Upper blepharoplasty too aggressive 2.5 months post op? Do I need revision or fillers or something? What are my options! (photos

Question

was told only needed skin removed. While in surgery surgeon asked « did we discuss fat removal ». I said no but he removed fat anyway. I posted here a couple weeks postop because incisions were uneven. It’s now been 2.5 months. In the morning my eyes are swollen and look acceptable but at end of day it’s as if there is no fullness anymore in upper lid. I would like your opinions if possible. Do the results seem acceptable or not? Was too much tissue removed? Is there anything I can do? Ptôsis?

Kenneth D. Steinsapir, MD · Answer

That means I take results that my colleagues think are good enough and make them much, much better.  When someone tells you to "get a hobby," they are obviously not really interested in hearing your concerns.  You deserve a result that makes you happy.  You result is basically symmetric and reasonably orderly.  So why is it unsatisfactory?  Unless one can answer that, it is impossible to improve your situation.  What you have is what I call the Post Upper Blepharoplasty Syndrome (PUBS).  It is not a horrible example.  As you can tell, this result would be acceptable to many surgeons.  Here is what is going on with your eyes that make this result unsatisfactory: 1. Bilateral upper eyelid ptosis. 2. Upper eyelid lash ptosis. 3. Excessive upper eyelid platform show. 4. Compensatory eyebrow elevation. 5. Too much skin and muscle left below the upper eyelid crease. 6. High upper eyelid creases.  The effect of this is that the eyes look dull and lack the brightness that make the eyes look jewel like.  I am attaching below a video that demonstrates how I repair these.  Generally, I recommend waiting 6 months to fix these.  If you look into this surgery now, by the time you get on the operating room schedule, you will be at that date.  Don't let anyone put filler in your upper eyelids, it is not going to solve the basic problem here. It will just compound the issues by adding funky volume to the upper eyelid fold.

Mehryar (Ray) Taban, MD, FACS · Answer

Consultation is needed to determine what (if anything) you would benefit from. I doubt more surgery is needed but perhaps filler injection. Discuss with your surgeon and see an oculoplastic specialist.

Brian K. Machida, MD, FACS · Answer

Usually a discussion takes place about any pre existing ptosis and what the options are. I don't think fat removal caused your problem.  It sounds as if he primarily removed skin in which case this is an expected result.  Its not a matter of removing too much.  If you did have pre existing ptosis and did not want that addressed, then this would be an acceptable result.

John J. Martin, Jr., MD · Answer

You are healing well at this point.  Your creases look pretty even, and the lid platform looks the same.  There is no significant ptosis.  When you look down you have some deepening of the central sulcus on the left.  However when you look straight ahead,  I would not say it looks hollow.  When doing an upper bleph, I usually either trim the medial fat pad, or will move it more laterally if someone already has hollowing.  Over resection of the central fat pad can cause hollowing of the superior sulcus.  If you think you look too hollow, you could add some HA filler.  I think you look good and would leave it alone. Before pictures would be helpful to help judge how much fat you might have had pre-op.

Tim Sayed, MD, MBA, FACS · Answer

You have normal-appearing eyes. You posted 4 photos but it is not at all clear which, if any, are preop photos vs postop ones. All of the photos look normal. It is not unusual for patients to scrutinize their results obsessively in the weeks after surgery. Only an in-person exam can help you as a surgeon has to examine you with eyes open and closed, looking in all directions, etc. and assess the fat distribution and function of the eyelid structures. However, the short answer to your question as to whether your eyes look acceptable, the answer is yes. If you are not happy and feel your eye sockets were hollowed out by fat removal, then fat grafting might be appropriate, but that is very hard to discern from these photos.

Michael Law, MD · Answer

Many patients see me for fat grafting to the upper eyelid following a too-aggressive blepharoplasty. Adding fat can provide a beautiful, smooth, natural youthful appearing result for the right patient.I am seeing only a very small portion of your eyes in the photos provided. It looks like you might be fine with no need for correction. In order to make that determination, a plastic surgeon would need to see photos from many angles.

A.K. Bhattacharya, MD, FACS · Answer

Hello, 
Thank you for sharing your photos and question.  Your eyes look great.  I do not see significant asymmetry.  It appears as if you have a beautiful surgical outcome, and I would recommend that you do not do anything at this point.  If you were to have another surgery, or try to alter your outcome non-surgically (fillers), your risk goes up for having an unacceptable outcome.  I hope this was helpful to you.   
Best Wishes, Dr. B.

Chris Thiagarajah, MD · Answer

To be frank your eyes look really great. I would not doing anything to your eyelids. Even as an eyelid expert, it seems your eyelids are fine. If you do something it would risk actually messing up your eyelids. Leave it alone and develop some hobbies.

Michael J. Rodriguez, MD, FAACS -Account Suspended · Answer

My personal opinion is that your eyes actually look pretty great! You are healing just fine. Swelling at this point in the morning is all very normal. Your eyes look even and incisions as well. I think you should let them heal completely before doing anything further. I dont think you really need anything at all.

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