Fat injections and repeat lower blepharoplasty
The goal of an upper lid blepharoplasty is to remove excess skin and a little bit of fat from the upper lid area causing the puffiness. There are two fat compartments in the upper lid and when removed gives a more natural contour to the upper lid and will not have any effect on a slim face.
The goal of lower eyelid surgery is to remove the fat bags that create puffiness on the lower lids. Additionally, a small strip of excess skin can be removed through an incision just below the eyelashes. All the fat is typically removed through a transconjunctival approach on the inside of the eyelid.
The browlift procedure is intended for a patient who has very low eyebrows and strong facial muscle contraction, such as vertical corrugator line between the eyebrows and horizontal frontalis lines.
Injecting fat into the cheek and lower eyelid sulcus is not a good idea because of the inconsistency in the amount of fat that will be resorbed.
Repeat lower eyelid surgery will not cause lower lid droop if done correctly.
Redo blepharoplasty rarely indicated
Repeating upper and lower lid blepharoplasty is rarely a good idea if it was done correctly in the first place. Usually it's worth considering a forehead or browlift instead of redoing the upper lids. Because of your high hairline, I would think about a hairline incision forehead lift. This would shorten the forehead and lift the whole upper face. The downside of the hairline incision is that you would need to reconfigure your hairstyle to camouflage the scar until it fades.
You are right to worry about the potential for redo lower lid blepharoplasty to pull the lid down. Your best bet is to have more than one or two consultations with board certified plastic surgeons who have a lot experience with facial aesthetic procedures. There are a lot of other options available to you, including volume enhancement, laser rejuvination, and surgical intervention, and the first step is to find someone who understands all of these.
Avoid fat injections around the eyes!
The full res view of your picture actually shows a good bit of detail. From this one photo, here are some observations and ideas:
1) Avoid fat injections around the eyes and eyelids! Too many times I've seen these result in hideous, lumpy messes and they are very difficult, if not impossible to fix.
2) You may have a little bit of orbicularis hypertrophy of the lower lids (a muscle issue, not a fat or skin issue). This is NOT something fixed by lower blepharoplasty. I do not see a lot in this photo that would suggest a lower bleph would help at all.
3) A trichophytic browlift, where the incision is placed just within the anterior hair line can provide a good lift and yet not create an even higher hairline and longer forehead. The trade-off is having to initially conceal the scar with bangs while it's healing.
All the best,
Facial rejuvenation with thin skin and previous cosmetic surgery
Hi Bclark - You raise some very good points, and it's difficult to tell without physically assessing your skin and facial contours. However, from your attractive photo I would recommend a lateral temporal browlift (limited incision hairline browlift,) Restylane underneath the eyes (fat can look lumpy here,) and a full facelift with a necklift. It can all be done with one operation giving you only one recovery and saving on facility fees and anesthesia costs. Consult with several other plastic surgeons to get a feel for what you want and what the surgeons can do for you. Make sure you view some before and after photos as well. Good luck!
Reapeat eyelid surgery is riskier than the first time
Scondary eyelid surgry cn be riskier than the first time and should only be done if you really need it. It sounds as though you are unsure so I would suggest you do the lower face and see if you are happy with the result. You will have saved yourself some potential complications that are difficult to treat by avoiding a second lower lid surgery.
Fat injections under your eyes will not make your face look fat.
1) I urge you not to have a brow lift. Your brows are high enough already, and you also have a high forehead. Not a good idea.
2) Skillfully done fat injections under your eyes help to create a smooth transition between your lower lids and your cheeks, and this is the look of youth. The amounts of fat are tiny, and you can keep your thin face.
3) From this one picture, it is not clear that you need a conventional facelift. You look quite good and I don't see much jowling. You might benefit instead by a scarless mid facelift, which is done through the mouth. It lifts the cheeks and the corners of the mouth, and it also improves the lower lids.
Repeat Lower Blepharoplasty
There is not enough detail in the picture to tell very much about your particular needs. It does appear that you do have a hollowness under the eyes. This is a common problem resulting from the way we used to do blepharoplasty. Sometimes, a redo blepharoplasty will correct this by tightening the tissues enough. Occasionally, however, we need to replace the fat that was removed in the original surgery. If this is what your surgeon wishes to do, then it is very reasonable. This will only return the normal contour to your eyes, not change your face.
You are right to be worried about problems with repeat lower blepharoplasty. Eyelid droop is one of the most common problems. However, in very experienced hands, especially if a canthoplastycanthopexy is done and the lower lid is stabilized to the lateral orbital tissues, this should not be a problem. About half of the blepharoplasties I do are repeats. With careful technique, I see no more problems than with primary procedures.
Do what you are comfortable with
Once you have done your homework to find well qualified surgeons to do your cosmetic surgery, the chemistry of confidence is the most important next element. Part of that chemistry is finding someone who listens to your concerns and does not just do their thing. Perhaps you might do well with fat grafting.
However, if you are not comfortable with it, don't have it done. I also agree that more eyelid surgery can significantly increase your risk of having an altered lower eyelid shape. I don't think that thinness of the face is really the issue here. I would encourage you to interview more surgeons. You will find someone who is absolutely right for you.
Facial surgery and fat injection around eyes
Facial surgery may be a good proceudre for you. I personally do not like to inject fat around the lower lids for fear of lumpiness developing. If you have poor tone in the lower lid, then a canthopexy can help support them.
Blepharoplasty for "thin" face
I cannot reach any clinical conclusions from your photo because it doesn't show enough detail-but every cosmetic consultation should address your particular anatomy and the treatment options to get from "point A' to "point B" . If these options don't make sense to you then don't proceede.