47 year old, 9 months post upper/lower bleph with fat transfer. Not feeling good about the way things are settling. (Photo)

I had upper/lower bleph w/fat transfer 9 months ago. I was unhappy with my uppers but I am happy after a revision. But at 9 months the lowers are settling strangely. I like my doc but she is very conservative which is great and I certainly want to look natural. Still, I can't imagine this aging well and wondering about options. Is this the best I can expect from lower bleph? What are options to tighten up the lower lids? I now have a sag below where my tear trough deformity was before surgery.

Doctor Answers 8

The challenge is that you are ridgy after lower eyelid fat transfer.

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I seen 2 to 3 new consults each week for individuals who had lower eyelid fat transfer and they are unhappy with the result.  Simply, in my opinion, surgeons overestimate their ability to control this surgery.  Fat causes scars that damage the glide function of the lower eyelid/midface layers.  The photos you have provided are not ideal because you are not looking straight ahead which allows one to judge the position of the eyelids.  I suspect that you have residual ptosis in the left upper eyelid with a compensatory brow elevation.  the lower eyelids look harsh and ridges from fat or scar tissue prevent the lower eyelid from looking serene.  Yes, brilliantly performed hyaluronic acid filler can be used to smooth in the eyelids.  Finding someone to sculpt the eyelid will fillers is very challenging even in a city as large as Chicago.  Surgeons can promise you the stars, the moon, and the sky.  The real question is can it be delivered or will the result make you look tired and older rather that better and fresher?  Consider down loading my free ebook cited below which talks a lot about fixing damaged eyelids.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Unhappy after fat transfer to lower lids

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Thanks for your question and photos. I think at this point you are lose to your final result. If you are still unhappy after 1 year of healing, then I would recommend speaking with your PS about your options. It may be as simple as resecting some of the transplanted fat under local anesthesia in the office. The problem with fat transfer is the variable rate of fat survival which makes getting symmetry under the extremely thin eyelid skin, very tough. You can use fillers to help disguise the tear troughs that you have but this is a temporary solution to a permanent problem. I would favor a small amt. of fat resection which is much more predictable. Your upper lids look great!! Best of luck!

Options after upper lower bleph

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Overall, I think your upper lids look great. You do have some visible irregularities of your lower lids, but I don't see where you have any pulling or ectropion, which is good news. The irregularities may be able to be camouflaged with some HA filler. I'd discuss this with your surgeon. If the irregularities persist after a year, I'd consider revision surgery.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Lower lid blephs with fat grafting - options to make you more thrilled

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HI Zolie,

Thank you for the question and images.  It would be best to see you for photos where you are not looking up.  It is hard to assess your current issues with these images.

In short your PS has provided a good skin resection and you are not overly tight.  This is ideal as I see many patients from other PS in my area where those PS have over-resected the skin.  This is a serious issue for those patients.

It appears that you may have a little excessive fat in the central fat compartments - your PS can resect this fat with a TC blepharoplasty. This is a very straight forward procedure and take a few minutes under local if it is needed.   

The residual skin changes / fine lines / etc. can be easily addressed with technology (RF treatments) or PRP treatments.  PRP, when done properly can treat residual fine lines, pigmentation changes and also improve the skin quality in the lower lid.  Seek out a physician that has extensive experience with facial aesthetics if your PS isn't able to provide these options and you want further improvement.

I hope this is helpful,

All the best,

Scott Barr, MD, FRCSC, Plastic Surgeon

Scott Barr, MD
Sudbury Plastic Surgeon

47 year old, 9 months post upper/lower bleph with fat transfer. Not feeling good about the way things are settling.

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I might offer HA filler micro injections to lowers to try to smooth out?>>>>>>>>>>>>>>>>>>>>>

Concerns post blepharoplasty

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It appears that you had a conservative blepharoplasty, which is far better than an aggressive one. You appear to have a small amount of fat in the lower lids that can be removed, but there are other options. I would recommend you return to your surgeon to discuss your concerns.

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

Residual puffiness post blepharoplasty

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 Thank you for sharing your questions and posting your photographs. Your doctor performed a conservative blepharoplasty which is far better than being aggressive. There is a mild to moderate degree of residual fat bulging in the lower eyelids. It may or may not be worth having revision performed. You should discuss this with your surgeon. Keep in mind, sometimes going after perfection leads to problems. Good luck.

Post Blepharoplasty/Fat transfer Concerns.

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Thank you for your question. Your issues are not uncommon. By 1 year, your appearance is likely the end result. Continue  massaging laterally towards your temples, ( lymphatic drainage).
The resorption of a portion of the deployed fat is not predictable, one of the downsides to fat transfer.
Communicate your feelings to your surgeon. You are still a walking example of their work. I am sure a solution will be offered.
Best wishes.

Greg Chernoff, MD
Indianapolis Facial Plastic Surgeon
4.7 out of 5 stars 32 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.