Revisions by definition address aspects that require a degree of modification for a number of reasons. Please mind that the first and probably the most important step is to assess what has to be changed and why. Are there reasons aesthetic in nature or functional or most often a combination of variable degrees of both aesthetic and functional reasons. The latter are the ones that refer mostly to the normal 'function' of the face and its anatomic features (musculature, innervation, overall mobility, sensation etc) which almost always also have an aesthetic component due to the totally exposed position of the face. Aesthetic reasons may not be directly associated with a facial function except maybe its function as the cornerstone of our identity, emotional, social and psychological function and interactions. Symmetry (static and during facial expressions), effective managment of the issues that led to the need of a facelift ( skin laxity, loss of definition, gravity and aging effects etc) when not fully addressed, are all valid reasons or a revision. Re-operating on an already operated tissue especially on the face is almost always more demanding than the first time. Every surgeon has his/her own personal style, philosophy, experience and skill. That means that having somebody else re-operate, you will be inviting a new set of the aforementioned aspects in an area already 'formed' by someone else. That makes your previous surgeon the most appropriate one. However if you are greatly dissapponted or lost your trust and 'chemistry' you could very carefully look for someone else. There are surgeons who claim to specialize on correcting the mistakes of others however I am not sure how much truth or importance this has. On the other hand and experienced plastic surgeon specializing on facial plastic surgery and facelifts would be a good general idea. Please always check credentials and experience. I wish you the best.
There are multiple issues with this condition. I would suggest specialists with extensive experience in facial plastic and reconstructive surgery, not limited on the periorbital region. Although there are excellent professionals and surgeons in other disciplines (head and neck surgery,ENT, occuloplastic surgery etc) plastic, reconstructive and aesthetic surgery is in my opinion the appropriate discipline. I would also say that this is a decision to be made on an individual basis depending on the specific experience of the surgeon, rather than on searching for a single specialty.
Although it would be much better if a preoperative photo could be shown to evaluate the degree of the ‘lower eye circles’ return, generally speaking, this could happen for a number of reasons. Infraorbital depression with or without hyperpigmentation (dark circles) could be due to fat over-resection or not sufficient fat rearrangement leading to lack of support and to various degrees of depression and/or ‘step-like’ deformity. Lower eyelid skin is thin enough to allow underlying structures and vessels to contrast with it and create the impression of localized darkness which in turn creates the illusion of depth (and depression). Orbicularis oculi (eyelid muscle) full-length incision also disrupts the muscle which loses its tension and support to the skin. However, this is usually temporary and not expected one year postop. Extension of the lower eyelid incision too far medially could also partially disrupt the innervation (buccal branch of the facial nerve near the medial canthus) responsible for maintaining the tension ‘strength’ of the orbicularis oculi muscle. Unfortunately, this isn’t visible in these photos. On the other hand, deep tissue scarring could lead to localized contraction and maybe even depression with or without lower eyelid retraction, but this has a much more disturbing presentation and such scarring cannot be observed in the photo (although a straight, horizontal level looking position would be appropriate). Reaction to the sutures is not unheard of and could be observed as early as a few days up to many years postoperatively depending on the type of the sutures, the size, the depth and the area of suturing, the suturing technique and several other factors. In this case, sutures could cause local inflammation as part of the effort of the body to encapsulate (non-absorbable sutures) or hydrolyze and absorb (absorbable) them. However, this is a very specific condition that requires medication and almost always intervention, either to drain a small abscess and/or remove the suture. If you haven’t experienced swelling, redness, pain and the need for medical and/or surgical intervention, the sutures are most likely not to blame. The lateral end of the incisions looks a little deep and maybe mildly constricted but a preop photo is appropriate to compare. Several excisions of excess skin are also mentioned. This means potentially more scarring and prolongation of the healing process but again it is not obvious in the photo. A new set of preop and postop photos showing more details as well as a clear description of what exactly has been done and when could lead to more specific assessment.
