Why do I still have crepey skin one year after upper bleph? How can this be improved? (Photos)

Question

I had an upper bleph one year ago and they took off 15 mm of excess upper eyelid skin. It looked good when it was swolen for 8 monthes and then the wrinkling/crepey skin came back. Is this an okay resukt or was i expecting too much from the surgery? Is there anything i can do to help myself?

Kyle Kimura, MD · Answer

Thank you for your question and photos. 
When it comes to eyelid surgery I will always have a thorough discussion with patients about conservative skin excision. I think it is very easy to pull the upper eyelid skin and think you need a significant amount of skin removed. However, I would caution this approach as most of the "bad" results after a blepharoplasty come from over aggressive skin removal. A small amount of fullness of the upper eyelid is actually a youthful feature and this often looks better than a hollowed out upper eyelid which can come from over excision. I think your best bet will always be to discuss with your initial surgeon and express your concerns. In some situations further skin excision can be offered but it needs to be a thoughtful discussion about the risks/benefits associated with this. 
Hope this helps and best of luck!Kyle Kimura, MD

Gary M. Horndeski, MD · Answer

From your photographs, it appears your eyebrows are below the level of the orbital rim medially. They should be at the level or above the level of the orbital rim. You may have descent of the eyebrows which contributes to the excess skin appearance of the upper eyelids. You may benefit from a browlift and would also benefit from a revision of the upper blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Michelle Zweifler, MD · Answer

Upper Blepharoplasty removes excess skin and hooding.  After swelling subsides, infrequently there may be a small amount of residual skin; there are several options including revision blepharoplasty with limited skin excision and/or brow lifting to help with the eyelid positioning.  Botox of the frown and crow's feet also help with a "chemical" brow lift temporarily improving eyelid position.  Also, Sofwave nonsurgical skin tightening gradually lifts the eyebrows.

Mihail Climov, MD · Answer

Thank you so much for reaching out and sharing your experience. This is actually a very common question, and I'm glad you asked it.First, the good news: your result is genuinely much improved from where you started, and your surgeon did an excellent job. Removing 15mm of excess upper eyelid skin is a meaningful correction, and the improvement you saw in those early months reflects exactly what the surgery was designed to achieve.Here's what's important to understand about upper blepharoplasty and skin quality over time:
Blepharoplasty removes excess skin &mdash; it addresses the volume and overhang of redundant tissue. What it cannot permanently alter is the intrinsic quality of the skin itself. Upper eyelid skin is the thinnest skin on the entire body, and over time, the natural loss of collagen, elastin, and hydration that comes with aging causes that fine wrinkling and crepey texture to gradually return. This is biology, not a surgical shortcoming.
When tissue is healing and mildly swollen, the skin is essentially being "plumped" from within &mdash; so those first several months often look beautifully smooth. As the swelling fully resolves over 6–12 months, the skin's true underlying texture becomes more visible again. What you're noticing is the skin itself, not a loss of the surgical result.
It's worth noting that a conservative, well-measured excision is actually a sign of excellent surgical judgment. Over-resection of upper eyelid skin can lead to an inability to fully close the eye &mdash; a condition called lagophthalmos &mdash; or outward pulling of the lower lid called ectropion, both of which can cause serious dry eye problems and corneal exposure. The fact that your result looks natural and your eye closes properly means your surgeon prioritized your long-term eye health, which is exactly right.
For the wrinkly/crepey skin texture specifically, there are some options worth discussing:
-Topical retinoids applied carefully around (not directly on) the eyelid can improve skin texture over time-Resurfacing treatments such as fractional laser or radiofrequency microneedling can meaningfully tighten and smooth eyelid skin without surgery-Neurotoxin (Botox) placed strategically around the periorbital area can soften fine lines-Medical-grade skincare with peptides and growth factors supports collagen maintenance
The surgical correction you had is holding &mdash; what you're managing now is skin quality, which is an ongoing process rather than a one-time fix. You're in a much better place than you were before surgery, and there are good non-surgical tools to help maintain and refine that result.

Kadir Berat Oyur, MD · Answer

Based on the photos, the surgical result appears generally well-healed, and the remaining crepey texture is likely related more to skin quality and elasticity than to excess skin alone. Upper blepharoplasty removes redundant skin but does not completely eliminate fine wrinkles or age-related skin changes. If the eyelid position and skin excess have improved but crepiness remains, options such as laser resurfacing, chemical peels, skin-tightening treatments, or carefully selected revision procedures may provide additional improvement. Your expectations were understandable, but complete elimination of fine eyelid wrinkles is typically not achievable with blepharoplasty alone.

Julian De Silva, MD · Answer

Thank you for the photos and for the detail that 15mm was removed. It helps to separate two different things. A blepharoplasty removes excess skin, the fold and the hooding. It does not change the quality or texture of the skin that remains, so fine crepe and wrinkling can still show, and can look more apparent once the post-operative swelling has fully settled, which often takes many months. So what you are seeing is not necessarily a poor result; it may be that the surgery did its job on the excess skin, and the remaining skin texture is a separate issue. Whether more skin could safely be removed depends on how much you have left, because over-resection of the upper lid causes problems closing the eye, so I would be cautious. For skin quality itself the tools are different: careful laser or energy resurfacing, or good topical skincare, rather than more surgery. The useful step is an examination to measure your remaining skin and check lid closure before deciding whether the answer is resurfacing or simply realistic reassurance.

Michael McCracken, MD · Answer

Blepharoplasty surgery removes excess skin but does not treat the quality of the skin (fine lines, discoloration, etc.).  It seems like your surgeon did a reasonable job with your blepharoplasty.

You would benefit from a resurfacing treatment to improve the quality of your eyelid skin.  Examples include laser skin resurfacing and chemical peels.

Why do I still have crepey skin one year after upper bleph? How can this be improved? (Photos)

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