My Surgeon is Blaming my Skin for my Botched Bleph? (photo)

My plastic surgeon says that my skin is the reason for the hollow and the large skin fold on my left eye. I had an upper and lower bleph then about 7 months later I had a revision to the left lower eye because of puffiness this is when I believe he took too much fat resulting in the large skin fold you see now. He says that he is willing to do a fat transfer to the lower lid to bring back some fullness. A free corrective fat transfer!

Doctor Answers 7

Factors in surgery, skin quality and skin treatment options

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is always a range of acceptable results in cosmetic surgery, and in my opinion the term botched is a bit extreme. The goal of every cosmetic surgery is always the improvement of your appearance and it can only be in the static position. If you had puffiness under your eyes, and it is gone after surgery when your face is relaxed, then that’s an improvement. If there used to be extra skin over your eyes and now there’s symmetry after surgery, that’s another improvement.
When you get into the dynamic activity of the eyes, you start raising a whole set of issues because you cannot operate purely on a dynamic problem. For example, a surgeon may take away some skin from the eyes based on the patient’s complaint, but because of that there might be an extra fold of skin after the surgery. As a surgeon, you must remove skin up to the point that it doesn’t compromise the shape of the eyes, so it can be a very tricky situation.
Based on your photos, I assume you had underwent transcutaneous blepharoplasty where the incision was made on the outside. The skin muscle flap was lifted, extra fat was removed and certain amount of skin was taken away. In other words, the skin was re-draped and placed back to where it belongs then stitched. There can be a difference between the two eyes in terms of the way the fold occurs. In your situation, I can say that the shape of your eyes look very good but when you smile, there is clearly a difference.
In my practice, wound healing or maturation in cosmetic eyelid surgery happens when the skin and tissue adherence become more firm and everything starts to balance out.  When somebody complains about folding or knot lines occurring when they smile, I will suggest a treatment like Dysport or Botox to help with the dynamic nature of those skin folds.
Skin quality does make an impact in the appearance of the eyes after cosmetic eyelid surgery. The lighter and thinner the skin, the less likely it will be smooth and flawless. The backbone of the skin, called the dermis, is very important. People with darker and younger skin tend to have less folding and creasing, while lighter and older skin tends to have more.
In my experience, patients come to us who have had fat placed underneath the eye, above the bony rim, or the rim part of the tear trough. This fat can become lumpy, irregular and hard, so they come to me to have it removed. The growth factors and the stem cells that may be derived from fat can help skin quality, but you also have to balance out the risks of having some type of lumpiness. To help people with skin quality, I do non-surgical treatments like platelet-rich plasma and/or laser treatments.
So I would not call your procedure a botched procedure. I think that there may be some communication here that can be improved. You have to be smart about your strategy and realize what kind of results you want as you and your doctor work together. I hope that was helpful, and thanks again for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Wrinkles/ folds/ creases after bletharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 An examination and pre-operative photo’s would be of great assistance in your case. However, I do believe I see what you are concerned about. Your surgeon is actually correct. The skin is most likely the issue. Treatment with Laser Ablation or resurfacing of the perioccular skin may be of greatest benefit to you to remove some of the wrinkles when you animate or smile with your face. For the laugh lines/ crows feet Botox would be of greatest benefit.
 Your complaint is why many cosmetic surgeons such myself insist on CO2 laser resurfacing/ ablation at the time of Bletharoplasty. Yes, it increases the cost but, the results are often much better. Best,

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

My Surgeon is Blaming my Skin for my Botched Bleph?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Try Botox to the area of the animated fold with or without droplets of fat. But besides that I would leave well enough alone. 

Blepharoplasty and skin issue

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

More details would be required to give a better suggestion.  You have the appearance of the same thing on the right side.  

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bad Skin Blepharoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you would truly like the most accurate opinion then you should provide a pre-operative photo.  The fold of which you speak occurs when you animate your face.  This fold is not readily apparent when you do not animate your face.  Blepharoplasty takes care of redundant skin and fat to improve your non animated appearance. Secondly, this fold is at or around the nasojugal groove and typically fat in not available for removal in that area.  You PS has a reasonable solution with fat transfer.  It may take several treatments to reach the desired result.  I would also recommend BOTOX® for your crow's feet which would soften your animated appearance.


Dr. ES

Sagging Skin after Lower Eyelid Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

  Preoperative pictures would be instructive here.  The area of the tear trough and its interface with the lower eyelid can be problematic.  I usually remove some fat in the lower eyelid to make this contour flat not sunken.  However, this is usually not enough and the tear trough has to be addressed as well.  Some transpose the fat from the lid to the tear troughI fat graft the tear trough for best results

Sagging skin after blepharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I'm not sure what your particular question is.  It sounds as if your main complaint is with the lower eyelids after your upper and lower blepharoplasty.  It appears as if there might be some crepiness of your lower eyelid skin.  If you did not have any skin removed with your lower blepharoplasty, that might be an option to help.  Additionally, ablative laser resurfacing could help with that issue as well.    

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.