Indentation After Upper and Lower Blephoroplasty. Causes? How to Fix? (photo)

After an upper and lower blephoroplasty, the area between the inner canthus and the upper bridge of my nose is noticeably indented on both sides.The surgeon says he hasn't seen this before and doesn't know what caused it, and nothing can be done to fix it that would be worth the risk. Have you encountered this, do you know what causes it, and would you recommend doing anything to fix it? I will try to upload a photo.

Doctor Answers 5

Indentation After Upper and Lower Blephoroplasty. Causes? How to Fix?

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 In this area of the upper eyelid, this indentation, IMHO, is most likely caused by over-resection of the underlying eyelid muscle as part of the upper eyelid surgery.  I would leave it alone for 1 year and see how it looks at that time.  I would not do fillers to the upper eyelid because of the potential complications.  

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Indentation After Upper and Lower Blephoroplasty. Causes? How to Fix?

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Based upon the one posted photo the only indentation I see is very small centrally. I do not agree with this being fat loss but I believe you have had a wound/incision separation that has healed by secondary intention. Minor scar revision under local can alleviate this. 

Indentation after Upper Blephoroplasty

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This is not often seen as the upper eyelid is very forgiving, it could be due to atrophy of the fat or over removal of fat. I would suggest allowing some time to pass, possibly 6 months, if still present at 6 months, you can harvest or re-arrange some fat to fill these voids, this could be done under local anethesia in the office with minimal recovery.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Indentation After Upper and Lower Blephoroplasty. Causes?

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As far as causes, it could be from fat removal in this area or some sort of fat atrophy from cautery.  It is a little unusual.  Some might consider placing a little filler in this area to reduce the concavity, but that is risky as the angular artery and other major vessels are near the area.  Acute vision loss has occurred after injections in this area.  I would wait a minimum of 9-12 months before considering any treatment as it may subside with time.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Preop photos

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The hollowness you are pointing out is in a region that is quite medial from the incision site and I would be surprised if your surgeon even came close to this region. It is possible, that as he removed excess skin, and possibly fat in this area, that it opened up the medial canthus region and made your natural anatomy more noticeable.

If you had preoperative photos posted, we might be able to more accurately evaluate this change. I would not be surprised, that this anatomy was present even before surgery, and now that you are looking at it more closely, it has become more apparent to you.

Honestly, your incision has healed quite well.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 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.