Is there an increased risk for a second blepharoplasty?

I had a blepharoplasty 6 years ago. It was a very natural look and I was very happy. I thought I would only have to do this procedure once. Now my upper eyelids are starting to show folds again and the inside corners are starting to have sagging wrinkled skin. Is it a mistake to have a second blepharoplasty? Is a second performed often? Is there more of a risk for a good result if a second is performed?

Doctor Answers 5

Risk with second upper eyelid surgery

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A second (or revision) upper blepharoplasty can be done for a variety of reasons.  The potential risks involved depend on what needs to be done in your specific case.

I see two common scenarios when patients are thinking about a second upper bleph:

1.) medial fat pad herniation and skin excess (loose skin and a bulge in the corner closest to the nose).

This is a common spot where not quite enough skin and fat may have been corrected the first time around, and it is a fairly simple procedure without much added risk to revise.

2.) loose redundant skin across the whole eyelid (especially on the sides).

Sometimes the issue is that more eyelid skin needs to be removed, but by far the more likely answer to this problem is that the brow has continued to droop which then causes the appearance of heaviness and skin folds in the upper eyelid.  It is very common for patients to notice changes in the upper lid but not immediately realize that the main underlying problem is actually the brow.

There are a variety of browlift options that can provide great improvement without leaving a surprised and unnatural look.

Charleston Facial Plastic Surgeon

There should be less risk with a secondary blepharoplasty.

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The biggest risk is the incision into the upper eyelid that cuts the skin and muscle.  This weakens eyelid closure in 100% of patients.  Many recover and have no issues with this.  However for some it is the start of significant dry eye symptoms.  As you have already had an upper blepharoplasty and presumably have no problems with the eyes, the risk of cutting through the skin an muscle again is unlikely to create a new issue.

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

Increased risk with second blepharoplasty

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Without photos to see what it is specifically that you are concerned about, it is my professional opinion that most people do not need a second blepharoplasty within 10 years, although it is very possible that your surgeon was conservative. To me, there is really only a finite amount of skin that you can cut out between your lash line and your brow. I see this scenario probably once a week in my practice and almost always, it is time for a brow lift when you have the droop and excess wrinkling that you describe. 

Repeat blepharoplasty

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It is definitely possible to have a second blepharoplasty. A new incision is created adjacent to the old incision so that the old incision is excised. The risks of infection, scarring, bruising, etc. are the same as with primary surgery. The risks of repeat blepharoplasty are mainly excision of too much skin with subsequent impaired closure and/or blink and damage to the superficial muscle that closes your eyes which could result in impaired blinking and closure. Perhaps your eyebrow position is a bit low and what you need is a brow lift. Or perhaps some Botox to the periocular area can improve your appearance. I would explore other options before considering a revision so soon after primary blepharoplasty. Good luck!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

Secondary Blepharoplasty

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Thank you for your question. Secondary eyelid surgeries are always associated with greater difficulty and higher complications rates. You may not however, need another upper blepharoplasty just yet. I can't tell what your situation is without pictures, but often, people have excess upper eyelid skin that is a result of the lids themselves, as well as from sagging brows. You had upper eyelid surgery just six years ago, and it is more likely that you have developed more drooping of the upper lids as a result of descent of the eyebrows. I would consult a local plastic surgeon or facial plastic surgeon to evaluate whether this is the case.

Ben Lee, MD - Account Suspended
Denver Plastic Surgeon

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.