5 months post op, don't see much of a difference after upper eyelid surgery. Am I being too unrealistic? (photos)

When evaluating patients for upper eyelid surgery it is very important to assess the position of the brow. In many patients, the excess skin of the upper eyelid is a dual problem of skin and brow descent. A browlift is sometimes performed at the same time as the upper blepharoplasty. It is difficult to assess this problem from a photo. I recommend that you follow-up with a surgeon who also routinely performs browlift surgery. Good luck 

It’s difficult to fully assess your result without seeing your entire face and forehead. What appears as excess skin after an upper blepharoplasty can sometimes be unaddressed mild or moderate brow ptosis. The brows and upper eyelid skin go hand in hand and often need to be addressed together. I would raise this with your surgeon so he or she can determine if further work needs to be done. A secondary removal of excess eyelid skin is easy enough. Good luck!

Thanks for the question and photos. Unfortunately, it is difficult to make a thorough assessment based on these images. It does appear a brow lift might help you further enhance your appearance. I recommend you schedule an appointment with a board-certified plastic surgeon who will evaluate you in person and listen to your concerns and goals carefully. From that meeting, you should be able to come up with a customized treatment plan that will put the finishing touch on your rejuvenation efforts.

There are 2 issues: 1) you still have some swelling in the upper eyelid which is contributing to the lack of a well defined crease.  I have seen improvement for as long as a year.  2) you have lest distance between the crease and your brow.  After upper blepharoplasty if the brow is not held in position by a browlift the force of closing the eyes can result in slightly pulling the brow down.  I have modified my technique over the years and it can easily be done as an office procedure with about 10’days of down time.

It does appear that there is less skin in the upper eyelid but that there is room to remove more skin laterally.  My goal in creating a youthful upper eyelid is creating a more parallel relationship between where the lid fold is and the lash line below.  On your photos, even more so on the afters, you can see an upward notching of the inner aspect of the lid fold (an A-frame deformity); there is a greater distance between lash line and lid fold in the inner aspect than in the outer aspect.  The distance can be increased in the outer aspect with more skin excision.  But this is only part of the issue, as we age there is volume loss in the inner aspect of the upper lid due to bone resorption.  To create a more youthful eyelid, and recreate the ideal parallel relationship between lid fold and lash line you would also need to restore volume loss.  I normally accomplish this with autologous fat transfer to the inner aspect of the upper lid if done at same time as removing skin.  Alternatively, volume can be added with injectable fillers.  

 Sad appearance after upper lid blepharoplasty.  Based on the photos you submitted I would guess that you were a Browlift candidate. I  would advise you not to have any further blepharoplasty and definitely not have a lateral brow lift which will make you look more evil. A central brow lift down at the hairline will give you what you were looking for. I would need to examine you to be certain. 

Your result does show a reduction in extra skin above the eye.  There is perhaps some lateral hooding that could be improved with a nerve sparing, hair sparing lateral brow lift.I would disagree with the notion that we have to create an artificial fold where none is or ever was present in a patient.  This can appear artificial and feel 'tethered'.Further removal of skin may result in a 'done' appearance or an inability to close the eyes at night time, resulting in dry eye and corneal damage.

With all due respect to my distinguished colleagues who are recommending snipping more skin from your eyelid, that is not your issue.  Your current surgeon has no idea what you are talking about and are likely gaslighting you if you have voiced concerns about your surgical result. In the spectrum of blepharoplasty results, this work is typical and perhaps even considered conservative by some surgeons.  Here is the issue, your surgeon may have done a blepharoplasty and left an upper eyelid fold, which is commendable, but you eyelid is missing structure.  There two issues, one is that you have a change in the eyelid contour.  That change is complex. You have more eyelid platform show in the inner half of the upper eyelid but less eyelid platform show in the outer half of the eyelid. THe eyelid platform skin is not well supported and the skin is crepey. Your iris is more brown in the after photo. If you are using Latisse, I strongly urge you to stop. In addressing this eyelid, you need an anchor blepharplasty. This is a surgical procedure that could have been a part of your original surgery but it was not. It anchors the eyelid platform to the levator to provide support for the eyelid platform. It makes a hard crease that snugs the eyelid platform skin to the upper eyelid crease like one snugs a bedsheet. The fold can also be adjusted at the time of revisional surergy. It all starts with a personal consultation.

Thanks for your question and great photos!  Yes it does look like there is still some excess skin present that can be removed.  Now, a cosmetic upper blepharoplasty is different from a medical upper blepharoplasty.  Please ask your surgeon to re-evaluate your results.  It can be a very easy revision in the office.  Good luck.

It does look like a revision with resection of a minimal amount of skin laterally could  be done.  I try to wait 6 months before revisions.  A physical examination is necessary to really determine if any more skin can be taken.  Obviously, the worst thing you can do is take too much skin.  Good luck, Jane