Is This Fluid Retention or Fat Left? (photo)

I had lower blepharoplasty 2.5 months ago. I still wake up puffy every morning. The puffiness goes down during the day, but small bags remain. My doctor said that is edema. It has been like rollercoster: I would have days of looking good ( with small bags), then being puffy, then one eye would be more swollen then other.. I would like to know if my persistent swelling is due to fat left or just fluid retention. If t is due to fluid retention, is there anything I can do to get rid of it?

Doctor Answers 2

Soft tissue swelling after a lower eyelid blepharoplasty

It would be helpful to understand the exact procedure and steps that your plastic surgeon took to perform you blepharoplaty.  From your pre-op photo it appears that you had excess loose skin, herniated fat, sagging of the orbicularis muscle and some degree of festooning or peri-orbital soft tissue swelling.  If I were to correct this problem I would do the following

  1. Subcilliary incision
  2. Separate skin and muscle flaps
  3. Repositioning and contouring of the herniated orbital fat
  4. Full release of the orbitomalar ligament and mobilization of the malar fat pad
  5. lateral suspension of the malar fat pad
  6. resuspension of the orbicularis muscle
  7. conservative skin excision

At this point I would give it more time with massage over the next 3 months.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

It would be very helpful to know precisely what type of lower eyelid surgery you had.

I would very much like to also see your pre-operative photos.  Sometimes, one finds evidence of skin laxity that was not notice prior to the surgery.  I would also like to know your thyroid status and if there is any history of receiving under eye hyaluronic acid fillers.  The bottom like is these photos show lower eyelid festoons or bags.  Swelling can certainly make this worse.  Occasionally it is worth a short trial of steroids to see if this has any effect on the swelling.  There are options for improving these.  It depends on the nature of what was there before surgery, prior treatments, and precisely what was done at the time of surgery (such as arcus marginalis release).  Generally if surgery is needed to improve the situation, we wait 6 to 12 months before considering further work.  It is difficult to be more specific without answers to these questions and an actual examination in person.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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