Hi, You are pretty young to need this kind of surgery, so likely your genetics are a big contributing factor. This may predispose you to the same thing happening down the road. Regardless, the 'shelf-life' of a lower lid blepharoplasty is different for everyone. In addition to genetics, weight gain and loss, sun exposure, and smoking, many other variables contribute to how well surgery holds up over time. So I believe your surgeons are being kind in letting you know it may not be a one time fix, especially given your young age. If performed properly, a lower lid blepharoplasty should not lead to drooping of the lower eyelids. I prefer a transconjunctival approach with fat transposition of the orbital fat to the fat/SOOF of the upper cheek. IMO this helps soften the tear trough area via a kind of permanent fat filler effect. I also like to tighten the lateral canthus at the same time to help reinforce the lower lid, further discouraging drooping of the lid from surgery and aging. But every patient is a little different, and speaking to at least a couple of surgeons is a great idea. I'm 100% biased, so take this with a grain of salt, but I would probably seek the opinion of at least one oculoplastics doc (if you haven't already) to make sure removing the lower lid fat will not negatively impact eyelid function. I think you are on the right track. Best of luck!Tom
Hello, I agree with many of the replies, and contact lens wear can lead to a drooping upper eyelid. A detailed exam with an eyelid expert is useful to rule out other causes. Also, as mentioned in the 'ping pong' post, there is something called Herring's law. If one eyelid is droopy, your brain is essentially telling both eyelids to lift up higher. In essence, our brain has only only have one 'volume control' that connects to both eyelids. So if one eyelid is droopy, the dial gets set to 11 (it's louder than 10 ;). So the other, seemingly normal eye, may actually be a little bit droopy too. However, the overstimulation makes it look like it's in the correct spot. And once you fix the droopy eye, you might realize that the previously good eye is now droopier, as the volume control has been turned down by your brain. Herring's law can therefore make eyelid surgery tricky when there is baseline asymmetry. There is a test that can be performed in the office which is sometimes helpful in figuring out if this is going to happen. See a good eyelid specialist and best of luck!
Hello, Nerve damage that causes loss of sensation is from damage to a sensory nerve. The kind of nerves that are used to feel things, like touch, heat, cold etc... It sounds like that is the kind of nerve you injured, and why your forehead feels numb. Botox/neurotoxins are used to relax muscles. These muscles are controlled by motor nerves. These are the kind of nerves that we use to activate muscles to do something, like lifting your forehead up to wrinkle it. In theory, botox should not affect sensory nerves and you should be safe to receive additional injections. However, I would discuss your previous experience with your current injector so they can perform a physical exam and evaluate your motor and sensory nerve function. Hope this helps! All the best, Tom
Hello, We agree with attempting to minimize blood thinning medications in the 7 days prior to injection (including aspirin, ibuprofen, fish oil, etc..). Based on Dr. Mark Hallett's research published in 2015, we also avoid applying ice to the injection sites as decreased temperature may limit uptake of the Botox. However, if a bruise develops during injection we hold pressure and then ice the area, as the Botox will tend to spread with the bruise and may end up in unwanted areas. Based on the same research, I also ask my patients to use the muscles we just injected as much as possible for the first 1 or 2 hours after injection. So patients are often seen walking out of the office frowning, smiling, or raising their foreheads excessively for no apparent good reason :) Best of luck! Tom
Hi, I agree with others, and I would consider Botox under the eyebrow to help elevate the brow a bit. This usually helps camouflage the asymmetry. I would just want to make sure you didn't have severe dry eye syndrome before attempting, as it may weaken eyelid closure. Also, I would like to see what your eyelid looked like as it gets tired out during the day, as there may be a small underlying component of lid ptosis as well. Best of luck, Tom
