Lower blepharoplasty - is there a solution for this swelling? (Photo)

Question

I had lower blepharoplasty done 20 months ago, undereye bags are gone but now I have permanent swelling below undereye are which was not there before the procedure. I also have little fat in corner of one eye which doctor said that he didn’t remove enough fat from there but he doesn’t want to redo it since it room long time for swelling to go down. I feel like I solved one problem but created another. Is there a solution for this swelling? Thank you.

Chet Mays, MD · Answer

Thank you for your inquiry! Keep an open communication with your plastic surgeon regarding your concerns. If you're unhappy with your results then we would be available to see you in person or virtually to evaluate your eyes and discuss revision options. Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals!

Lawrence Kass, MD · Answer

There is no doubt that the persistent swellings you have 20 months after lower blepharoplasty are a result of festoons. Also called malar mounds or malar bags, these swellings which actually occur below the inferior orbital rims can be worsened by lower lid blepharoplasty (as in your case), cheek and tear trough fillers, or by face lifting.  There's no easy fix to your problem and you may need surgery which few doctors have the knowledge and experience to perform well. This surgery should only be done by oculofacial plastic surgeons and you should only seek out surgeons who can show you lots of before and after photos. My advice is to avoid at all costs doctors who propose fillers or fat grafting but you could consider noninvasive options include radiofrequency microneedling treatments and doxycycline injections. Otherwise, if it bothers you sufficiently, you could consider surgical correction.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of any plastic surgery procedure, we usually need to see a complete set of proper before and after pictures.
If you don’t have before, and after pictures and ask your surgeon to forward the pictures they took.
Some people are prone to having or developing malar edema. I have some of this myself.
Underlying ideology is poorly understood and we don’t have good treatment options for it.
Volume restoration in the midface just below the area of edema, could potentially camouflage the swelling to some degree.
Sometimes the juxtaposition of removing the fullness in the lower eyelids can make the edema look more prominent. Sometimes the surgical procedure can contribute to the edema.
 I don’t know of any good treatments for this nor do I know anyone who has a good explanation for the cause.
Sometimes this is confused with a condition called festoons which has an underlying etiology but is also nutritiously difficult to correct. 
Best,
Mats Hagstrom MD

Lower blepharoplasty - is there a solution for this swelling? (Photo)

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