Several Concerns After Transcutaneous Lower Blepharoplasty (One Month Ago)

I strongly agree with Dr Steinsaper.  We routinely see this type of complication, but what is really scary is that often the primary surgeon does not acknowledge or recognize it and considers this normal healing.  It is wrong to call out a particular group of surgeons as we have seen a blatant disregard for the functional anatomy of the lower eyelid from every subspecialty including oculoplastic surgeons.

A properly performed transconjunctival blepharoplasty (approaching the fat through the inferior retractors rather than through the orbicularis occuli) eliminates the potential for this complication.

It is important for a surgeon who has experience treating this complication, known as middle lamella syndrome to work with you.  If there is a palpable scar contraction that is contributing to the lower lid malposition, it needs to be released.  The lower lid can be supported in a more normal position while the orbicularis oculi recovers using restylane injections.

Finally you can help others by spreading the word that patients need to have serious conversations with their surgeons about potential risks and benefits of all cosmetic surgeries, but particularly lower eyelid surgery.

You have a valid concern and problem after surgery and should work with your surgeon to resolve the issue. You do not state whether your surgeon acknowledges that their is a problem. If he/she does not, ask for a referral to a colleague for a second opinion. Once they acknowledge the problem or you get them to do so you need to know the contributing factors (skin deficiency, muscle weakness, swelling and/or scar formation) and a treatment plan (massage, passage of time, temporary traction suture) to resolve the issue - stop it from getting worse. It is too early in the healing process for any revision surgery.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Lower eyelid bags are the result of loss of support at the junction between cheek skin and lower eyelid skin.

When you remove fat, muscle or skin it can aggravate the problem or make the space under the eye look hollow.

The best answer if your eyelid does not correct after 3-4 months is to add back the support at the cheek with fat injections. This will both push up the lower eyelid margin and give you a more youthful look. A lateral canthoplasty may distort your eyelid shape and I don't like doing it for that reason.