Under Eye Loose Skin and Wrinkles Normal After Blepharoplasty?

Question

I had upper and lower Blepharoplasty two weeks ago.  The main reason was for bags, loose skin and wrinkles under my eyes.  I was told that these could be corrected by removing some fat and tightening up the loose skin.
While it looks like some of the puffiness is gone, I am very concerned about remaining loose skin and wrinkles under my eyes. I am feeling very upset and disappointed at my result.  I don't feel like the skin under my eyes was tightened up and deep wrinkles are still present.  Is this a normal outcome and is it  acceptable? It does not seem acceptable to me. Thanks.

Kenneth D. Steinsapir, MD · Answer

Jill
Your dissatisfaction is not uncommon.  Much depends on exactly what you had done, what your issues were to begin with, and what is going on once you are 4 to 6 months out from your surgery.  Nothing replaces a personal consultation.
At two weeks out, you are extremely early from surgery.  Many of the healing processes that we think account for new collagen formation take time to develop and are at their maximum at about 4 to 6 weeks after surgery.  This is when the long term remodeling of fat begins to take place.  So try to be patient.
I would caution you about rushing your surgeon for help right now.  I have seen people talk themselves into unnecessary procedures.  Your surgeon is basically a problem solver who may try to placate you by "doing something to make you happy" before the dust has settled.
For now I strongly recommend that you let yourself heal.

Richard J. Bruneteau, MD · Answer

It's not unusual for patients to have significant swelling following blepharoplasty surgery. This swelling can obscure the final aesthetic result and be the source of tremendous anxiety for patients. In some cases, it can give the appearance of excess skin and residual eyelid wrinkles.When patients undergo this procedure, excess skin and fat are removed from the lower eyelids. Unfortunately, this procedure doesn't always impact fine wrinkles that occur on the lower eyelids. Efforts to remove fine wrinkles by removing additional skin can be associated with severe complications. Under these circumstances, the lower eyelid can pull in a downward direction. This condition is called an ectropian and often requires revisional surgery. It's difficult to evaluate the aesthetic result in someone who's still swollen and only two weeks post-op. It's, therefore, important to be patient and give your swelling time to resolve.Once your swelling has resolved, you might ultimately be happy with your result. If you're not happy with your result because of eyelid wrinkles, you may still be a good candidate for eyelid re-surfacing.

Robert W. Sheffield, MD · Answer

Thank you for your question! First and foremost, congratulations on getting a blepharoplasty to resolve your eye bag, loose skin, and wrinkles issues. That is possibly the best option out there for these, what I like to call, irregularities. Regarding your concern of not yet seeing the results that were promised, I would advise waiting a bit more. Patience is a virtue and you need to be fully healed first prior to seeing the actual results of blepharoplasty. In my practice, I usually advice my patients to wait for up to 3 months or later before full and complete recovery is observed. If you have undergone fat repositioning, you may still observe excessive skin for a few weeks since it has not retracted well yet. Healing takes time. Now, after 3 months or up to 6 months, and you are still showing wrinkles and excessive skin, then that is the time to worry. You may need to consult your board certified plastic surgeon at this point for progress evaluation. Do not ask for the excess to be removed so early on as this may affect the retraction needed for the lower lid. If this affected by removal of skin prior to full healing, major problems may arise. You need to be more patient on this.

Phillip Langsdon, MD · Answer

There are some great things about blepharoplasty. It can improve sags and bags and reduce the excess skin, but it cannot remove wrinkles or re-inflate the groove between the edge of the (very thin) lower eyelid skin as it transitions into thicker upper cheek skin.
It is way too early to be concerned. Most of the swelling usually disappears in a few weeks, but it will take up to a year for the remaining minimal swelling to finally go away. The incision lines will become pink and firm for a while, then soften and lighten after a few months. This is normal. This is expected.
Wrinkles are treated with skin exfoliation and hydration. A daily skin care regimen will help over time. If you have deep wrinkles, some form of chemical peeling may be needed. Remember, it took a while to develop the wrinkles, puffiness, etc. 
So, it will take a while to get things better. Laser is an option, but with 23 years of experience, we have found peeling to be far superior.
For a better evaluation, please post frontal and side view photos.

Christopher L. Hess, MD · Answer

Two weeks is definitely too soon to be talking about revision but I understand your frustration.  Removal of skin from the lower lids a tricky and requires other procedures to be done at the same time such as a canthoplasty and cheek support.
You mention deep wrinkles.  If the wrinkles are low on the eyelid, ie at the orbital rim. then removal of a small amount of skin from the superior part of the eyelid will not help.  This area can only really be helped by a midface lift or standard facelift.
So give it time.  Then consider laser or peels to help the wrinkles and if that doesn't do it consider other surgery.

Robert M. Freund, MD · Answer

There are many ways to improve the lower eyelids. Above all else, doing no harm is essential. Perhaps more than any other cosmetic procedure, lower lid blepharoplasty can create horrific and severe problem if not done well. Some doctors will shy away from doing too much to avoid these problems. This may be the case with you. However, at two weeks after surgery you should be patient and save judgement until at least 8 weeks after surgery.

Philip Young, MD · Answer

The loose skin under your eyes can be improved by doing a pinch blepharoplasty technique without increasing your risk of your lower eyelids getting pulled down like a hound dog. This pinch blepharoplasty technique is very simple and can be done in under an hour and usually takes 30 minutes. I wouldn't be too upset. I'm sure your doctor will be happy to do this for you. 
One thing that can help those wrinkles and make you look more natural is too add volume under your lower eyes through dermal fillers or fat injections. This is a more natural way to improve the appearance of your lower eyelids and any sunken cheek type of appearance. This can lift your cheek and help remove the bags under eyes and improve the dark circles under your eyes. This is definitely a great option for this area.
Consulting a board certified facial plastic surgeon would be something that I would always recommend. We specialize in the face and are the best qualified to help you in the face and neck area when it come to facial plastic and reconstructive surgery.

Lisa Cassileth, MD, FACS · Answer

First, wait until the surgery has fully healed. Especially with fat repositioning surgery of the lower lids, skin can look excessive because it has not retracted yet.

When you fully heal - I"m talking 6 months here - you could always consider some form of skin tightening, like fractionated CO2 laser, to smooth out your skin.

As a surgeon, we never want to overly remove skin of the lower lids, as this can cause major problems with lower lid retraction. So, don't insist on your surgeon removing more skin!

Francisco Canales, MD · Answer

Jill
It sounds like you are very disappointed because you still have wrinkles and loose skin. Beware!  The procedure , if properly done, allows for you to open your mouth fully without having your eyelids start to pull down. 
A great majority of the lower eyelid problems we see after surgery have to do with skin that was tightened so well that no wrinkles were left. The result is a pulled down lower eyelid, with constant irritation in the eyes. Many times there is pain associated with this condition and patients have to tape their eyes at night. Surgery with grafts is sometimes necessary.
Let your healing progress and when you have stabilized, review the results with your doctor. Sometimes a chemical peel or a light laser to the area will improve matters.  But, in the end, better to have wrinkles and fully funcitoning lower eyelids than to have the problems of tight skin under the eyelids.

Harrison C. Putman III, MD (retired) · Answer

After only 2 weeks you should not be so concerned. Nontheless, if these persist after 6 months or so an appropriate additional treatment for exfoliating the skin can be performed. It will be important to assess your eyelid tone first. The surgeon will perform a "snap" and a "distraction" test and also look at the current eyelid position to ensure there is no scleral show or retraction. Then a form of chemical peel or a conservative laser peel will further improve dermatochalasis, wrinkles and pigment irregularities should these be present.

Under Eye Loose Skin and Wrinkles Normal After Blepharoplasty?

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