Is there a fix for a bad eyelid surgery / bleph result besides filler? And will filler help? (Photo)

Question

I (F/early 40s/light skin) had transconjunctival lower bleph with repositioning of lower eyelid fat but no fat grafting almost a year ago. I'm very dissatisfied with the results. One lower lid, in particular, has a depression which makes it look lumpy and worse than presurgery. The original surgeon thinks filler may help with the contour issue but ive heard troubling things about it including from him. Is there another solution? Will filler help? Should this be a revision surgery candidate?

Zoran Potparic, MD · Answer

It looks that bulk reduction of transposed fat flap may help, as well as further transposition underneath the current groove. Addition of filler, in skilful hands, may help as well, but will not correct problem entirely. Second opinion, in person consultation, may also be considered. Good luck.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From this photos It is difficult to make a proper evaluation.If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. Anyway, from your photos there is not extra skin so you do not need any revision lower blepharoplasty. For the area that you bothers you can be solved with fat injection to under eye area. Best Regards!

Derek Fletcher, MD · Answer

To me, it looks like there is persistent inflammation of the transposed fat. When that occurs for one of my patients, I use a mixture of two anti inflammatory medications (Kenalog 10 and 5FU) in very small doses (0.01-0.02 mL) to inject the inflamed fat. 1-2 injections performed 4-6 weeks apart often corrects the swollen fat. Then I can accurately assess the volume of the lid-cheek junction, tear trough, and cheek. For people who are experiencing volume depletion of the mid face, I favor micro fat grafting over filler because the results last for many years and fat performs better in the tear trough area.

Kenneth D. Steinsapir, MD · Answer

This question can only be answered by a careful and thoughtful consultation with a detailed physical examination of the lower eyelid and orbital rim. Sadly, many patients never get an actual physical examination before the original surgery. One has to define the problem. In some cases, the original surgeon got it wrong and lower eyelid surgery was not the issue. A lot of these lower eyelids only ever needed hyaluronic acid fillers. Others do benefit from an experienced had to perform a revisional surgery. I am advising you against having your original surgeon revise the eyelid or put fillers in the eyelid. If they really knew what they were doing, you would not need to be posting here. Your eyes can be your best feature.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! I see what you're referring to. For any minor depressions or lumpiness, you can try something like fat transfer. Adding fat can smooth the area. If the areas are very irregular, you may need a revision to the procedure to address any fat pad asymmetries. Another option would be Morpheus8 RF microneedling. This can help condition and tone the skin under the lower eyelids. I would revisit with your surgeon to see if these options make sense for you. Hope you find this helpful!

Is there a fix for a bad eyelid surgery / bleph result besides filler? And will filler help? (Photo)

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