I am 62, and have had lower Blepharoplasty 10 years ago. Now, my under eyes are sunken and the skin has a crepey appearance? What can be done for these?
Crepey Skin and Hollow Eyes After Blepharoplasty
Doctor Answers 32
Correcting Hollow eyes post over aggressive blepharoplaty
The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.
Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery - it just looks youthful.
Lower Blepharoplasty volume loss
There have been changes in the way surgeons perform lower blepharoplasty. The general trend in lower blepharoplasty is toward conservation of the lower eyelid skin, preservation of lower orbital fat, avoiding tension on the lower lid, performing a canthopexy or canthoplasty, and filling the tear-trough depression. It sounds like your surgeon removed too much orbital fat, which along with the normal volume loss with age has contributed to the depression below your eyes.
I would recommend a two stage approach. First, start with fat grafting to correct the lower orbital and tear trough volume loss. Second, once volume loss is corrected, determine the degree of skin tightening required and perform laser resurfacing of the loose skin as needed.
Composite fat grafting to plump the hollow eye and fractional laser resurfacing to remove wrinkles
The hollowness or sunken area occurs because fat was removed during your blepharoplasty and during the past 10 years, the cheek fat pad has descended lower in the face.
As our faces age, depressions and a hollow look below the eyes is very common. The crepiness of the skin is caused by skin aging, which thins the skin and repeated motion of the eyelid muscle beneath the skin, which causes the eyelid skin to form wrinkles.
Excellent results and improvement in the sunken look or hollow eye appearance can be achieved with a procedure called the transconjunctival arcus release and fat grafting. In this procedure a small opening is made with the laser on the inside pink part of your lower eyelid. A small piece of fat is taken from around your belly button and placed or grafted into the sunken or hollow area beneath the lower eyelid. Results can be excellent (see before and after photos).
The patient above also had fractional laser resurfacing to remove the crepiness of the lower eyelid skin.
DO NOT have filler injections or fat injections beneath the lower eyes. They are risky, frequently leave lumps and bumps and permanent discoloration.
The procedure I mentioned earlier places your own fat into the proper location under direct vision.
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Crepy eyelid skin after lower blepharoplasty
Crepy eyelid skin after lower blepharoplasty can occur many years after a primary blepharoplasty procedure. This is often the result in the loss of elasticity in the lower eyelid skin with the aging process exacerbated by a previous surgery. Often a chemical peel or CO2 laser can improve that appearance. I would not recommend any additional lower eyelid skin removal since it can result in a pulled down eyelid appearance or create rounding to the lower eyelid area. As far as the hollowed appearance, too much fat removal could be the culprit or loss of inframalar fat can exacerbate the problem. One possible remedy is hyaluronic acid augmentation to the tear trough regions. Another is fat transposition especially if you have any left in the lower eyelids in another area of the lower eyelid region.
Lower blepharoplasty usually causes sunken appearance
Lower eyelid blepharoplasty entails fat removal and skin removal from the lower eyelids. This is part of the reductive philosophy that has dominated surgeons, and plastic surgeons.
An analogy is that of a grape when it loses its volume and turns into a raisin. Based on traditional approaches, a plastic surgeon would take that raisin and remove the skin of the raisin to make it into really just a smaller grape. But based on this analogy, the smaller grape would not look like the grape that it used to. This same idea applies to a person's face.
A person loses volume as they age. When people have their tissues taken in a reductive manner, they will no longer look the same as they did when they were young. The youthful face looks the way it does because of that volume. A person may look a little better after these reductive type of procedures such as lower eyelid blepharoplasty, but not necessarily better in a younger and natural way.
Volumizing a persons face and turning the face from a raisin back into a more youthful looking grape is the most natural way of making a person look younger in a natural way. What you can do for the sunken appearance is to bring back the volume. Fat injections is the most natural substance to use, and when applied to the lower eyelid and cheek, this procedure can make a person look a lot more natural and younger than lower blepharoplasty.
I would always recommend consulting a facial plastic and reconstructive surgeon. We specialize in the face and are the ideally the best to take care of any plastic surgery issues in the face and neck area.
Hollowness after lower blepharoplasty 10 years ago
Crepey Skin and Hollow Eyes After Blepharoplasty
- Plastic surgery, like all science, evolves over time. It was once thought that removing more skin and fat was better.
- We now know that we lose tissue volume as we age, so it is imperative to create an aesthetic change while preserving volume.
- Modern blepharoplasty techniques try to reposition fat or minimize tissue resection so that the result is longlasting.
- Having said that, we cannot reverse the aging process (yet!). So even after surgery, you will continue to age, but will often times look better than you would have had you not had surgery.
Removing a small amount of skin and fat injections
The crepey skin on the lower lids can be excised through a subciliary incision and a small amount of skin can be pinched and removed so as to conservatively help with the wrinkles. This is usually glued with Histocryl tissue adhesive. Any hollowing under the eyes can be addressed with fat injections into the orbit to give more fullness.
Crepey skin and volume loss after Blepharoplasty
There are so many factors that contribute to the appearance you describe but generally they are associated with loss of facial fat and skin elasticity with time and environmental damage.
You may want to contemplate using injectable fillers to "try out" the appearance of a fuller lower eyelid. If you like them, you could consider a long term solution such as fat injection, open fat repositioning/grafting, or cheek lift with SOOF or malar fat pad suspension.
The aging of skin is difficult to reverse but can be the result of many factors. Retinoids may be useful in thickening the skin. Discoloration or superficial wrinkles may benefit from peels or laser fractional resurfacing. We are somewhat reluctant to remove more skin unless the lower eyelid is supported; this can result in a surgical appearing lower eyelid.
Time for another repair or maintenance procedure
Ten years ago, the standard blepharoplasty involved elevating the skin and muscle layer of the lower eyelids and removing the excess fat. At that point it was considered the correct operation. With the passage of time and improved understanding of the aging process we have come to believe that the fat of the face is a precious commodity and should not be removed in all cases. It can look good initially but with time and aging, the upper face and orbital areas become skeletonized. There is a loss of the smooth transition between the cheek and the lower eyelids.
As the cheek descends, it drags the lower eyelid with it, resulting in an ovalization of the eye. To combat these signs of aging, we currently try to preserve the fat, re-positioning it either back around the eye where it came from or re-drape it over the bony orbit. You can expect most facial rejuvenation procedures to last 7 - 10 years. It sound that as you have aged your eyes have become a bit sunken and some of the loose skin has recurred. Depending upon your exam there may be several options including a re-draping of your skin and a suspension of the muscle around your eye.
Other options may include fat grafting or even a tear trough implant. An evaluation by a competent plastic surgeon would help to put you on the path toward rejuvenation. maintenance procedure