Too Much Fat Removed During Lower Bleph - What Options Do I Have Now?

I read your concerns and reviewed your photos. You look better than you think. Your "scleral show" on your left is barely perceptible. And your lower lids do not have a hollow, operated appearance. If I had to guess, you're either using Latisse, or you're blessed with long, thick eyelashes. I don't think you should consider any further eyelid surgery.

You appear to have typical lower eyelid grooves which could be improved by a well performed Injectable Filler treatment. You should make sure your physician is experienced in the delicate art of filling lower eyelids. My personal preference is to use Silikon-1000, an off-label filler, for permanent results.

I hope this is helpful for you.

When you are smiling in the right-most photo the scleral show is not visible.  In the photos on the left, there is about 1mm of scleral show.  You could try gentle upward massage of the lower eyelid to try to lengthen the tissues.  I would recommend conservative Restylane in the periocular hollows to revolumize and Botox for dynamic wrinkles by an Oculoplastic surgeon or someone experienced with injectables in this area.  I would only use a hyaluronic acid based filler, not a permanent filler, because you can reverse it if needed.  No surgery is indicated at this point.  Less is more. 

Based on some studies with trans malar repositioning of the orbicularis we notice improvement in lower lid position with a "undermining" of the orbicularis occulis during a microfat grafting procedures.  This will release the attachments of the lid and allow it to be raised by inflation.  This works well in patients with more scleral show than you manifest.  I agree canthoplasty surgery will probably not be high on the list of choices.

Hi 2426anon in NJ,

Thank you for the question and providing photographs. First, it's very difficult to provide more specific answers without a comprehensive in-person evaluation. Generally, facial asymmetry is very common, in fact considered normal. Based on your photographs, your brow, upper eyelid, eyeball, and inner eye asymmetry  suggests that the lower eyelid may have been asymmetric at baseline. In addition, plastic surgery treatment cannot reliably improve these small asymetries.

Lastly, fat removal alone generally does not affect eyelid position. Rather, excess skin removal or scarring may pull the eyelid downward. Infections may not lift the eyelid upward reliably. Further facial surgery may be required. However, after 3 lower eyelid surgeries by eyelid specialists, it may better to stop further surgery all together. Best of luck.

Dr. Chaboki

You made a couple of comments that require some clarification for other readers.

1.  Putting fat back into the lid will not make a malpositioned lower lid go back up.

2.  Lid malposition & scleral show is not caused by taking the fat out.  It is caused by a shortening (usually from scar) of one of the 3 layers ("lamella") of the lower lid.

 

Correction of this problem gets complicated and technical- more than this forum can do.  Your photos actually look pretty good - I don't see any scleral show in them.  At this point, consider just a little HA in the lid - but avoid further surgery unless there is a really good indication.

 

All the best,

First of all, I agree that you should not have another surgical procedure.  If anything, have an HA (Resytlane or Juvederm) injected - and only small amounts.  Second of all, it is impossible to evaluate your before and after since you are unanimated in the before pictures and smiling in the after pictures.  When you smile, your cheek is naturally going to raise and cause some wrinkling in your lower lids.

 

Good Luck.

Too much fat removal and scleral show after multiple blepharoplasties. You will do better by seeing a good eye surgeon for only Restalyne at this point--no more surgery.

Dear Anon

From the before photo, you most likely could have avoided surgery by having hyaluronic acid filler for the under eyes.  In the after photos you are smiling not doubt to demonstrate how your lower eyelid heaps now that you have had eyelid surgery.  I think you need to take steps that are less likely to get you into trouble.  Fillers with a very experienced injector is recommended.  I would definitely stay away from alloderm or fat grafting.  While fillers do need to be maintained, once you find the right injector, these treatments last well over a year.  Please be careful out there.

You had a total of 4 surgeries on your lower lids with only minimal result from the three canthopexies.

This tells me that your lower lids do not respond to modest surgical tightening but would require a formal canthoplasty for additional repositioning and change. You will need to make the decision whether this is really worth it to you but I definitely would not just "try" something - especially when it comes to the delicate lower eyelid! Often, a conservate approach (watchful waiting, injectable fillers - maybe) will give you the best outcome.

Your scleral show is mild. A canthoplasty only on one side may result in new asymmetries without overall aesthetic gain.

I have a feeling that the bulge you have in the preop photo was not fat but actually for orbital rim (bone) visible with a blue hue that mimics shadow from a fat bulge. it then follows that fat removal further exposed the bony rim leading to a worsening of the "bag". your scleral show is generally not related to fat removal except when it creates scarring in the middle layer or lamellae. at this point surgery is not the answer and may lead to a worse result. without a proper exam recommendations cannot be specific but a filler like restylane usually is safe or at least reversible  if nothing else. good luck