I had a LB 2 years ago.I have never been happy with the results. When I smile, I have folds of skin and a TON of wrinkling (I did not have this before sx). The folds are so substantial, you could flick them with a fingernail.I also am starting to get small folds when not smiling, as the area overall just looks really tired & very aged.My PS insists the only solution left is laser.I think he simply did not remove enough skin.Is a pinch bleph an option from another surgeon? Or is this it?
Folds of Skin and Excessive Wrinkling Solutions Following Lower Bleph? (photo)
Doctor Answers 6
There are two kinds of skin wrinkles: 1) dynamic and 2) static. The first means the wrinkles are caused by movement of underlying muscles and the treatment for this kind of wrinkle would be botulinum toxin (Botox) to weaken the muscle and improve the dynamic wrinkles. Static wrinkles are present at rest. There are various treatment options for static wrinkles, including surgery, laser, and peel. Static wrinkles in the lower eyelid can be improved by surgery (skin pinch technique, etc), laser, or peel, while dynamic wrinkles can be improved by modest Botox injections. Consult an oculoplastic surgeon for proper assessment and consideration for treatment.
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What to do For Excess Lower Lid Skin After a Blepharoplasty
Based on the photos it does look like a conservative lower lid pinch technique would help (as disappointed as you sound, you are much better off having too little, as opposed to too much skin removed during your surgery). There is so much extra skin present that while a laser peel would improve the quality of the eyelid skin, it will likely not give you enough tightening to make enough of the wrinkles go away. I would probably start with a conservative lower lid pinch, let it heal, and if there is still some laxity present afterwards, would do a laser peel to improve skin quality at that time.
After Lower Blephs
A nice conservative approach to the lower lids could include surgery or perhaps the use of lasers to tighten the skin.
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Lower Bleph Wrinkles
1.) Conservative skin excision is always preferable to over-resection - a true nightmare.
2.) I agree with your PS. Your problem is not one of quantity of skin but quality. Your skin is crepey with multiple fine wrinkles. CO2 laser will greatly improve this.
A Pinch Bleph Might Help.
The real problem is not that your plastic surgeon did not take enough skin. The problem is that the surgery damages the glide plane on which the lower eyelid skin rest. It is not just surgery that causes this. We also see this type of bunching with chemical and laser peels and midface surgery. Removing a pinch of skin can reduce the appearance of the heaping and is a reasonable direction here.
Unhappy with #blepharoplasty #surgery
From the photos, it appears that you do have some degree of skin excess but this is difficult to appreciate without the pre-op photos. Anyone will have some wrinkling with smiling, but the question is how much difference did it make overall. Taking out too much skin with a lower blepharoplasty can be a major problem for patients, so this operation is one in which conservative approaches are best. Get a second consultation in person to confirm the above.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
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