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Can a lower blepharoplasty be safely and successfully repeated?

Twenty years after a lower blepharoplasty, my eyes desparately need rejuvenating. The skin looks crepy and hollow with pronounced tear troughs. I've always had large, round, sensitive eyes. An occuloplastic surgeon said it would now be necessary to do grafting or some such thing while a facial plastic surgeon said there should be no problem with a basic blepharoplasty. I want a natural outcome with the least chance of complications.

Doctor Answers (14)

Repeat Lower Blepharoplasty

+1
The short answer is YES you can repeat this operation.  However, there are several caveats. 
  • The margin of error shrinks dramatically.  You can still remove some fat, but over doing it and making the eyes look hollowed is easy to do. 
  • If you had a lower skin pinch or a skin-muscle flap blepharoplasty done with the first, the risk of ectropion (rounding or pulling down of the eyelid) is much higher.  I would probably recommend some type of lower eyelid suspension (tarsal strip or canthoplasty) done at the same time to prevent this from happening.  
This is not meant to scare you or discourage you from having surgery.  Remember that in experienced hands you can safely repeat this and still get fantastic results.  Just pick someone who has enough experience, someone who specializes in only the face.  



Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 35 reviews

Can a lower blepharoplasty be safely and successfully repeated?

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I am a board certified facial plastic surgeon and have performed Blepharoplasty for over 25 years.  The simple answer, to your question, is that "it depends on what was done during the first Blepharoplasty Surgery and what your lower eyelids look like today".

This means that if your lower eyelids exhibit malposition (drooping and or rounding at the outside corners) there is an increased risk of worsening that especially with a transcutaneous bleph where the incisions are along the lower eyelid skin.  A transconjunctival lower bleph (incisions inside the lower eyelids) would be better in that situation.  It important to understand that a revision blepharoplasty would most likely not be able to remove much of that creepy skin that you mentioned as this would increase the risk of lower lid malposition.  You can however remove a small portion, of that skin and then apply a mild chemical peel to the lower eyelid skin to improve the texture of the skin.

The best thing to do is have another consultation/opinion, hopefully during which you'll have a clearer picture of what can be done and more importantly what can't be done and why.  You can send us e-mailed photos of your face and eyelids to drfpalmer1@aol.com for review.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Blepharoplasty 20 years later

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Pictures would be helpful. In general blepharoplasty can be repeated since your sister years ago it should be easily repeated. Whether you need additional scan or some type of grafting depends on your examination. Good luck.

Earl Stephenson, Jr, M.D., DDS, FACS

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

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Repeat Blepharoplasty

+1
Repeat blepharoplasty can be done safely and can provide excellent correction when done by an experienced surgeon. There are several problems with repeat blepharoplasty. First, one has to consider what was done initially. Especially when the first surgery was done as long ago as yours, the usual method was to subtract tissue. This is, in addition to the problem of age itself subtracting tissue from the orbital area. You may, therefore, need fat or other tissue added. There are also many late effects of the older methods, including laxity of the lower lid, that must be corrected. Secondly, the method needs to be modified to prevent significant problems. Over 50% of my blepharoplasties are repeats, and after many years I am still learning things as each previous surgery and each individual present their own problems that need to be considered before the surgery. Occasionally, the best option is not repeat blepharoplasty but simply a filler or fat injection. Make sure that whomever you choose has significant experience in both eye rejuvenation in general, including injection techniques, and redo-blepharoplasty.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Repeat lower blepharoplasty can be very risky without orbiculopexy

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 Thank you for your question.

Avoid and stay away from the surgeon who said there is no problem with a secondary blepharoplasty of the lower eyelids.

A secondary lower blepharoplasty without adjustment of canthal ligament most always in his in the disaster of an ectropion or downward pole of the lower eyelid which creates a sad I appearance.

Please find an expert board certified plastic surgeon with specific experience in oculoplastic surgery.

A secondary blepharoplasty can be a very successful operation, however the support of the lower eyelid needs to be strengthened by a procedure called a canthopexy which tightens the lower eyelid and presents of the downward pole of the secondary procedure.

If you want to test the expertise of your plastic surgeon, ask them to do a Jelks test to assess the laxity of your lower eyelid.  If they look that you with a quizzical look run don't walk from their office.

It is extremely important for your safety that the proper surgeon with experience and lower eyelid surgery and canthopexy only be allowed to treat your lower eyelids.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 30 reviews

Revision Blepharoplasty

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Cosmetic issues earlier in life such as hereditary "bags" or steatoblepharon may require different techniques than those you want to treat now: crepy skin and tear troughs/hollowing.
An effective nonsurgical option is Total FX fractionated CO2 laser to tighten and smooth out the eyelid skin, followed by Belotero and/or Restylane filler injections to the tear trough hollows.
Surgical option would be fat repositioning via incision under the eyelashes or inside the eyelid, muscle and fat resuspension with excess skin removal. Fat grafting instead of or adjunctive to fat repositioning may also be indicated.

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Lower eyelid blepharoplasty can be repeated

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Usually, the  primary goal for lower blepharoplasty is to remove a conservative amount of fat in the 3 fatty compartments on the lower lids. The fat is removed from the inside of the eyelid through a trans-conjunctival approach. When excess skin is present,  a  pinch technique is performed on the lower lid skin at the lash line on the outside. For many examples, please see the link below to our eyelid surgery photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Lower blepharoplasty can be repeated in certain patients

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This depends on how the original blepharoplasty was done and what your current examination looks like. In some cases, with time redundant skin reaccumulates and can be removed. In others, fat needs to be repositioned or removed.  You'll need an examination with an experienced oculoplastic surgeon to determine what is best.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Can a lower blepharoplasty be safely and successfully repeated?

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Thank you for your question. Yes it can be repeated, however you would want to consult an occuloplastic surgeon because it may not be as simple as just removing more skin. You might need to have the tendon tightened or you may indeed need a graft. Seeing a board certified occuloplastic surgeon would be your best option for a good outcome without complications.

Kristin J. Tarbet, MD
Bellevue Oculoplastic Surgeon
5.0 out of 5 stars 10 reviews

Can a lower blepharoplasty be safely and successfully repeated?

+1
The answer to your question is, of course it can. But whether or not it is possible for you specifically could not be answered without close up front, side and oblique facial photos or an exam.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 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.