I had a quad bleph and the incision isn't in the natural crease. Eyes are uneven and lids overhang. What can be done? (Photo)

Dr. Insisted I needed quad bleph. He made his incision starting below the crease and then out over the crease. Removed all fat pads from lower lid now I have troughs.

Doctor Answers 8

Pre existing assymetry

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It's looks like you have pre-existing assymetry of your eyelids. Usually it is difficult to make your eyelids look exactly even. You should give your eyelids a chance to recover before you assess the final result.

Ontario Facial Plastic Surgeon
4.1 out of 5 stars 24 reviews

Quad Blepharoplasty swelling and asymmetry

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Hi Leisa1,

Thanks for your question and photos. Based on your preoperative photos you had levator ptosis or when you open your eyes, they do not fully open and sit on the pupil portion of your eye as compared to the upper part of your iris. It looks like you still have residual skin after the upper blepharoplasty. This is common due to the fact that after skin removal the brow typically relaxes and adds skin to the upper eyelid(herings law). 

It seems that you are still early in your recover. I would wait 3-6 months before final judgement is made. Discuss with your plastic surgeon your concerns. The scars will eventually blend away. But ultimately you may need a touch up to remove excess lateral hooding and likely need a ptosis repair surgery to help open your eyes more. Good luck.

All the best,
Carlos Mata MD, MBA, FACS

Carlos Mata, MD, MBA, FACS
Scottsdale Plastic Surgeon
5.0 out of 5 stars 38 reviews


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I am so sorry that you are unhappy with your results. Based on your photo, you appear to be fairly early in your healing process. For now, be patient and kind to yourself as your body continues to recover. Once you hit the 3 month post op mark, reassess your results. If you are still not happy with what you see then either speak with your surgeon about revision options or schedule a consultation with another board certified plastic surgeon in your area to discuss options. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Quad bleph

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Some of this swelling and asymmetry may be due to normal post op swelling.  You didn't mention how long ago this surgery took place. 

Chad Robbins, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 56 reviews

See oculoplastic specialist

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The incisions should heal better. There a few other things going on. You have hollowness above and under your eyes. There is also asymmetric upper lid ptosis. See an oculoplastic specialist for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

4 lid bleph

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You seem to be in the early post-op phase.  So the swelling will get better.  The lower lids don't look bad although you may end up needing some volume in the lower lids. 
In the upper lids, it looks like not enough skin was removed laterally on the left. You have a very deep sulcus which you also had pre-op which can be improved by placing some filler or fat into the upper eyelid.
Any revision should be done after 6 months.      

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

I had a quad bleph and the incision isn't in the natural crease. Eyes are uneven and lids overhang. What can be done?

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Hello Leisa1,

Without knowing how long post operative you are, it makes the answer a little more complicated.  It is important to wait at least 6 months before considering any further surgery given the swelling that is taking place.  Having said that, for the troughs you can consider filler as long as you are at least a few months out.  Since the filler is only temporary as the swelling is going down the filler will also be slowly going away.  Another option down the road would be fat grafting to the area.  However, I have responded to a few of your posts and it sounds like you haven't had the best surgical experiences, so maybe sticking with the non invasive and non permanent option like filler is best.  As far as the overhang the best way to assess this would be with an in person evaluation.  

I'd recommend you consult with another facial plastic surgeon or plastic surgeon to make an in person evaluation and determine what are the best treatments both for your current issues and to help with future signs of aging.  

I hope this helps and good luck.   

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Uneven post bleph

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You don't sa how long post op you are but my experience has been that the upper eyelid incisions will do well with time ie months.The troughs can be corrected with some simple fat grafting to the area.If you ar enot several months post op just sit tight.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

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