Bulge Under Left Eye After Blepharoplasty

I had transconjunctival Blepharoplasty 14 weeks ago. Right eye has healed, but left eye heals slow. There's a slight bulge directly beneath where the bag used to be (can't be fat, way too far from lid). If you were to place the tip of your thumb on a piece of paper, trace it with a pencil, that's the shape of it, with the rounded edge facing downwards. Is this residual swelling? Is it normal to have swelling in that region? Why do eyes heal at different rates? (Hard to see in photo, very apparent in person)

Doctor Answers 13

Boy, I think I would give this a whole lot of time to resolve.

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Dear DDC38

The thing you are pointing to is well outside where the eyelid fat lives. And yet, in the photograph it appears to be in continuity with a ridge extending from the medial portion of the lower eyelid where the lower eyelid fat does live.

This is where a personal consultation is invaluable because in person we would know exactly what you are pointing to. However, assuming that what you are pointing to is the fullness outside of the orbital rim, this is a little relaxation in the cheek. It is not dramatic. When they are bigger, they are called festoons. I am going to go out on a limb and suggest without having seen your before pictures that this was actually present in the before images and is just a little more obvious to you because you have spent more time after surgery studying this area than you did before surgery.

If the issue was present before, then it is unlikely to resolve on its own with more healing. Generally this things are best treated by using a filler like Restylane to fill around the fullness. Cutting skin or lasering are excessive punishment for an issue like this.

If this was not present before surgery, then more healing is the answer. In this case, I would recommend that you wait a full year before thinking about doing something surgical about this issue.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Gravity allows Blepharoplasty swelling to "pool" on cheek bone

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Swelling, edema, after eyelid surgery is not uncommon. Each side can heal independently of one another; just like the right arm is different in strength to the left. If you sleep on this side it is more likely that the swelling will remain longer.

After eyelid surgery, we get swelling that gravity pulls down to this lower eyelid/ cheek junction. It should improve over time. Speak to your doctor about using gentle massage techniques and warm compresses to help hasten the swelling. If this does not alleviate the swelling your cosmetic surgeon may discuss other techniques.

Healing after surgery

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First off to answer your last question first, the reason the eyes heal at different rates is because the anatomy is not exactly the same on both sides. Just like an eyeglass prescription can be different in two eyes because they are different, the eyelids can heal differently because they are anatomically a little different. Also if you sleep on one side, that may create more edema on one side as opposed to another in the healing process. I would give this 6 months to a 1 year but this should resolve with time. 

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

Prolonged swelling in a facial fat pocket

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To address your last comments:

There are several fat compartments in the face. A transconjunctival blepharoplasty will only address the three lower lid fat pockets. You have some swelling of the other pockets. Lymphatic massage helps a lot.

Hard to tell without exam

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This may indeed be resdual swelling, or cheek fat pad left behind/displaced.  Have your doctor examine it to see if this will heal on its own, or perhaps a steroid injection may help.  Massage?


Give your Blepharoplasty some time

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I would give it another three months before considering any additional treatments. It certainly could be some residual swelling especially since it is below the operative site. If it hasn't corrected itself after three more months, then go back to your surgeon and discuss options. Malar swelling can be corrected with a variety of techniques, including fillers to camoflage the bump.

See your surgeon

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It is mere speculation to determine what is happening without examining you or knowing what transpired at surgery. You might ask if fat wassimply removed or if the surgeon tried to reposition the fat over the lower orbital rim. Any acute swelling from the surgery should be gone by 14 weeks although it is standard for bilateral procedures to heal at slightly "different rates." It is possible it might be a seroma, or collection of fluid, or fat, if it was repostioned.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Post-operative Healing And Swelling

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It's not unusual for patients to experience swelling following blepharoplasfy surgery. In some cases, this swelling may persist for prolonged periods of time. When this situation arises, the swelling may involve the surrounding tissue because of gravity.

In this particular case, the swelling appears to have extended beyond the original field of dissection of the transconjunctival blepharoplasty. It's asymmetric nature is probably positional in origin.

Under these circumstances, it's appropriate to be patient. Patients should minimize salt intake and elevate the head whenever possible. When these steps are taken, this problem should gradually resolve.

It's important that you maintain close contact with your plastic surgeon. Your surgeon should be able to get you through this difficult experience.

Bulge After Blepharoplasty

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Bulges after blepharoplasty can be disconcerting to the patient.  Early on after blepharoplasty, it is not uncommon to see some asymmetry of the lower eye / cheek complex.  Persistence of lower lid swelling under the eye can be from the following causes:

  • Malar edema
  • Festoon persistence
  • Lower lid fat
  • Medical condition (especially thyroid or allergy)


Discussion with a well qualified surgeon can identify the solution to the persistent bulge after blepharoplasty.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews

Bulge under eye after blepharoplasty may be a festoon or malar bag

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I agree that asymetrical healing is common after blepharoplasty but at 14 weeks your eyelid looks well healed.

In some cases, particularly after puffy eyes or eye bags have been removed, a swelling on the upper cheek becomes apparent that was not noticed before the eye bag was removed.

If this is the case and you do have a festoon or malar bag, the swellking will not go down.

Festoons are usually present on both sides although they can be more noticeable on one side. They are very difficult to treat.

Ceck your pre op photos and see if the prominence of the left cheek was present before your blepharoplasty. Of course consult your doctor.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.