What to Do About Hollow Eyes After Blepharoplasty?

I had blepharoplasty on both upper and lower eyelids. The right eye had a slight ectropion which is a lot better than it was (almost 100%). My eyes are very dry since this surgery last Feb.10. which has been very aggravating to live with. My eyes are also hollow looking especially the one that had the ectropion. What is your suggestion since the surgeon I chose doesn't seem to want to admit that he probably removed too much fat. I definitely am scared of more surgery.

Doctor Answers 6

Hollow Eyes after Blepharoplasty

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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

Hollowness after blepharoplasty

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The current trent to not remove as much fat as was done in the past.  However, depending on your anatomy, a significant about of fat may need to be removed.  Without pre and post op pictures, it is impossible to comment specifically on your surgery.  However, after surgery if there is too much fat missing, then you may need some fat grafting to fill the areas.  Alternatively, you may try a temporary dermal filler  to see if you like the difference.  A word of caution... make sure the person injecting you is experienced.  Also, I would suggest using an HA product so if you don't like it, it can be melted with Hyaluronidase.  Good luck.

It is probably time to find a surgeon who specialized in fixing eyelid surgery.

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It is my personal belief that many of the paradigms upon which lower eyelid surgery is performed are probably incorrect.  This means that a surgeon can perform a perfect lower eyelid surgery and still get an unfavorable results.  This scenario lends itself to surgeons that don't believe that there is anything wrong with a results like you are describing because they have trained themselves to believe that this is the expected outcome.  

Without a personal examination, it is impossible to render a meaningful opinion.  However, many people in your situation can be helped without surgery using under eye filler.  The effects last a year or longer (easy two years in some cases).  For some this time frame makes a very workable alternative to more eyelid surgery.  For others, reconstructive midface surgery with a hand carved ePTFE orbital rim implant is the answer.

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

Hollow eyes after blepharoplasty.

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It seems that your lower lids are tight in addition to being hollow. The dryness can be improved by supporting your lower lids with a bilateral canthopexy. This reduces the evaporation of tear from your eye and improve your dryness. At the same time fat grafting can be done to improve the hollowness.

Hollowness in lower lids

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Sometimes it is difficult to gauge how much fat to remove from the lower lids. Sometimes fillers or fat can be used to augment the hollowness.

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

Fat transfer is great for volume replacement

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Although, you may not be happy with the volume loss, it is often difficult for doctors to judge the adequate amount to remove when getting rid of lower lid bags. Correction of this problem can only be performed with micro-droplets of fat. The viafill system is designed to accoplish this correction.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

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.