Extra Baggy Skin After Blepharoplasty (photo)

Question

I'm in tears every day due to a Blepharoplasty surgery and Laser Resurfacing. I am only 36 and looking back, there was nothing wrong with my eyes. Now I do. I have extra baggy skin, extra folding sunken eyes, and wrinkles which I never had before and not sure how to repair this. I probably should never had the surgery in the first place. My eyes were fine. It's not even a year later and now I have a huge problem. What can be done about this?

Sanjay Grover, MD, FACS · Answer

I prefer to use an external incision on many of my blepharoplasty patients to address the fat (excision or redraping), along with muscle tightening, skin removal and canthal tightening. You may need to have the skin/muscle addressed at this point and should seek further consultation.

James Chan, MD · Answer

Without knowing the full details of your preoperative condition, and what surgery was performed, it is difficult to comment on what can be done to improve the situation. My advice is to talk to your surgeon and develop a plan that meets your needs. You can also get another opinion from a specialist in this area.

David Shafer, MD, FACS · Answer

Based on your picture, it looks like you need skin tightening. This can be accomplished with a chemical peel, laser resurfacing, or skin resection. You just have to be careful the the tension of your lower lid is sufficient, since multiple lower lid procedures may cause the lid to pull away from the eyeball if a canthopexy (tightening stitch) is not used.

Frank P. Fechner, MD · Answer

I assume that you had a transconjunctival blepharoplasty (performed through the inside of the eyes). You had already laser resurfacing. Therefore, options to consider now include additional skin removal through a incision just beneath the lash line. Volume enhancement with fat transfer (or injectable fillers) can improve the sunken aspect.
I hope this helps.

Hisham Seify, MD, PhD, FACS · Answer

A full contact Blepharoplasty with muscle and skin redraping will address this issue for the long term. Laser could have a role but since it did not work for you it is better to try surgery.

Kamran Khoobehi, MD · Answer

You have after pictures that shows sunken upper eyelid and extra skin over the lower lid. you may had too much fat taken from upper lid and not enough skin taken from lower eyelid. I believe you had tranconjunctival blepharoplasty and laser resurfacing. This a very common problem from this combination. You may want to get a consultation from a board certified plastic surgeon that does redo.

Scott E. Kasden, MD, FACS · Answer

I see the skin problem, but on this view, I can't fully appreciate the sunken eye situation (I see it in the upper lids).
Let's talk about the skin first. I am not sure why you have the excess after the laser and the blepharoplasty. Some less invasive things to try to smooth the wrinkles would be Kinerase, which you can get over the internet, and apply 2X/day. It will give some improvement as long as you use it.  You may also want to try to get a chemical peel like a Vipeel or some other type (TCA, glycolic, etc.).
Ultimately, it looks like the excess skin should be surgically corrected, and if there is still some crepy skin after healing, try the above, or if needed, laser. I know you don't want to hear this, but at least I feel that this problem is treatable.
The hollowing of the upper lids is due to the removal of fat during the blepharoplasty. This is a harder situation to treat. Sometimes this can be corrected by going in and puling the remaining fat forward to fill in the void. A fat transfer may also be helpful.
Whatever you decide to do at this point, be sure to use a very experienced surgeon who feels comfortable doing secondary blepharoplasty with these cosmetic issues.

George J. Beraka, MD (retired) · Answer

Hi!  I think I may have answered a question for you already?
From your picture, I think you need lower lid skin removal WITH a canthopexy to prevent the lids from falling.  You could probably also use fat injections at the same time.
I don't think injecting fillers will make you happy. At any rate, definitely do not use Perlane. Restylane (in very small amounts)  is more forgiving in this tricky area, if you want to try a filler.

Brooke R. Seckel, MD, FACS (retired) · Answer

Intears,
I am sorry to hear of your situation. Skin excision to remove the excess skin might help, but an open blepharoplasty a second time would risk weakening the support of the lower eyelid and could create a "sad eyed look", thus I would avoid any additional incision on the eyelid.
My approach would be to use a laser incision on the inside of the lower eyelid-the transconjunctival approach, and harvest fat from around the belly button to use as a graft to plump the lower portion of the eyelid. I would do an arcus release which would allow the graft to be placed beneath the very lowest portion of the eyelid, on the cheek bone. This would plump the depression or hollow and fill some of the loose skin which is in folds along the lower portion of the lower eyelid.
I would also do additional fractional laser skin resurfacing to tighten the skin. I would use the ablative 2940 fractional laser which will improve wrinkles, tighten the skin and improve skin texture, unlike old time CO2 laser resurfacing.
You can see a before and after picture of this procedure.

Extra Baggy Skin After Blepharoplasty (photo)

Answers (9)

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