Blepharoplasty 7 months ago, eyes always puffy. Right eye more puffy with worm shaped hard 1/4 inch mass in bag area? (Photos)

I posted last week under brenna18 with no pictures. Here are some pics. Doctor offering 3 'Therma smooth' eye treatments he says will help tighten my skin. I think he could of taken more skin from upper & lower lids, he says no. Had fat transfer also. He said last month during my visit it seems like some kind of nodule & would go away. Isn't 7 mos enough healing time? So self conscious and discouragesd right now. I searched for best doctor in my area when I found him. Do I use him again?

Doctor Answers 7

Revision lower blepharoplasty<

7 months is still a bit on the early side, things may get better but it looks like the "worm" you describe may be residual swelling and normal scar tissue underneath.  However, more specifically it looks like orbicularis muscle that is bunching up.  This can be a normal postop part of your physiology and may have been present prior to surgery but because of the bags present the "over-riding orbicularis" may have gone unnoticed.   Revisions of lower blepharoplasties need to be handled carefully.  You may benefit from a skin-muscle flap where these two layers are lifted up and laterally together to tighten this area.  Again that needs to be performed by experienced hands and you may need additonal procedures such as a canthopexy and tarsal strip.  This is all speculative on my part so don't worry too much.  Just follow up with your surgeon and get a few opinions with Facial Plastic Surgeons or Oculoplastic surgeons.
Chaser Lay, MD

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 71 reviews


Thank you for your photos. 7 months after a blepharoplasty without complications is enough time to see final results. From the photos, you may need a revisional surgery to remove a small amount of skin from the top and to smooth out any fat irregularilities in the lower lid, but it is best to have an in-person examination to determine exactly what is the issue and what can be done. Energy-based skin tightening procedures can be risky on the lower eyelid and may not always be the best step after a previous lower eyelid procedure. It is important to find a plastic surgeon who you can trust and feel confident in, but you should feel comfortable to openly communicate with your current physician and explain how you feel.  Hope this helps!

Johnson C. Lee, MD Plastic Surgery

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 12 reviews

What to do after lower eyelid blepharoplasty result?

Removing lower eyelid skin is always a risky endeavor. It may seem like you have extra lower eyelid skin but in reality, most people do not. It never hurts to get a second opinion, but I would listen to your surgeon about the limits of further skin removal.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 11 reviews

Revision blepharoplasty procedure

Since it has been seven months after your eyelid procedure,  the majority of healing has occurred and this should be a permanent result. From the very limited photographs it appears that there is residual skin and fat in both the upper and lower lids. In our practice we do not recommend a fat transfer procedure. Make an appointment with three busy eyelid surgeons in your area for second opinions

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews


Yes, I think you could easily have more skin removed from the upper lids.  But it always is better to have less skin removed them too much. Going back and taking a little more skin out should be a very simple process with local anesthetic. The under eye problem is of more concern. It is not usually a good idea to do Fat Grafting  in that area because it is so unpredictable and how it shows. He will probably need to open up the skin and go back and take out the fat graft, a very tedious process. If you have a board-certified plastic surgeon, he should be able to do that. If you did not,  then you need to find one. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

I think your surgeon is concerned about making you worse.

My father likes to say "when the butcher tells you the meat is bad, you should listen."  I think this surgeon is worried about damaging the eyelid position or making the lower eyelid contour worse.  You did not share a before picture so we do not know where you started.  I do not think there is any harm in getting second opinions regarding what is going on with your eyelid and what others think are your best options now.  I recommend against rushing into these services.  I would be very careful with the Thermismooth on the lower eyelids.  While some report good results with this treatment, there are also troubling reports of issues with this treatment.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews


Thank you for your question. It is difficult to determine a concrete timetable for how much longer you will need to heal. Each patient and their recovery process is unique, however, you should be able to notice improvement by the 7 months mark.Is your surgeon board certified? My recommendation is for you to complete your healing process and then determine if you want to revisit the procedure, at which point you should consult with a few different board certified facial plastic surgeons in your area. Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 93 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.