Droopy Eye Corner Skin After Blepharoplasty

Question

I am 5 weeks post-op bilaterial upper Blepharoplasty. My left eye is healing fine but the inner corner of my right eye has sagging or droopy skin! I saw my surgeon after a month, and she said to be patient, I won't see a total result for 6 months. I don't see how the skin will tighten; I thought the skin usually relaxes with time. Do you think this will shrink? It sure looks to me that I will need a revision to just remove the excess skin. Can this be done as soon as 3 months? Thanks.

Brent Moelleken, MD · Answer

There is a tradeoff on the medial eyelid skin. If the incision is too medial, it shows even when the eyes are open. A conservative approach is usually best so that the smallest, least visible correction can be made.

Andrew Miller, MD · Answer

With lower eyelid surgery, it is vital that the surgeon does not remove too much skin, which can be very hard to correct. If there is some excess skin you can always go back and remove a little more easily. At only 5 weeks out, I would definitely wait because the skin may tighten on its own. 
If nothing changes, and at 3 months your surgeon sees no swelling of the lower lid, then revision can be done at that time. Be sure to discuss your concerns with your surgeon so that they can be followed closely.
Dr. Miller

Scott Tucker, MD · Answer

Typically, I like to wait around 3-6 months prior to doing a revision because many times things will settle down with time. It is possible that if it is obvious on physical exam that I left a little too much skin I will do a revision sooner just so you can get on with enjoying your result.
Hope this helps.

William Portuese, MD · Answer

The skin on the inside corner of the upper eyelid does take quite some time to settle down. There is occasionally some residual wrinkling that is present on the upper lid closest to the nose. The design of the upper lid crease and incision sometimes does not allow for full correction of all of the excess skin in that area of the upper eyelid. Sometimes a small tuck of excess skin can be removed, but careful attention to not make the incision more noticeable in that area is very important.

W. Tracy Hankins, MD · Answer

It is best to follow the advice of your surgeon and wait. The skin in the medial area of he eyelid often takes a little longer to retract, especially if you had a large medial fat pad that needed to be removed. It is always best to work with your original surgeon during the immediate post-op period, as she knows exactly what was done during your surgery.

Richard D. Gentile, MD · Answer

There are many patients who heal at different rates on both sides of the same surgery.  There are also preoperative asymmetries that can affect the ultimate result.  
Give this some time and see how things look at six months. If there is redundancy that concerns you, it is simple to correct.

Scott E. Kasden, MD, FACS · Answer

You may get a revision as early as 3 months.  I would agree to the waiting, what's the rush, you are already half way there!
 
sek

Jeffrey Zwiren, MD · Answer

When designing the incision on the medial or inner aspect of the upper eyelids we do not like to extend it too close to the nose skin. This will leave an unsightly scar. There are several techniques available to help to blend in the corners while removing most of the loose skin. There are several factors that must be taken into account when determining how much skin to removed. You certainly do not want to be left with an upper eyelid that will not close or an over resected upper eyelid creating an A -frame type deformity. Some degree of conservative skin excision is always performed. A plastic surgeon attempts to remove enough skin to make a nice difference. On occasion this is very difficult to determine. If the procedure was done under local anesthesia there is a fair degree of immediate swelling due to the infiltration of the local anesthetic. Therefore the marks made on the skin and lid prior to surgery become the best guides during surgery to remove just the appropriate amount of skin. This region in the medial corner is very loose skin. It tends to swell after surgery. Give it some time to resolve, usually the three month point. If the asymmetry persists then a minor skin revision may be indicated.

Michael A. Marschall, MD (in memoriam) · Answer

Small elements of asymmetry or skin excess can indeed change with time. 3-6 months of waiting would not be unreasonable prior to entertaining any revision. In general, a small correction corresponds to a shorter downtime and quicker recovery. Discuss this with your surgeon and come up with a plan if anything further is necessary.

Brooke R. Seckel, MD, FACS (retired) · Answer

You still may be swollen after upper blepharoplasty and I would wait 6 months for revision. If you do it now and there is swelling, too much skin may be removed.
There are commonly 2 possible reasons for fullnes of the medial upper eyelid skin after upper blepharoplasty.
Most commonly some medial upper eyelid fat is left behind, and this causes the bulge inside the corner near the nose.
The other situation is that not enough skin was excised.
Both of these problems can be easily revised under local anesthesia.
Hopefully, what you see is swelling and will resolve.

Droopy Eye Corner Skin After Blepharoplasty

Answers (10)

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