Can a lower blepharoplasty be safely and successfully repeated?

Question

Twenty years after a lower blepharoplasty, my eyes desparately need rejuvenating. The skin looks crepy and hollow with pronounced tear troughs. I've always had large, round, sensitive eyes. An occuloplastic surgeon said it would now be necessary to do grafting or some such thing while a facial plastic surgeon said there should be no problem with a basic blepharoplasty. I want a natural outcome with the least chance of complications.

John Bitner, MD · Answer

The short answer is YES you can repeat this operation.  However, there are several caveats. The margin of error shrinks dramatically.  You can still remove some fat, but over doing it and making the eyes look hollowed is easy to do. If you had a lower skin pinch or a skin-muscle flap blepharoplasty done with the first, the risk of ectropion (rounding or pulling down of the eyelid) is much higher.  I would probably recommend some type of lower eyelid suspension (tarsal strip or canthoplasty) done at the same time to prevent this from happening.  This is not meant to scare you or discourage you from having surgery.  Remember that in experienced hands you can safely repeat this and still get fantastic results.  Just pick someone who has enough experience, someone who specializes in only the face.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Pictures would be helpful. In general blepharoplasty can be repeated since your sister years ago it should be easily repeated. Whether you need additional scan or some type of grafting depends on your examination. Good luck.Earl Stephenson, Jr, M.D., DDS, FACS

Kenneth D. Steinsapir, MD · Answer

That is certainly the case with lower blepharoplasty.  However, the indications for surgery often change.  The two surgical options you are being presented are starkly different.  Unless you have a good intuitive sense of which surgery and surgeon seem the most reasonable, you may benefit from some additional opinions.  You could also consider reposting on this forum with photographs so we have a better idea of your needs.

John J. Martin, Jr., MD · Answer

After 20 years you may have some skin laxity again.  You may also have some laxity of the tendons which support the lid, so just taking off skin may pull the lid down.  If the oculoplastic surgeon told you you would need a graft to safely do the surgery, they probably were talking about a graft on the inside of the lid so that it won't pull down with a skin excision. If you are hollow with deep tear troughs, you may also need filler or fat.

Frank Lista, MD · Answer

Cosmetic surgery does not stop the natural ageing processes
of the body.  As it has been many years since your original
surgery, it is very possible that the results have diminished.  If possible, you may want to return to your
original surgeon to see what they have to say.  If that is not possible, I recommend speaking to an experienced surgeon
about your expectations for results and use his or her advice to help guide
your decision.

Edmund Fisher, MD · Answer

Cosmetic issues earlier in life such as hereditary "bags" or steatoblepharon may require different techniques than those you want to treat now: crepy skin and tear troughs/hollowing. An effective nonsurgical option is Total FX fractionated CO2 laser to tighten and smooth out the eyelid skin, followed by Belotero and/or Restylane filler injections to the tear trough hollows. Surgical option would be fat repositioning via incision under the eyelashes or inside the eyelid, muscle and fat resuspension with excess skin removal. Fat grafting instead of or adjunctive to fat repositioning may also be indicated.

William Portuese, MD · Answer

Usually, the  primary goal for lower blepharoplasty is to remove a conservative amount of fat in the 3 fatty compartments on the lower lids. The fat is removed from the inside of the eyelid through a trans-conjunctival approach. When excess skin is present,  a  pinch technique is performed on the lower lid skin at the lash line on the outside. For many examples, please see the link below to our eyelid surgery photo Gallery

Matheson A. Harris, MD · Answer

This depends on how the original blepharoplasty was done and what your current examination looks like. In some cases, with time redundant skin reaccumulates and can be removed. In others, fat needs to be repositioned or removed.  You'll need an examination with an experienced oculoplastic surgeon to determine what is best.

Kristin J. Tarbet, MD, FACS · Answer

Thank you for your question. Yes it can be repeated, however you would want to consult an occuloplastic surgeon because it may not be as simple as just removing more skin. You might need to have the tendon tightened or you may indeed need a graft. Seeing a board certified occuloplastic surgeon would be your best option for a good outcome without complications.

Steven Wallach, MD · Answer

Without an exam it is imposisible to tell you if your surgery can be repeated for the problems that you are concerned about.

Can a lower blepharoplasty be safely and successfully repeated?

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