2 Questions: Fat Graphing Regarding Overly Aggresive Upper Eyelid Lift. Thank You!

2 Questions: 1)Can fat graphing/adding fat make the eyelid close better to help dry and light sensitivity due to too much skin being removed in an upper eyelid lift? I never had dry or light sensitivity in my life before my upper blepharoplasty and now have both 2)If adding fat can help dry eyes and light sensitivity, can a surgeon know for sure with an assessment of my situation, that in fact, there was too much skin removal (causing these 2 issues) and adding of fat will help these 2 issues?

Doctor Answers 7

Fat Grafting for Hollow Upper Eyes

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Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery.  

 I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.

Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Dry eyes post bleph

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Usually dry eyes from bleph may be due to lack of tear production and momentary swelling.It also can be due to too much skin being removed.Fat grafting in that situation probably will not help.You need to make sure you have complete eyelid closure.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Filler injection to help close the eyes

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This can be a difficult problem to fix. Filler injections may be better option that fat injection in the eyelid itself, although there may be a role for fat too (brows). If there is significant shortage of skin, then surgery may be necessary. See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Treatment for overly aggressive skin excision from the upper eyelids

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An examination would be needed to help understand your particular anatomy.  Fat grafting will add volume to your lids but will not help if you are having difficulty closing your eyes.  If too much skin was removed and after attempting massage of your lids then you may need to consider skin grafting.   More than likely skin would be harvested from behind your ears and interposed to lengthen your lids and allow for complete closure.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Upper blepharoplasty issues

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If you have had too much skin removed in the upper lid, then fat grafting will not help. You may need a skin graft.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fat Grafting after Upper Eyelid Retraction

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   If you have upper eyelid retraction after upper eyelid surgery, it would helpful to know how far along you are in recovery.  If you are early, use the artificial tears and ointment or tape at night depending upon severity and anatomy.  If you are beyond 6 months or so, you could contemplate a revision to replace skin in the upper eyelid and scar release.  Fat grafting may or may not be appropriate depending upon physical exam findings.

Too Much Skin Removed After Bleph

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Based on your description of excessive skin removal causing light sensitivity and dry eyes it is unlikely that fat grafting will be helpful.  You have to have skin replaced in the form of a skin graft or a flap. 

Dr. ES

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.