Office-based Blepharoplasty Revision?

I had lower Blepharoplasty about 4 months ago. Surgeon says this bulge is not swelling, and it can be rectified in his office by making external incision beneath eye, then reach downward. If fat or scar tissue, then he will remove it. If skin draping issue, he will tighten it to obliterate bump. Does this sound like a plausible solution, or is there a better way of dealing with this? What are the risks? Have any of you done this in your practice – what was the result? How long should I wait before doing this?


Doctor Answers 6

Malar crescents are formed by descending orbicularis

I agree that if there is still swelling in the area this can take up to six months to subside. If there is fullness there after six months this a called a malar crescent which in its most extreme condition is called a festoon. Festoons are more common in smokers. Malar crescents and festoons are difficult to eradicated completely but have many teatement options.

Youngstown Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews


I would do the same thing.  The risks are the same as with lower blepharoplasty.  You should expect a good result.  The risks are low.


Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

I Would Wait...

Your photo shows swelling of the upper cheek, an area where I would not expect excess eyelid fat. These "malar bags" can sometimes harbor swelling for 3 months or longer.

Personally, I would be concerned about "going in" surgically and dealing with tissues that have not healed. Your surgeon has the advantage of knowing what he has done (did he do other things such as fat grafting?), but I would certainly wait. It is this patience from surgeon and patient alike which often is healing and keeps us out of trouble.

In addition, revision lower blepharoplasty is a delicate procedure which is best planned accurately beforehand...

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

It's better to wait several more months

The surgical plan that has been suggested in reasonable, but there is a very strong argument for waiting another 3-4 months. It’s certainly possible this is not swelling, but it’s hard to be sure unless you wait and see.

Surgically revising a result at an early date can sometimes be justified if there has been a clear surgical error leading to an unambiguously poor cosmetic or functional result. Your picture shows a definite cosmetic concern, but one that’s fairly subtle and might well improve with the healing process. If your surgeon ultimately does revise the result in the future, he will have greater confidence that he’s aiming at a stable target.

Hope that’s useful.

Paul L. Leong, MD, FACS
Pittsburgh Facial Plastic Surgeon
4.9 out of 5 stars 46 reviews

Wait 6 months before Blepharoplasty revision or festoon removal

The area may be a festoon, but at 4 months could still be swelling. Wait a couple more months and massage the area to reduce swelling.

If the swollen area is a festoon, then a lateral cheek lift through an extension of the lower blepharoplasty incision is the only solution. However, this is a complicated procedure, and has to be done by an experienced board certified plastic surgeon if it is going to work well and not cause complications.

Potential risks are a noticeable scar on the outside of the lower eyelid and cheek.

Another risk is ectropion, a downward pulling of the lower eyelid also called the sad eyed look. This occurs if too much skin is removed or if the eyelid support is damaged.

Frequently, this procedure requires a canthopexy to enhance support of thre lower eyelid.

If your doctor is a very experienced board certified plastic surgeon who does a lot of eyelid surgery, then this may be safe.

However, I would be very cautious and discuss these issues with your doctor.

I am not so sure

At only 4 months, I would still say you are not totally healed, especially if that area was not there before your surgery. This area is pretty far from your eyelid and making an eyelid incision and "reaching down there" isn't necessarily as easy as it might seem. Personally, I'd wait a few months, massage the area and hold off on the revision. You can't go wrong by waiting.

Also, make sure this doctor is truly qualified as either a Board Certified Plastic Surgoen, Otolaryngologist or Ophthalmologist and has extensive experience. Early revisions are usually a bad idea.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

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.