I had a blepharoplasty 3 years ago at which time the lower fat pads were removed. I have very deep folds when I smile (Photo)

The surgeon tried a co2 laser but it didnt help. He said any further surgery would pull the lower lids down. Can anything be done to get rid of the deep empty folds when I smile?

Doctor Answers 7

Complication of the lower lid blepharoplasty, Skeltonization of the orbital region.

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I agree with the comment of DR John Martin: "The main problem here is the lack of volume which can occur after a blepharoplasty with fat excision.  Taking off skin and more laser will not correct this, and: "trying some filler such as Restylane" is not the solution.You need to understand that, when fat is removed for treatment of baggy eyelids, this fat is coming from inside the orbit, from the normal fat which help to maintain the eyeball,So the outcome of "good" treatment of bags of the lower lid (always too much), is some degree of skeltonisation in the orbital area. In my experience, you need a total reshaping of orbital region (Orbital rim bones, Orbicularis oculii muscle and malar fat pad) with Adipose stem cells as done by the FAMI procedure (in US Europe or Asia) which will give you back normal younger folds, only by injections.

London Plastic Surgeon

Hollowing and folds in the lower lids after blepharoplasty with fat removal

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You are noticing volume loss and skin folds which may be improved - perhaps not completely corrected - by filler injection and laser resurfacing to contract and plump the skin. I agree with Dr. Steinsapir's approach to fill and to shrink the skin. To preserve your results, it is important to avoid hand-to-eye contact and eye-rubbing as this will destroy the delicate structures of the eyelid. Rubbing gives the skin a dark and crepe-like appearance. Best wishes.

You have a number of issues and a number of options.

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You do have excess skin in the lower eyelid.  While it is very difficult and perhaps impossible to completely control the heaping of the skin.  You lower eyelid are very hollow from prior fat removal.  Fillers are an excellent option here.  I suspect that removal of some of the skin could be helpful here.  A chemical peel would also shrink wrap some of the skin.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Deep lower lid folds

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Sorry to hear about your experience. The folds could be treated with filler to attempt to correct the contouring. Best wishes.

Lower lid hollowing

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The main problem here is the lack of volume which can occur after a blepharoplasty with fat excision.  Taking off skin and more laser will not correct this.  You are going to need some volume added.  The easiest thing is to try some filler such as Restylane.  This should last for at least one year.  You are pretty hollow so may need a fair amount of filler.  Fat grafting may also help.  This is a difficult procedure so should only be done by someone with a lot of experience with fat transfers. 

Lower Blepharoplasty

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Thank you for sharing your case and photos.  I'm sorry that you haven't had an ideal result after blepharoplasty and laser resurfacing.  There are many different options to help you - everything from fillers to revision blepharoplasty to canthoplasty to prevent your eyelid from drooping.  Without examining you in person, it is tough to judge the looseness of your skin and what should be the next step.  Schedule a consultation with a board certified oculoplastic surgeon to discuss your goals.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.9 out of 5 stars 35 reviews

Hollowing after lower blepharoplasty

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It does not look like you have enough excess skin to remove any more at this point. There is a significant amount of hollowing in the lower eyelids, for which filler injections should help. This treatment will make more of a difference when you are not smiling (when your face is at rest), but will also help at least a little when you smile.

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