greeley Facial Plastic Surgeon

Too much surgery for the lower lid in a young patient

+2

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
5.0 out of 5 stars 48 reviews

Not bad... less is more

+1

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 hyaluronic acid based filler, not a permanent filler, because you can reverse it if needed.  No surgery is indicated at this point.  Less is more. 

Debra M. Kroll, MD
New York Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

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Too much fat removed

+1

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 recommendations cannot be specific but a filler like restylane usually is safe or at least reversible  if nothing else. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

Canthoplasty and tightenings can work

+1

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, FACS
New York Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Loosening the orbicularis with fat grafting can raise the lid

+1

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
Youngstown Facial Plastic Surgeon
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Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

+1

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 have enough fat to support it. Taping it hasn’t helped. Should I try AlloDerm, fat graft, or Restylane
?"

Thank you for the beautiful pictures. The sequence from Left to Right tells a VERY sad story of high goals and unmet expectations.

You began with very mild scleral show on the left picture / left eye and mild fat prominence of the right eye. You looked beautiful and I would have suggested you do nothing or , at most, consider either Restylane or fat grafting and nothing else. Instead, you underwent an excessive removal of the fat pockets which aged you overnight by unveiling the lower rim of the eye socket and the appearance of loose lower lid skin. Three consecutive cantopexies corrected your minimal left scleral show but overall you are left with older looking empty lower lids and pronounced tear trough deformity.

There is great merit to stopping now and "cut your losses" since each operation complicates and diminishes the yield of subsequent surgery. I love Restylane but owing to the large amount required you are likely to end up with a Tyndall Effect of bluish dark lower lids.

If you want one more operation, as a New Yorker, I would recommend you consult Dr. Sidney Coleman, a Plastic surgeon in New York who specializes in fat grafting of the face. If he cannot help you in this area, no one else is likely to be able to. You can find him at wwwplasticsurgeryorg .

Good Luck.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

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

+1

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 treatment. You should make sure your physician is experienced in the delicate art of filling lower eyelids. My personal preference is to use Silikon-1000, an off-label filler, for permanent results.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 276 reviews

Eyelid Asymmetry after Lower Blepharoplasty and Fat removal

+1

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 small asymetries.

Lastly, fat removal alone generally does not affect eyelid position. Rather, excess skin removal or scarring may pull the eyelid downward. Infections may not lift the eyelid upward reliably. Further facial surgery may be required. However, after 3 lower eyelid surgeries by eyelid specialists, it may better to stop further surgery all together. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Lower lid problem

+1

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 photos actually look pretty good - I don't see any scleral show in them.  At this point, consider just a little HA in the lid - but avoid further surgery unless there is a really good indication.

 

All the best,

Thomas Fiala, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 27 reviews

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.