Plastic Surgeon Removed Too Much Skin in my Upper Eyelid Surgery, What Are My Options In A Revision?

Without a physical examination, it is hard to fully answer your question.  However, if there is any suspicion that excessive eyelid skin was removed at the time of your upper eyelid surgery, I would strongly discourage a brow lift.  The only indication for further upper eyelid surgery would be if had corneal irritation as a result of lagophthalmos ( inability to fully close your eyelids).

Dear Dolly in Seattle

They are really only a handful of us in the country who are in the business of address post eyelid surgery complications.  So it is likely that you will need to travel to get appropriate surgical help.

I am concerned that despite your severe surgical complications, you are still interested in having more cosmetic surgery.  Any type of forehead lifting will be at the expense of eyelid closure.  You need a bit of spare skin in order to be able to have a forehead lift.  Typically when one is "short of eyelid skin"  in the upper eyelid, one is short of an even more important resource which is functioning orbicularis oculi muscle in the upper eyelid.  This muscle is also commonly removed at the time of upper eyelid surgery.  

The best option for repairing an upper eyelid compromised by overaggressive upper eyelid surgery is to vertically lengthen the lower eyelid.  You indicated that you have upper eyelid but you did not indicate if you also have had lower eyelid surgery in the past.  

You aesthetic needs need to be balanced by the need for the eyelids to protect your eyes from drying out.

I would recommend that you do your homework to identify the true experts in addressing post blepharoplasty complications.  You need to find a surgeon who is more interested in what is right for you.

Too much skin removal from the upper lid cannot be "fixed" without a skin graft. This is probably not worth it unless you have a functional problem as this often looks like a patch. In my book on forehead lifting I state that once too much skin has been removed the brow can never be set at the proper location. Sorry for the bad news.

I have never seen a patient who had too much skin removed from the upper lids after blepharoplasty although I know it can happen.  The remaining skin might stretch a bit but after two years it's more likelly that I graft would be necessary to correct the problem.

Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.

Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

 

Dear dolly1258,

A lot will depend on your actual examination.  It is best for you to get a face to face consultation because your condition is complex.  You are probably better off seeing an Oculoplastic surgeon who commonly deals with such problems.

When too much skin is removed from the upper eyelids the result is lagopthalmos, which means the lids are tight and may be difficult to close completely, especially at night. The side effect can be dryness and irritation, and a skin graft may become necessary. If your tightness does become 'normal' over the course of the day you might wish to leave things alone, as a brow lift may cause things to become worse.
Best of luck,
peterejohnsonmd

It sounds like you may benefit from a skin graft from another part of your body to the eyelid that is affected by over excision of skin.  I would recommend a full thickness skin graft, possibly from the supraclavicular (lower neck) area to correct the problem.

If you have truely a lack of skin, then skin repacement is the answer. However if that were true i would expect an in ability to close your eyes leading to severe irritation. If that is not a problem then leave it alone and don't risk complcations>

This is a difficult scenario where skin related to the eyebrows is removed during an upper eyelid surgery resulting in a decreased eyebrow after the procedure.  IMHO, your best bet is to have several consultations with experienced Brow Lift and Blepharoplasty surgeons for evalution and treatment recommendations.  You didn't mention any dry eye symptoms which would be the primary complication to you having a Brow Lift at this point.