Should I consider a third double eyelid surgery revision? (Photo)

Question

I had my first double eyelid surgery done 27 years ago. It resulted both eyes were uneven. As time went by, both eyelids haved dropped. However, the right crease was still too high and the left crease was too low and yet becoming a triangle eye. I had my 2nd revision 3 wks ago. I regretted it because the left eye looks significantly older now with multiple creases. The right eyelid looks even deeper and thicker. How to remove multiple creases? Should I consider the 3rd revision?

Lu-Jean Feng, MD · Answer

You are only 3 weeks after surgery. Both your right and left upper lids below the incision are still quite swollen.The multiple creases above your left upper lid may be from scar adherence. You can gently massage your upper lid above your incision with a Q tip to loosen the scar. You really need to wait 4 to 6 months for full healing before you can judge your result. If the multiple creases do not correct after 6 months, you may need a revision on the left side to release the upper lid skin from the muscle underneath.

Amiya Prasad, MD · Answer

It’s not unusual to see a scenario like this in a second or third
surgery. When you had the original Asian eyelid surgery, you probably had a lot
more fat and thicker skin when you were younger. It probably involved removal
of a little bit of skin and fat. It also involved anchoring of the skin to the
levator muscle, the muscle that lifts the eyes which is responsible for the
crease. As a lot of Asians get older, they lose volume and fat in the orbital
space. What was once an area of fullness becomes relatively hollow. In my
practice, I had many patients who had this situation occur and paradoxically, I
place a filler to add volume and to create the fullness right below the eyebrow
in order to create that shape.

As far as the concern about the appearance at this point, you must
understand that at 3 weeks, there are a lot of dynamic changes occurring and it
is not uncommon for people who have Asian eyelid surgery to be concerned about
swelling, irregularities and asymmetry at this stage. If your surgeon was an
experienced cosmetic surgeon focusing on eyelid surgery for Asians, then
typically they’ll have more than enough experience to know what to anticipate
and to help you get through this transition phase. You can’t necessarily draw
long standing conclusions about what is going to happen 3 to 6 months from now.
In my practice, I tell patients that it takes 6 months to a year for full
healing. Therefore, you don’t want to go in and do something prematurely.

When I perform eyelid surgery, whether it’s ptosis surgery or in some
cases of Asian eyelid surgery, I’ll actually have the patient open and close
their eyes during the surgery to see how they look. Through this, I get a good
sense whether or not the shape of the eye is responding to what we are trying
to achieve.

That said, I think it’s important that you communicate with the doctor
you trusted to perform the surgery and get a sense of what’s going on and why
there’s a difference between the two eyes. It’s reasonable to observe for the
next couple of months how things settle out. Sometimes, a little enhancement is
necessary, but at 3 weeks after the surgery, you don’t want to draw conclusions
that would ultimately likely resolve on their own. I hope that was helpful, I
wish you the best of luck, and thank you for your question.

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Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

At three weeks postop, you are healing still. There is some swelling present and it is too early to consider a revision. Allow yourself to heal for a few months and if the issues persist, discuss the options with your surgeon.

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Should I consider a third double eyelid surgery revision? (Photo)

Answers (3)

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