Can upper bleph be fixed? (Photo)

Question

I had an upper blepharoplasty about 7 months ago. While I do notice a slight difference, my eyelid still droops on both sides (one more than the other) and my eyelashes rest on the lid. My surgeon said she couldn't take anymore skin or I wouldn't be able to close my eyes, even though there seems like plenty. She suggested a brow lift now but said I didn't need one at my initial consult and that my brows were aligned with brow bones. Can this be fixed? If so, how?

Thomas A. Mustoe, MD, FACS · Answer

You have some residual lateral hooding and the best approach is a temporal browlift. Currently I combine temporal browlift with upper blepharoplasty in the majority of patients because it is the only way to correct lateral hooding. Theater portion of the brow sags along with eyelid skin laxity as part of the aging process.  The only way to improve lateral hooding without a browlift is to extend the incision laterally beyond the crease where it becomes visible.

Jose Perez-Gurri, MD, FACS · Answer

Hi. As was pointed out to you initially, a brow lift would be the indicated procedure going forward. The lateral redundant skin is brow tissue not upper lid skin. there must be a reason why your surgeon suggested a brow lift but now is reluctant. I would suggest another meeting with your surgeon to inquire why she is reluctant to proceed with a brow lift. Good luck, Doc PG

Anshu Gupta, MD · Answer

Thank you for your question. Based on your description, it does appear that there is still some excess skin on the lateral sides of your upper eyelids. While it’s difficult to fully assess your brow position without an in-person evaluation, the residual skin on the eyelids could potentially be addressed with a revision upper blepharoplasty. Your surgeon’s caution about removing too much skin to preserve proper eye closure is valid, but a detailed assessment could clarify if further refinement is feasible.
As for the brow position, it’s worth noting that a subtle brow droop could contribute to the appearance of excess eyelid skin. While a surgical brow lift is an option, a non-surgical approach like a liquid brow lift using Botox might achieve excellent results by slightly elevating the brow and opening the upper eyelid area.
A thorough consultation with a board-certified plastic surgeon, ideally one experienced in eyelid and brow surgery, will help determine the best course of action to correct your concerns.

Gary M. Horndeski, MD · Answer

You may benefit from a brow lift.  Your eyebrows are at the level of the orbital rim and they should be slightly above in women.  You will also need a revision of the blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

Kenneth D. Steinsapir, MD · Answer

Having said that, of course you can have this revised to accomplish your goal of having more eyelid platform exposed. I employ a technique called anchor blepharoplasty to help expose the upper eyelid platform without removing the upper eyelid fold. For some, a stabilizing endoscopic forehead is helpful. These are issues than can be resolved at the time of a detailed in-person consultation. It may be that your original surgeon is just a conservative individual but you can most definitely have a result that better meets your aesthetic goals.

William Portuese, MD · Answer

You do appear to have residual skin in the outer 2/3 of your upper eyelids. An in-person consultation would be required to make sure that you're a candidate for a revision upper eyelid surgery. This can be performed under local anesthesia as an outpatient procedure. General anesthesia is not necessary. The height of your eyebrows also appears great, so no brow lift is necessary.

Darryl J. Blinski, MD · Answer

It appears your surgeon was lacking expertise in doing upper eyelid surgery. A revision is indicated. Best of virtual consult with. Fee range from $5000-$8000.

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