Why is my eyelid uneven 10 months post-op blepharoplasty? (photos)

Question

I had an upper and lower blepharoplasty with a brow lift 10 months ago. The lid of my right eye now has a peak or high point, and the outside of the lid seems droopy. Prior to surgery, the lid was a normal, symmetrical semicircle without any peak. I feel a slight pressure at the crease. When the eye is closed, a couple bumps are visible where the incision was made. My surgeon is unconcerned and said my eyes 'look great'. I disagree. Should I get a second opinion or will this resolve itself?

Kenneth D. Steinsapir, MD · Answer

It sounds like your surgeon is gaslighting you. This is not great. You do have a peak which is also called an A-frame deformity. The sulcus is hollow, the crease is high. The skin on the eyelid platform is not controlled and is crepey. The upper eyelid lashes are not supported and are droopy. This is called the Post Upper Blepharoplasty Syndrome PUBS. I am giving you a link to an article on this topic. The lateral canthus is disinserted allowing the eye to look more round than almond. The lateral position of the lower eyelid appears somewhat compromised. This can contribute to dry eye symptoms. I have developed techniques to reconstruct the upper eyelid fold. The success of these methods do depend on what sort of resources have been left in the eyelid after the prior eyelid surgery. There is no substitute for a detailed in person assessment to determine what resources are likely left in the eyelid so you know what to expect from aesthetic reconstructive eyelid surgery. Your eyes can still be your best feature.

David Mattos, MD · Answer

this is very hard without comparing it to preop photos also. Both the lid position and the peak that you're describing need to be closely compared to the preop photo first. Things that can cause your crease to have a peak is if there is an area where a bit more fat was removed from the orbit, which can leave a peak behind. Was any work done on the levator for tightening of the lids? I assume not, but that would also impact the outcome. These would all be things to discuss with your surgeon. At 10 months out the result is pretty final. If you're dissatisfied with your surgeon's explanation, then seek another plastic surgeon to evaluate you up close to see what can be done. Sometimes some grafting is in order to soften any peaks or divots. Good luck!

Sergey Y. Turin, MD · Answer

You have an excellent example of something called an A-frame deformity - this is something that can be quite common unfortunately, and was a popular 'look' a couple decades ago. The issue is lack of volume underneath the brow (where the 'peak' is) - this is caused by excessive skin resection or fat excision in the area. Correction can be done with fat grafting that site and you may be able to achieve a good result with that. If you think intuitively that putting fat there in unattractive, consider looking at some photos of celebrities like angelina jolie when they were younger vs now - you'll see the upper lid is full and youthful, not hollowed out. This is a concept that has only been talked about for the last couple of years, so not every surgeon is yet a believer. I'll post a link to some before and after results below and you can see that leaving some fat behind is important for a very natural, aesthetic result

Why is my eyelid uneven 10 months post-op blepharoplasty? (photos)

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Everything you need to know about Eyelid Surgery

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Why is my eyelid uneven 10 months post-op blepharoplasty? (photos)

Answers (3)

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.