Need help on determining what can be done. Any suggestions? (photos)

I had a facelift, midfacelift through the eye and rhinoplasty done 9 months ago to repair skin sagging following a jawsurgery. They also recommended a fat graft below my eyes which I agreed to. Now I look weird and disproportioned. I don't understand why I look so different. I feel like i look "mean". Is there anything that can be done,and if so,what would you suggest? I appreciate any help.

Doctor Answers 12

What Makes a Surgical Result Look "Weird"

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Many patients have wisely said, before surgery, that they don't want to look like certain celebrities who appear "done," "weird," and unlike themselves anymore. When patients and I look at those photos together and isolate the "weird" elements, we see many things:  too much fat/fillers to the face and lips, fat/filler in the wrong place, noses that are inappropriate and don't suit their facial proportions, brows that are too high, excess excision of skin of the upper and lower eyelids, ears that lack lobes, mouths that are pulled at the corners etc.  There are many anatomical features that, if you do not as a surgeon have a sense of nuance and naturalness, can become obscured or overly emphasized. These elements, in concert, or independently, are to be avoided at all costs. Your most obvious issue that your ciliary margin before surgery looked natural and now it appears "pulled down." In other words, you now have white showing below your eyes. This could be due to the swelling of fat that was put below your eyes, but after nine months, a high degree of residual swelling is highly unlikely. It is always important to review a surgeon's before-and-after pictures to look for the quality of his/her work. Reading reviews is helpful as well, and board-certification is also highly recommended.

Looking mean

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I see a lot of mid face lifts done through the eye that require adjustment.  The combination of anchoring the mid face  at a higher level along with scarring of the lower lid support structures  can result in this deformity.  I would see an ophthalmic plastic surgeon who has expertise in correcting this defect.

Barry N. Silberg, MD, FACS
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 5 reviews

MidFace Lift Issues

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The photos show an individual who had some degree of scleral show (right more than left) preoperatively, which is now accentuated 9 months after surgery.  This is a known complication of a trans-blepharoplasty midface lift and may be related to mid-lamellar scarring, anterior lamellar deficiency, or both.  Although this can be fixable, I would suggest that you see an Occuloplastic Surgeon experienced in these type of repairs for further guidance.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Unnatural looking facial features

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It appears that there are significant scleral show due to downward pulling of lower lids and over filled cheeks that created your unnatural look. You may want to seek second opinion from expert facial surgeons.

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

Scleral show after Surgery

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Dear chi.girl1972, You appear to have some scleral show post operatively exposing the white under your eyes in the fourth photograph. I am not seeing much difference in your rhinoplasty surgery as well. I would discuss your concerns with your surgeon and you can always seek a second opinion for further advice. If you seek a second opinion it would be helpful to have a copy of your original preoperative photographs and your operative report. The ectropian or scleral show can be fixed surgically however if you are seeing improvement  it may correct itself on it's own as the fat and swelling dissipate.  Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Options after facelift

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Thank you for your question and sharing your photos.  I would give the results more time to settle before considering other procedures.  However, I would also discuss your concerns with your surgeon.  I hope this helps!  

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Concerns following midface lift

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Thanks for your question. It appears you have lower eyelid scleral show, or a pulling down of the lower eyelids, exposing some of the white scleral above the margin of your lower eyelids. This gives an unnatural appearance and can look strange. You will most likely need corrective surgery to reposition the lower eyelids. I would recommend you follow up with your surgeon and express your concerns. Otherwise, seek a qualified plastic surgeon or occuloplastic surgeon who has experience with these types of surgeries.

Sean Maguire, MD
Louisville Facial Plastic Surgeon
4.8 out of 5 stars 24 reviews

I feel i look 'mean'

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It is difficult to determine with certainty based on the photos, but you may be having a problem with the lower eyelids; revisionary surgery is more complex than primary surgery, so I definitely recommend a formal consultation to discuss your concerns and have an exam be performed. I would follow up with your surgeon and/or obtain a second opinion. good luck!

Bryan Correa, MD
Houston Plastic Surgeon

Unhappy with mid-face lift result

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Thank you for asking about your mid-face lift.

  • Your photos strongly suggest that you have an ectropion ( pull down of the lower lid with the white of the eye showing below the pupil.)
  • If this has been slowly improving, it may be worth waiting a year before doing more.
  • But in the meantime, return to your surgeon to discuss what has happened and its surgical correction.
  • And get a second opinion as well. 
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Beware of complications from a midface facelift.

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The photograph demonstrates what is a two often seen a complication of the midface lift. Surgical correction almost certainly be necessary. This is something you're going to have to discuss with your surgeon. The correction needs to be carefully planned.

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.