Revision advice - can more skin/fat be removed? (Photos)

Question

I’m looking for some advice. I had an upper bleph + ptotis repair. I’ve had a final post op review and she informed me that the maximum amount of skin was taken off/that there was no fat to remove; however, I don't see much difference. I was also informed that my eyebrow has dropped as a result of the upper bleph and I received confirmation that the ptosis was unsuccessful as the measurements were the same pre-operatively to post-operatively. I’ve been given one option - A revision on the ptosis repair which I’m happy to go ahead with but I do still feel there is some excess skin/fat (again, I’ve been told this is not the case and that it is just brow drooping). I trust my surgeon as she seems very knowledgable, but the purpose of seeking further advice is to keep my expectations realistic and also to ask the correct questions prior to my ptosis revision.

Carl Truesdale, MD · Answer

Whether more skin or fat can be removed depends on three things: how long you are post-op, what was done originally, and your current lid position.
Timing first. Most surgeons want at least 6 months between any eyelid operations to let tissue fully settle. The lid skin and muscle change appearance through the first 6 to 12 months of healing, and revising too early sometimes corrects an issue that would have resolved naturally.
What was done originally matters a lot. If you had a transcutaneous approach (external skin incision), the scar tissue is in a different plane than a transconjunctival case. Revision dissection can be more delicate. Your operative report from the original surgeon is useful to bring to any revision consult.
Current lid position is the safety constraint. If your lower lid sits at the iris on resting gaze, conservative additional skin or muscle removal is usually safe. If you have any lid retraction or scleral show already, additional removal is risky and can worsen the appearance. The exam matters more than the photo here.
What can typically be revised:
Persistent fat herniation, especially in the medial pocket, which is sometimes underaddressed in the original operation.
Modest residual skin redundancy, usually 2 to 4mm at most, beyond which the lower lid risks pulling down.
A wider canthal angle that wasn't tightened sufficiently the first time, addressed with a canthopexy.
What gets harder to revise:
Over-resection of muscle (rare but creates a hollow appearance).
Notching at the lid margin if the original skin incision was placed incorrectly.
My honest read: revision is appropriate for a defined issue with a clear plan. Going back for a small generic tightening rarely satisfies. Find a surgeon who does eyelid revision specifically and can show you cases similar to yours. The revision portfolio matters more than the primary one.

Revision advice - can more skin/fat be removed? (Photos)

Answers (1)

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