Fat Transfer Upper Eyelid Post Blepharoplasty - is this my only option at this point? (Photo)

Question

I am a healthy fit 49 year old women. I had upper and lower lid surgery Dec 2020. Photos attached. My left lid had too much skin removed. The Dr thought it was an eyelid issue and did two surgeries after to tighten the upper lid muscle - each sx 6 mo. after the next and each time the upper lid looked worse and after the third sx my left lid is tight and always proped way to open. He now wants to do fat transfer to improve the appearence but I'm concerened - my only option at this point?

David Samimi, MD · Answer

Your cosmetic concerns are obvious based on the photos. Looking at your pre-op photos, I believe there is some asymmetry in the orbital volume with your left orbit being slightly less volumized to start. This became unmasked and more noticeable after your first surgery. Ultimately, having some conservative fat grafting would help your overall aesthetic by giving your brow and midface some youthful projection and likely help the orbital volume asymmetry. The key would be knowing that the fat blossoms over the course of a year so need to be patient after any treatment. However. you could consider a revision blepharoplasty whereby the upper orbital fat on the left is released and advanced forward along with the closure of the upper eyelid crease incision. We presented our results doing this at our Oculofacial Plastic Society meeting in Chicago a few weeks ago showing that there was a trend towards improvement in upper eyelid asymmetry with this technique however not perfect. In the end you may need a combination if things but I would consider getting another opinion from a skilled oculoplastic surgeon in your community before proceeding. Best of luck to you.

Mats Hagstrom, MD (license on probation) · Answer

First and foremost before ever having an aesthetic surgery operation patients need to vet the provider to confirm that the surgeon has the skill and experience to do the procedure correctly. This is true for all procedures.
The easiest and best way to do that is to ask the provider to show their entire collection of before and after pictures for the procedure you are inquiring about.
If your doctor wants to do eyelid fat transfer then hopefully he’s done that in the past with consistent quality results. If not you should consider finding one that has if adding fed is the correct option. Personally I would steer anybody away from fat grafting around the eyelids because the procedure is inherently unpredictable, imprecise and unforgiving.
If volume deficit is the problem then try fillers as a temporary measure and if that perfectly fixes the problem then you can later look into more long lasting solutions.
An experienced provider should have at least 20 sets up before and after pictures for complex or slightly unusual procedures. Highly experience providers will have hundreds.
Simply being shown a handful of sample pictures which most likely represent the best results of the providers career is insufficient to get a clear understanding of what average results look like. This would’ve been true for your eyelid surgery in the very beginning as well.
At this point or perhaps far earlier in the process you should’ve considered getting a second opinion.
 Why it’s true that surgeons are responsible for the outcome of their procedures some surgeons simply don’t have the skill and experience and get themselves into a situation they can’t get out of. while a bad outcome is bad enough having more surgery making it worse is simply just that it’s worse.
Giving quality results by grafting fat in the upper eyelid is exceedingly difficult without having some undesirable side effect. The areas prone to lumpy fat necrosis and while there are most likely plenty of providers who can do it well there are lots of patients who regret having had this done.
To get a proper second opinion consultation scheduled those as in person consultations with local board-certified plastic surgeons, facial plastic surgeons or oculoplastic surgeons. The key is to find people who have a lot of experience and an overall good reputation.
You should come prepared for a second opinion consultations by bringing with you all before and after pictures and that includes for each one of your procedures. You should also bring a copy of the operative report for each of your previous procedures. They are part of your medical record which you are entitled to if you ask your current provider.
My recommendation to you is to get multiple second opinions before moving forward with any more surgery with this provider.
Best,
Mats Hagstrom MD

Fat Transfer Upper Eyelid Post Blepharoplasty - is this my only option at this point? (Photo)

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Fat Transfer Upper Eyelid Post Blepharoplasty - is this my only option at this point? (Photo)

Answers (2)

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Everything you need to know about Facial Fat Transfer

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