46, male. Lower bleph left skin flaps. What are the best next steps? (Photos)

Question

In January 2026, I had a transconjunctival lower blepharoplasty. I adhered to post-op procedures well, and to this day still sleep slightly elevated to reduce inflammation. The results gave improvement, but there are still skin flaps rather than the taut under-eye look I expected. The surgeon has been gracious and said he agrees the results are not what we wanted. He has suggested, as a next step, an Eco2+ laser treatment under the eyes, which he would do for free, to see if that will tighten up the skin under my eyes. Is that a meaningful next step? Is there going to be some other surgical intervention needed? I'm a 46 y/o male.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos without the benefit of a physical examination, I see that you have residual and excess skin. A laser treatment on the skin will not correct the issue fully. You will need to have lower eyelid surgery. I would not approach this from a transconjunctival approach (those tissue planes are scarred). This would involve an incision under your lashes since redundant skin needs to be removed and the residual fat pocket removal or repositioning can be done from this approach. See a board certified plastic surgeon, facial plastic surgeon or an oculoplastic plastic surgeon for an in person consultation/evaluation. Good luck.

William Portuese, MD · Answer

From these photographs, you continue to have significant residual fat deposits that were not addressed in your original procedure. Each lower lid has three compartments of fat, which are removed from a trans conjunctival approach on the inside of the lower lids. If you have any access skin than a small pinch of excess skin is made on the external approach directly below the eyelash line.

Lawrence Kass, MD · Answer

I don't disagree with the other doctor who replied. Certainly you have residual skin after the transconjunctival lower blephs. But it seems pretty likely to me that the fat removal and repositioning was too conservative and that you are undercorrect ed. I don't think that a laser alone will make you happy.  Best see an oculofacial plastic surgeon, unless your own doctor will make it right for you.

Julian De Silva, MD · Answer

Hi, thank you for your question, and for describing it so fairly. A transconjunctival blepharoplasty works on the fat compartments from inside the eyelid. It deliberately does not remove any skin, so when the fat is addressed, some patients are left with the loose skin now more visible. That is what your photos and description suggest, and it does not mean the operation was done badly. It sounds as though you have a thoughtful surgeon who is being honest with you, which is worth a great deal. Laser resurfacing is a genuinely meaningful next step for mild skin laxity, and at eight months post-op the timing is reasonable. It tightens skin modestly, so keep expectations proportionate. If the excess is beyond what laser can address, the surgical option is usually a conservative skin-pinch excision just below the lash line, a smaller procedure than your original surgery. In my oculoplastic practice I would want to examine lid tone and skin quality in person before choosing between them. Stay with the conversation you have. It sounds like a good one.

46, male. Lower bleph left skin flaps. What are the best next steps? (Photos)

Answers (4)

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