Eyelids heavy and uneven 4 months after upper bleph/brow lift surgery. Should I consider a revision? (photos)

Question

I had an upper bleph and endoscopic brow lift 4 months ago and I feel like my eyelids are still heavy and appear uneven. I had to move back hometown a month ago to help my mother who is sick and I am wondering if I need to fly back home to discuss a revision. I'm not sure I my results are expected (I know surgery isn't 100%) or if I should discuss with the surgeon. Before and after photos below, thank you.

Kenneth D. Steinsapir, MD · Answer

I seriously doubt that they will understand what they have done to your eyes. That makes if very hard for them to fix the issues. It was improbably that you needed a forehead lift. It is also clear that the surgery can caused post-surgical changes that are not helping you. First it should be noted that your after photo is terribly lit. That lighting would make even the best result look less than idea. That issue aside, in the after picture, the lateral canthal angles are disinserted from their position in the before picture. The effect is that the eyes look much more round. Also the support for the upper eyelid lashes has been harmed by surgery. Now the lateral eyelashes hang and are not helping your appearance. When the lateral canthal position is repaired, it will make another issue more evident. It is likely you now have partial levator disinsertion of the levator aponeurosis tendon that raises the upper eyelid. That means that your eyelids would be slightly heavy if the canthal angles are restored to their presurgical location which will be needed to restore the almond eye shape. The upper eyelid fold have been shortened by the blepharoplasty and crease lowering and fold reconstruction would soften this effect. The brow lift was very modest in its effects and the eyebrows are actually now lower than they were in the before picture. Generally I recommend waiting 6 months before performing revisional eyelid surgery. At 4 months, little will change at this point and it is reasonable to consider revisional surgery. You eyes can still be your best feature.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! Sorry that you're having trouble with your result. I think a discussion with your prior surgeon - if you're comfortable - is certainly merited. If not, seeking consultation with another would be appropriate - even virtually to discuss a possible revision. At 4 months, we would expect a vast majority of the swelling and settling to have occurred. I appreciate the photos and can see what you're talking about. Hope this is useful for you!

Camille Cash, MD · Answer

The before and after photos show a conservative improvement to the eyes.  I encourage you to discuss your concerns with your surgeon.  If further correction is desired, surgical intervention will be needed.  At four months post op there are only minimal changes if any that would be expected going forward.

Darryl J. Blinski, MD · Answer

Posted photos demonstrate a moderate improvement. If you desire more open upper lid only revision can offer that. Best to see your initial surgeon to see if he/she will even consider revision at this time. Fees fro revision from $4,000.

Eyelids heavy and uneven 4 months after upper bleph/brow lift surgery. Should I consider a revision? (photos)

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