Bulge Directly Under Eyelids After Lower Bleph. Residual Swelling?

Question

I had a lower bleph 2 1/2 weeks ago. As acute swelling died down, I noticed I now have direct bulges under my eyelid incisions. I know I am early in the recovery but is it possible to tell if this is swelling that will disappear in time or a part of my anatomy? Left bulge is more prominent & soft to the touch,leads to believe its swelling. Would swelling stay this high in the eyes? Its irritating that I had this to remove one problem and am now left with these bulges. Something to worry about?

A.J. Amadi, MD · Answer

The "roll" just underneath the incision site is swelling within the orbicularis muscle [which is responsible for eyelid closure] which will resolve over time. The swelling further down on the eyelid, as it transitions to the cheek, dubbed festoons, develops as the fluid/bruising settles due to gravity,.  Often this swelling is the last to resolve, sometimes taking weeks. In younger patients such as yourself the resolution is usually quicker.

	You are early in your recover, so no need for be too anxious.

	Best of luck

Ritu Chopra, MD · Answer

Certainly, swelling associated with bruising is still acute. It changes daily and really changes in the hours between when you go to bed and wake up. Start every day with cold compresses. Watch the salt intake. Make time for cool or lukewarm compresses during the day. That will boost your recover speed.

David J. Levens, MD · Answer

It can take several weeks to even a month or two to see all the intial swelling from eyelid surgery resolve completely. As long as your eyelid function is good, that you are able to open and close your eyelids, protect your eyes from drying, and that you are having no visual difficulties, be patient. Discuss your concerns with your surgeon and you will see continued improvement with time.

Kenneth D. Steinsapir, MD · Answer

Dear Rookshire

	The two side almost never heal at precisely the same pace.  One side certainly looks more bruised.  This will be associated with more bruising and swelling, which is what you have.  A bad bruise can easily last 3 to 4 weeks.  I do recommend letting your surgeon know about the bruise if they are not already aware.  Occasionally, the bruising can organize into more scaring and this can affect symmetry.  You most definitely want your surgeon to follow you for this.

Stephen Prendiville, MD · Answer

It is totally normal to have residual swelling and even bruising 2 weeks after a lower lid Blepharoplasty; there is nothing abnormal with your photos. The questions you raise and the reassurance you need are best addressed by the operating Surgeon.

John Pak, MD, PhD · Answer

The bulging of the tissue underneath and parallel to the incision is related to swelling of the underlying orbicularis muscle and potential scar formation. As others have voiced, the swelling should recede so that the bulge is not present. If , however, the bulge remains after several months and increases in girth with smiling, it might be merited to consider injection of botox the muscle area to determine and treat the orbicularis muscle.

Peter E. Johnson, MD · Answer

After two weeks swelling is persistent just under the lid onto the cheek where your bruise is located. The swelling can be greater in the morning and settle as the day progresses. The bulge that you see just blow your lash line incision is a small roll in the eyelid muscle which should smooth in as the scar matures.
	Best of luck,
	peterejohnsonmd

Darryl J. Blinski, MD · Answer

As Dr Pendiville states and I fully agree., much too early for you to comment. Allow at least a 4 to 6 weeks healing phase to occur. Regards

Francis R. Palmer, III, MD (retired) · Answer

From the picture, this looks like a tissue bruise over the cheek.  This can occur during lower eyelid surgery and should slowly resolve over the past several weeks.

Kimberley Lloyd O'Sullivan, MD (retired) · Answer

The bulging you have is quite normal and is related to the junction between the thin, easily stretched lower eyelid skin and the heavy cheek skin which does not swell as easily. The fluid will follow the path of least resistance and once it hits the cheek eyelid junction it can not easily flow further down and must be absorbed over time. If the bulge were higher up, it could represent residual fat hernia which is most common in the lateral compartment of the eyelid. In these photos, you should rest assured that things will settle relatively soon.

Bulge Directly Under Eyelids After Lower Bleph. Residual Swelling?

Answers (10)

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