Should I Get a Lower Bleph? (photo)

I had restylane injected under eyes 4 months ago by a novice nurse injector. That resulted in large lumps, a protruding vein, and bulging fat pad. I had 5 sessions of hyaluronidase, which left saggy, loose skin, as well as the fat pad and vein. I waited a month for swelling to subside, then had Restylane reinjected in troughs to camouflage fat pad and vein. The Restylane helped a bit. I would like to repair my eyes once and for all and am willing to proceed with a conservative lower bleph, if necessary.

Doctor Answers 9

Lower blepharoplasty

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The primary goal of a lower blepharoplasty procedure is to remove the bags (fat compartments) in the lower lids.  The secondary goal is to remove any excess skin in the lower lids.  Removal of the bags involves placing patients under general anesthesia, making an incision on the inside of the eyelid (called a transconjunctival approach) and removing a portion of the fat from the fat compartments of the lower lids.  If required, any excess skin is removed through a subciliary incision on the outside and closed with tissue glue, not sutures.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Lower Lid Blepharoplasty after Restylane

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When you have had more than one restylane injection and hyaluronidase so recently, it would make sense to allow some more time to see what it will look like once it resolved. At that time you can better assess whether a blepharoplasty would help. Another option for tear trough area is injection of your own fat. Be sure to use an experienced surgeon as this area can be tricky.

Give it plenty of time to heal

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Thank you for the question and photo.  I suspect the ideal solution will be to wait a little longer and have your tissues return to near baseline status.  This will allow the planning of your lower eyelid rejuvenation to be more accurate.  Based on the photo alone fat grafting will likely play a big role in your eyelid rejuvenation process.  As scary as it my by to consider injections, fat grafting with or without any skin tightening (peel or excision) will be an important component.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Lower Blepharoplasty Following Restylane

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I'm sorry to hear about your experience.  I know this can be frustrating, but it would be best to wait for a few months before proceeding with anything.  The undereye area has recently experienced a lot of trauma with the restylane followed by 5 sessions of hyaluronidase and having surgery right away is generally not recommended.  Please consult with a board certified specialist who can assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Lower Blepharoplasty after filler and hyaluronidase?

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Above all give things time to settle.  Never shoot at a moving target, which is exactly what a surgeon would be doing if he were to perform a blepharoplasty procedure over the near term.  I can't tell for sure from your pictures if a blepharoplasty would even be required.  Perhaps a judicious fat transfer to the cheek and tear trough areas might be more beneficial.  Avoid aggressive lower lid fat resection, as this will just make you look more hollow.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Lower blepharoplasty is a good idea in 6-8 months

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I agree with the sentiment of my colleagues that a lower blepharoplasty would provide you with a good result. However, given what you've been through and the fact that you still have filler in your undereye area, it would be best to wait 6-8 months in order to heal and for the hyaluronic acid filler to dissolve. I hope this information is helpful.

Stephen Weber MD, FACS

Lower blepharoplasty and swelling after fillers etc.

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Lower blepharoplasty and swelling after fillers etc is not a good idea. You need to wait at least 6 months for the filler to be gone and the swelling and or other changes have gone to know what to do next. See a very experienced surgeon for any surgery so it is NOT OVERDONE.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Lower Blepharoplasty after filler injection

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Given the fact that your lower eyelids has underwent repeated injections recently, I would advise that you wait until all the fillers are gone before proceeding with any lower eyelid surgery. It appears that your original untreated photo (only one view) suggest that you have a mild tear trough hollow and minimal fat herniation and skin excess. The condition was made worse by unsuccessful injection of fillers. To determine whether you are a good lower blepharoplasty candidate, I need to assess your periorbital anatormy, lower eyelid skin quality, amount of fat protuding and severity of tear trough hollow. This really can only be accomplished with a inperson consultation. Talk to your plastic surgeon and express your concerns in person.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Lower blepharoplasty after unsuccessful filler injection

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With all the trauma your lower lid has endured, you may be best off doing absolutely nothing for a period of six months, when most of the swelling and reaction from your interventions will have dissipated (and most of the restylane will be gone as well).

The trauma of Restylane injection, dissolving with hyualuronidase, and reinjection will likely have caused temporary changes to your lower eyelids; it is unwise to perform surgery on a temporary condition.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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.