Are Oculoplastic Surgeons Better at Fat Transfer?

Your case is complicated, as there is already a previous operation clouding the issues.
In general, an oculoplastic surgeon will be very well qualified to deal with all your issues, but so will a well trained PlasticSurgeon. The oculoplastic surgeons are not as attuned to the overall esthetic issues of the face, the Plastic Surgeons are not as attuned to the functional issues of the eyelids.
There are also many Plastic Surgeons who are also trained ophthalmologists. In your particular case I would focus on the surgeons particular expertise, so ask around other medical professionals for a referral.

Both Plastic Surgeons and Oculoplastic Surgeons are trained in these problems. In your case since it is a secondary procedure as a result of a "failed procedure" you need to find the best possible surgeon which is not necessarily from which discipline he/she trained in. Further you need to select a surgeon that is an expert in revision surgery and Asian eyelid surgery. This involves a lot of research and asking the right questions including the number of cases like yours that he has performed, asking to see before and after photos, references and making sure he is a board certified plastic surgeon.

 

At the very least you want to see someone who is a specialist in Asian eyelid surgery AND has experience in reconstructive procedures.  Oculoplastics surgeons are great and specifically trained for eyelid work, however, only a minority of them will be experienced in your specific issue.   The issues your are having occurred a lot in the '70's and 80's when this sort of upper lid surgery was popular in the Asian female demographic, no I am seeing those patients back and have been performing their revisions with fat or facsia grafts.  Let me describe a some of the potential solutions to your problems.  First remember, revision work with free tissue grafting is somewhat unpredictable but will still give you a great improvement, it just may not be perfect.  How it's done:

1.  You're left upper lid does have some ptosis (droop) and significant hollowness.  The ptosis can be repaired simultaneously with the tissue graft by shortening the muscle & tendon that opens your eyelid.  This is done through the same incision used to placed the graft.  This doesn't add much to the healing time.

2.  The hollowness would be repaired with either fat from your abdomen or facsia from behind your ear.  The grafts from either place will do you no harm but the fascia from above/behind your ear will give you a better cosmetic result for the graft site since the incision is hiden in your hair as opposed to fat graft from your abdomen or thigh.  My prefered graft is fascia.

3.  Your right lid I would not touch and simply try to match the left side to the right as best you can. 

4.  Get several consults.  A lot of surgeons may say they do this but the reality is that unless you  have a doctor who see's a lot of Asian eyelids, chances are they haven't really performed this procedure.

5.  As a temporary measure adding some fat to the upperlid would help the hollowness if you can't go through surgery any time soon.

Hope that helps.

Dr. Chase Lay