Bulge Under Left Eye After Blepharoplasty

Question

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)

Kenneth D. Steinsapir, MD · Answer

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.

Richard J. Bruneteau, MD · Answer

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.

Anil R. Shah, MD · Answer

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.

David Shafer, MD, FACS · Answer

Healing rates after blepharoplasty can vary. Swelling can settle under the lower lid and sometimes take weeks to resolve - sometimes even months. It is hard to tell for sure without examining you. The best advice to follow up closely with your surgeon. Good luck.

Mark Berkowitz, MD · Answer

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.

Chris Thiagarajah, MD · Answer

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.

William Portuese, MD · Answer

There is always asymmetrical healing with respect to eyelids. One eyelid always heals faster than the other. The bulge that you are describing is difficult to see and can be related to malar edema in the high cheek area. Make sure that any allergies are under good control so as not to create more swelling and edema in the lower lids.

Christopher L. Hess, MD · Answer

The area of concern that you are describing is the lid/cheek junction.  This protrusion can only really be caused by one thing-lower lid fat.  The fat of the lower lid is divided into three distinct compartment, medial, middle and lateral.  When doing a transconjunctival bleph it is imperative that all three compartments be opened and the appropriate amount of fat removed.
You have an interesting postoperative appearance.  You still have tear trough depressions and you have excess fat over the infraorbital rim.  It's really not clear if not enough fat was removed from the lateral compartment or it was opened and the fat allowed to redrape over the rim. 
In any case see your surgeon and plan to get a revision for this.

Hisham Seify, MD, PhD, FACS · Answer

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.

Scott E. Kasden, MD, FACS · Answer

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?
sek

Bulge Under Left Eye After Blepharoplasty

Answers (13)

More Eyelid Surgery Questions

WE SEND PRETTY
EMAILS

Answers (13)

More Eyelid Surgery Questions

Steroid Injections for Scar Tissue from Blepharoplasty?

Brusing and Swelling After Blepharoplasty and Mid-Face Lift

One Eye Looks Different After Upper Blepharoplasty

Pulling or Stretching Eyelid After Blepharoplasty

Droopy Eye Corner Skin After Blepharoplasty

Lumps and Swelling After Blepharoplasty

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS