Options for Correcting Bad Blepharoplasty Results?

Question

I still have scars under my eyes and corner of one eye two years after a bad Blepharoplasty. I also have circles and puffiness under my eyes, and I look tired because of these. What options do I have to correct or address these problems? Should I go back to my old doctor or should I consult a new one?

Kenneth D. Steinsapir, MD · Answer

Dear Scareyes
Repairing eyelid surgery is a highly specialized practice.  There are only a handful of us in the world with practices dedicated to fixing problematic eyelid surgery.  You are welcome to look at my website: www.lidlift.com/fixing/.  This contains specific examples of how we approach the repair of cometic eyelid surgeries that are unsatisfactory.  Depending on how severe your issue is, it is worth making the trip out to consult to learn your options.
What will need to be done very much depends on the actual details of how your eyelids have been damaged by your prior blepharoplasty.  The website has a lot of content regarding these issues and it is a very good place to start.  The bottom line is that there is a lot that can be done to help restore your appearance.

Daniel Reichner, MD, FACS · Answer

I don't have photographs of your eyes so it is difficult to give you specific advice.  That being said, it sounds like your surgeon performed a traditional lower blepharoplasty and may have been too aggressive in removing skin.
There has been a paradigm shift in Lower Eyelid Surgery over the last 10 years.  The trend is toward conservation of the lower eyelid skin, preservation or repositioning of of lower orbital fat and filling the tear trough with micro fat grafting.  I would recommend that you seek consultation with a Board Certified Plastic Surgeon comfortable with revision lower blepharoplasty.  The corrections will depend on how much skin was removed, how much lateral canthal support is necessary and how the lower orbital fat was removed or repositioned.

Frank P. Fechner, MD · Answer

It is not easy to recommend what exactly needs to be done in your case but here are a couple of ideas.
Secondary lower blepharoplasty commonly requires some lid tightening (canthoplasty or canthopexy) in order to prevent droopiness (ectropion).
Scar removal/improvement requires another incision under the lid lashes (skin/muscle flap approach); likely with canthoplasty or -pexy.
Most patients benefit from filling the tear trough area rather than further fat removal. This can be effectively doen with fat grafting. Sometimes, conservative fat removal from isolated "pockets" is helpful.
It is commonly a good idea to see your original surgeon in follow up. You will certainly not regret seeking another opinion before going ahead with secondary blepharoplasty.

Michael Law, MD · Answer

There are many options for correcting bad blepharoplasty. However, blepharoplasty correction requires specialized training and experience. Be certain to look at many, many photos and to carefully check the credentials of your plastic surgeon.Whether or not to continue with your plastic surgeon depends upon whether or not you still have confidence in your surgeon. It is important to discuss your concerns. It is possible that your plastic surgeon might be right for you. If you elect to find a new plastic surgeon you will need your compete medical records including all pre and post operative photos to help a new plastic surgeon with a surgical plan.

William Portuese, MD · Answer

A scar revision on the eyelid can be performed. It has to be performed very meticulously so as not to create more issues and also to not change the shape of the eye. The primary goal of a lower blepharoplasty surgery is to remove the puffiness and fat bags underneath the lower lids with trimming of a little bit of skin at the lash line if needed. It is a good idea to always check back with your original surgeon, and if he does not wish to re-operate on the eyelid, then one should seek another qualified facial plastic surgeon.

Richard D. Gentile, MD · Answer

Whether or not your result is "bad" or if you have just unfortunately developed side effects of the surgery should be examined. 
If it is not a bad result but a result you are unhappy with that has the likelihood of converting into a good result that you are happy with, this should be considered in consultation with someone very experienced with blepharoplasty.

Christopher L. Hess, MD · Answer

Since you stated that you had a "bad blepharoplasty" you probably shouldn't go back to the origninal surgeon.
Bad scarring can result from complications such as infection or wound healing problems.  In addition darker skinned patients are at a higher risk of hypertrophic scarring and keloid.  Although this is very rare in the upper lids it can happen in the lower lids.
I'm not sure what you mean by circles.  But puffiness can be caused by many things most commonly allergies, fatigue etc....  
See several surgeons before deciding on one.  Not just someone your friends know.

Hisham Seify, MD, PhD, FACS · Answer

Revision of your surgery with skin and muscle redraping and lid support (canthopexy) will give you a good result. Talk to your surgeon first and see if he is comfortable with a revision lower lid surgery.

Scott E. Kasden, MD, FACS · Answer

A photo would have been helpful.  However, you are disappointed with the results.  I would recommend a second opinion for an unbiased, objective evaluation and treatment recommendations.
 
There are several reasons for dark circles under the eys, and this should be addressed at consultation.
 
Best to you

Kamran Khoobehi, MD · Answer

Please revisit your surgeon and discuss your concern with him and he may recommend another surgeon that specialize in redo surgery. Redo and corrective surgery is more complex and please make sure that your surgeon is able to deliver the result that you are looking for.

Options for Correcting Bad Blepharoplasty Results?

Answers (12)

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