I'm concerned about the wrinkles around my eyes after upper and lower blepharoplasty and face lift. Need help understanding?

Question

Hello in July 2018 I had both upper and lower blepharolasty and facelift. The wrinkles around my eyes is dominant....especially when I smile. I'm really disappointed. After spending thousands I feel no better about my appearance. I hate to spend more money to go under the knife. Debating if I should do skin surfacing but not sure what type (there seems to be many), the cost and how long the results may last. I'm open to any ideas so feel free to express your thoughts.

Alexander Anzarut, MD · Answer

I agree with the other responses provide. 
Communication and understanding expectations is always important. 
Wrinkles around the eyes due to facial expression is not something that is generally treated surgically. This is something that can be improved with Botox. Removal of excess skin with surgery will lead to upper eyelid lagophthalmous (inability to close the eyes) or ectropion (deformity of the lower eyelid with tearing). If your surgeon did a low or standard SMAS flap / plication you may have a slight alteration known as a smile block. This is a normal side effect of a these types of procedures. 
Overall your result looks good. Your concerns seem to be related to expression lines which can be treated with Botox. Talk to your surgeon and let them help you to achieve the result you are aiming for.

Best wishes,

Alexander Anzarut

Sibel Atalay, MD · Answer

The upper and lower eyelid surgeries do not affect the wrinkles around the eyes. Botox and Thread Lift treatments are more suitable to get rid of wrinkles around the eyes.

Scott Trimas, MD · Answer

It is a common misconception that upper and lower eyelid surgery, that is blepharoplasty, will remove wrinkles. It actually can make them appear worse since the fat is removed and the skin can actually wrinkle easier. The purpose of upper eyelid surgery and lower lid surgery is to remove excess skin and fat, not to treat wrinkles. That being said, I would suggest starting with botox to make sure you like the effect of wrinkle minimization with smiling. Alternatively and at a later date a skin resurfacing with the CO2 laser is likely to be your best option to resurface and improve the lower lid wrinkles and the crows feet area.

Michael I. Echavez, MD · Answer

Since the lines that you see beside your eyes when you smile are due to muscle contraction, Botox would produce the best improvement for your issue.  It appears that you have minimal lines, if any, when your face is not animated.

Don W. Griffin, MD · Answer

These types of wrinkles around the eyes are caused by contraction of your eyelid muscles when you smile. No type of surgical correction can make these go away. They can be softened by using temporary muscle weakening with neuromodulators like Botox, Dysport or Xeomin. Resurfacing alone will not eliminate these lines, but if used after repeated, regular use of neuromodulators, it will soften them to some degree.

Brian K. Machida, MD, FACS · Answer

Your surgical result appears to be reasonable at rest.  As a matter of fact, all surgeries are done with the person at rest and not animating.  These are dynamic muscle lines accentuated by muscle movement.  When you smile and animate, the tendency to have these lines will always be present.  Think about it this way.  If I didn't like the way my elbow wrinkled with it extended and wanted all that "excess skin" removed surgically with it extended, what would happen when I try to flex my elbow.  Likewise, if you were able convince a doctor to remove those dynamic wrinkles surgically by pulling tighter, how would the result look when the face is relaxed.  You might want to try botox first and then if the wrinkles are still not to your liking, then resurfacing.  Otherwise, it looks like your result at rest is reasonable.

Robert M. Tornambe, MD · Answer

homerunpark.  I appreciate your concern, however your overall result is quite reasonable and any attempt to surgically correct your “smile lines “around your eyes would result in a very unnatural appearance. It appears that Botox would be the perfect solution for the crows feet wrinkles causing your concern. Follow up with your plastic surgeon and request advice about Botox for that region. Good luck.

John J. Martin, Jr., MD · Answer

Your result looks pretty good.  Unfortunately when you smile, you still have some significant wrinkling around the eyes.  This can be improved with some resurfacing and some botox.  You have fair skin and blue eyes, so should be a good candidate for the resurfacing.  You also have a very low brow.  This will allow the skin to bunch up more in the crow's feet area when you smile.  Can't tell from your picture if you have hair, but a forehead lift or at least a temporal brow lift would also help with those wrinkles.

Philip S. Schoenfeld, MD, FACS · Answer

Pre operative photos would also be helpful to assess the work that was performed.  When I counsel patients prior to surgery I discuss the difference between skin quantity and skin quality.  Your facelift and blepharoplasties are able to address skin quantity.  The wrinkling that you are seeing with smiling is due to skin quality and loss of skin elasticity which results from sun exposure, smoking, alcohol, age, etc.  Fair skin individuals progress faster than more pigmented individuals.  To address these periorbital wrinkles you see when smiling you will need skin resurfacing and Botox/Dysport.

Michael Zenn, MD · Answer

Those wrinkles are caused by the underlying muscles (orbicularis) that help close your eyes.  Botox can paralyze the parts of the muscle that cause that and still allow the eyes to close properly.  These muscles can also directly be removed during a facelift, though this was not done in your case.  Removing more skin is not the answer.  When you are not smiling, there are no wrinkles and no extra skin and the eyelids are already being pulled down slightly.  More skin removal would compound this.  Try botox with your surgeon's office and consider it a continuing investment in your youthful appearance.Dr. Zenn

I'm concerned about the wrinkles around my eyes after upper and lower blepharoplasty and face lift. Need help understanding?

Answers (11)

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