Too Much Fat Removed. Is There Something I Can Do to Look Normal Again? (photo)

If a patient had a blepharoplasty done in the 1980's or 1990's, chances are both excessive fat removal and a change in eye shape occurred.

We now are much more conservative with eyelid fat, and have cheek elevation (cheek lift) techniques, some of which were pioneered here.

The cheek lift enables the doctor to tighten the lower eyelid skin without altering eyelid shape.

If patients have had a previous blepharoplasty, often a cheek lift procedure done at a suborbicularis level can restore an almond shape to the eye.  The suborbicularis cheek lift is not, however, for severe cases of ectropion or multiple failed lower eyelid surgeries; it simply isn't powerful enough, and reconstructive procedure with longer incisions are then necessary.

We no longer perform conventional blepharoplasty that we were all taught in residency.  On any patient.  That's how much the field of lower eyelid surgery has changed.

Whether related to previous eyelid surgery with overagressive removal of fat or whether occuring naturally or due to aging, fat loss in the upper eyelid region can be a distressing cosmetic problem that leaves the individual looking cadaverous or skeletonous. Until relatively recently, I was using Juvederm Ultraplus XC for dealing with this problem and restoring the volume loss or depletion. More recently I have switched to the use of Belotero Balance, since this product is not associated with the risk of a bluish discoloration of the skin when placed in the thin skin of this area from the light scattering effect known as the Tyndall Effect. The entire procedure takes only a few minutes to perform and  the results are immediate and quite gratifying. One additional benefit is that these results may even be reversed with hyaluronidase, should the need arise. .

    Fat grafting done in very precise fashion and filler such as Restylane are the two most common methods employed to improve volume in the periorbital region after aggressive fat resection.  Both can be used effectively.  Restylane allows for more precise injection but must be repeated every year.  Kenneth Hughes, MD Los Angeles, CA