Second Blepharoplasty Incision?

I had an upper blepharoplasty two years ago where only skin needed to be removed. Now I'd like to remove underlying fat as well. Must my incision site (scar) be re-opened for this to occur?

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13 Doctor Answers | Asked by mbalta in tucson, az

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Use same incision

A second blepharoplasty incision should completely remove the previous incision. The scar is excised through the very same incision and fat is removed from underneath the eyelid.

Not necessarily

There is a procedure known as a "stab blepharoplasty" which can be used on the upper lid. Basically, there are two fat compartgments in the upper lid. Small "stab" incisions are made in the old scar and a measured amount of fat removed from the appropriate compartments. The incisions are so small they can be closed with either a single stitch or no stitches. I have had excellent results in fine-tuning any minor fat adjustments with this procedure. Best of luck.... more

Secondary upper Blepharoplasty can use smaller incision for fat removal

Dear mbalta, If you are very happy with the scar from your previous upper blepharoplasty then you may not want a full incision. If the puffy area of fat is primarily near the nose, a tiny puncture incision can be made through the old scar and the fat removed. If you have diffuse puffy swelling across the entire upper lid, excess skin, or an unsatisfactory upper eyelid scar, then re-excision of the scar and fat removal will be required.

Upper lid scar usually doesn't need excision

The upper lid heals so well that the scar does not need to be excised. In other areas, we completely remove the old scar. But in the upper lid, this isn't necessary. Because only fat needs to be removed, only two small areas of the scar need to be opened. This should be a very fast and relatively uncomplicated surgery.

Small incision best unless there is skin laxity

If we are performing a revision for fat reduction we would utilize a small incsion so as to to not create more scar tissue. If there is a noticeable bulge this would provide aesthetic improvement. Filling of the later rim and lid area above the incision with fillers or micro fat transfers can also add aesthetic improvement

Only minimal fat removal during secondary Blepharoplasty

Fat is only removed from the medial and middle compartments of the upper eye lid. The lateral compartment is occupied by the lacrimal gland. Only conservative removal is needed. Too much fat removed will create a deformity called a frame. This could be difficult to treat. If needed, your old incision will be used. This incision heals vey well. I think that good exposure is every thing during surgery, it is important to open enough distance to allow good exposure of anatomical structures.... more

If you already have the incision, use it again

As you have seen from the other answers, fat removal from the upper lids is much less common than it used to be. But if you need it and already have the incision, I would logically just reuse it.

Blepharoplasty Incisions

I would recommend going through the old blepharoplasty incisions to remove fat. The upper eyelid skin usually heals very well, so re-cutting the old incisions is not a problem. Going through the old scar is the safest, most effective way to remove upper eyelid orbital fat. If additional skin needs to be removed, this can be done at the same time.

Fat very seldom should be removed from the upper eyelids

Hello again. We used to make upper eyelids hollow. Full upper eyelids are attractive (look at models). So be careful. But if you are sure that fat needs to come out, it can be done from the INSIDE of the lid (transconjunctival approach). We do this in the lower eyelids routinely. So your scars don't have to be touched.

It is best to go through the same incision

Mbalta, It is best to go through the same incision site. You may not have to have the entire incision opened up to remove all the fat. It would be unusual to make a secondary incision if you already have one there. Good luck with your surgery.

Using the 1st blepharoplasty incision is the most logical approach

Short answer is yes. The reason is that you don't want more scars than needed, as it is unsightly. Additionally, cutting in more places increases scars and potential problems with eyelid function. Most likely, the surgeon will use the original incision, remove the old scar, and then close it-forming on nice scar.

Yes

The best thing is to remove old scar and extra fat. The only concern is if too much fat removed, you will get more sunken eye. The recovery from this surgery is very quick.

Kamran Khoobehi, MD

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New Orleans Plastic Surgeon

Probably

There are many ways to approach rejuvenation around the eyes. If it is determined that the underlying fat (orbital fat pads) need to be removed, than an incision will need to be made. For the upper lid, this will likely be made through the existing scar - so that no "new" scar is created. If lower fat pads are to be removed, this can be done from the conjunctiva, and and incision in the lower eyelid skin need not be made.