Crepey Skin and Hollow Eyes After Blepharoplasty

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.

Laser or chemical resurfacing can be done to improve the skin quality and adding volume (fat transfer is my preference) can improve the hollowness. 

We as a surgical community have learned a lot. We used to remove the fat under the eyes. Now most of us are transferring the fat or using it in other locations as apposed to removing it. We have made this change because of patients just like yourself. They looked good right after the procedure but then down the road we noticed a hollowed appearance. You have a couple options to treat this. The number one treatment for this issue in my hands is fat transfer. It does wonders in this area. I have many patients that have benefited from post bleph fat transfer. I attached a video discussing some pros and cons. For the "crepe" skin a laser or possible revision blepharoplasty with muscle suspension is your best bet. This would have to be determined after a good facial analysis and physical exam. Hope this helps.Best of luck,DrC

It's not unusual for patients to develop redundant lower eyelid skin with bulging fat pads during the normal aging process. When this situation arises, a large variety of surgical options exist to treat this condition. Many of these procedures involve removal of fat from the lower eyelids.Unfortunately, normal aging can also cause atrophy of the lower eyelid fat pads. In someone who has already undergone removal of fat during blepharoplasty surgery, this deformity can be accentuated resulting in a hollow look with crepey skin.When this situation arises, treatment usually involves the use of fat grafting. Injectable fillers can also be utilized to treat hollow areas beneath the eyes, but this treatment only provides a temporary solution to the problem. Crepey skin usually requires re-operative surgery or skin re-surfacing to address the problem. The exact procedure will depend entirely upon the physical examination.When this scenario arises, it's appropriate to consult a board certified plastic surgeon. This surgeon should be able to formulate a treatment plan that addresses your physical findings and aesthetic goals.

Blepharoplasty is often considered the removal of fat or skin from the eyelids. These days, more eyelid specialists are trying to preserve skin and fat while shifting the fat downward towards the cheek. It is best to be conservative, because the eyes will look natural. Enhancements are easier to perform on an under-corrected eyelid procedure compared to an over-corrected lid. If too much fat is excised, fat from another part of the body can be grafted in or fillers may be injected. 

In years past we removed the fat pads when
doing lower eyelid surgery that can leave a hollow “nursing home eye” look. In my practice, we are conservative and don’t
remove much fat, we transpose it. This
leads to a smooth and not “sunken” look.
If you had lower eyelid surgery 10 year ago, it is possible your fat
pads were removed, which was normal for that time period. You may be a candidate for fat grafting or fillers
to that area to camouflage the hollowness.
Without seeing you it is hard to tell and re-doing a lower
blepharoplasty does have its risks.
Make sure you are going to a board certified plastic surgeon with
experience in re-do lower eyelids and fat grafting techniques for best results.