How Many Times Can Lower Blepharoplasty Be Done?

Question

How many times can lower blepharoplasty be done? Is scar tissue build up going to be a problem with it?

Brent Moelleken, MD · Answer

The lower eyelid is the trickiest and most complication prone area in the body to operate on.  Every single operation produces more scar tissue.  The surgeon and patient must decide carefully on expected benefits, as well as the risks and benefits of each procedure.
Every surgery, from the first to the revision cases should have a very specific plan to reduce againg, but also to protect the eyelid from scarring and from changing its shape.  Changing the eye shape inadvertently can give a bizarre, operated appearance, or a staring appearance to the eye, not to mention problems with dry eye or even corneal damage.
In our practice, revision lower eyelid surgery, more likely than not, involves a cheeklift to restore the eye shape to a pleasing almond shape from a rounded appearance that is often seen after conventional subciliary blepharoplasties.  Often revision surgeries will involve placement of grafts into hollow areas (i.e. LiveFill), elevation of the cheeks, restoration of the canthus (corner of the eye), possibly replacement of tissue lost to scar tissue.
We have several articles and book chapters on our website drbrent.com for specific discussions of these issues.
So the question is why should so many repeat surgeries be necessary on the lower eyelid? 
Is the patient chasing any morsel of fat that appears at the base of a prominent globe?  Is there hollowness that is distracting from the appearance of the eye that could be treated in other ways?   The eye protrudes more in some patients than others. This causes a "chain reaction" of effects on the lower eyelid fat, the upper eyelid configuration etc.  Does the patient have a prominent globe?  Are the patient's needs reasonable or are they risky?
These are all issues to address before a trip to the operating room.

Vincent N. Zubowicz, MD · Answer

Generally eyelid surgery, upper and lower, is a once in a lifetime endeavor.  Redoing the lids is occasionally indicated but revisional surgery, especially with the lower lids, introduces more risk.  With the lower lid that risk is lid position.  Great care should be exercised by the plastic surgeon redoing lower eyelid surgery.

Michael A. Persky, MD · Answer

Hi BJ,
There is only so much skin in the lower lid, and only so much fat.  The majority of patients only need one lower blepharoplasty, some may have a second or revision, but it is certainly not an area where multiple procedures are indicated.  Good luck and be well.
Dr. P

Mark Berkowitz, MD · Answer

Surgery can be repeated on the eyelids more than once.  Each time the eyelids are operated on scar tissue forms. This scar tissue can pull the lid down ( retraction or ectropion).  This is more likely to occur if the surgery is performed through a skin incision ( transcutaneous) versus through the conjunctiva ( transconjunctival). When the incision is made through the skin there is a septum that becomes shortened which can retract the lid. Most patients that have eyelid surgery usually will not need a touch up for at least 10 years. Preventive measures are best.  So chose an Ocular Plastic or skilled Cosmetic Surgeon the first time you have eyelid surgerywhich can avoid early reoperations.

William Portuese, MD · Answer

A lower blepharoplasty can be done usually no more than twice in a lifetime of a person because of the fear of changing the shape of the eyelids.  The goal of lower blepharoplasty surgery is primarily to remove the fat pads and bags underneath the lower lids, and then if needed, to pinch a small portion of excess skin which is present at repose, not at animation.

How Many Times Can Lower Blepharoplasty Be Done?

Answers (10)

Answer: Each Additional Eyelid Surgery Adds More Risk

Answer: Each Additional Eyelid Surgery Adds More Risk

Answer: Lower blepharoplasty can be done more than once

Answer: Lower blepharoplasty can be done more than once

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How Many Times Can Lower Blepharoplasty Be Done?

Answers (10)

Answer: Each Additional Eyelid Surgery Adds More Risk

Answer: Each Additional Eyelid Surgery Adds More Risk

Answer: Lower blepharoplasty can be done more than once

Answer: Lower blepharoplasty can be done more than once

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.