6 months after lower bleph. My eyes look bigger and rounder. Shape of the lower eyelid has changed. Is this permanent? (Phoo)

I do not think that this is an acceptable result but it is a common result following through the skin lower eyelid surgery.  Across the width of the lower eyelid your lower eyelid is pulled down.  This cannot be massaged up to restore the shape of the lower eyelid.  I think that this is something surgeons tell patients so they can shift the blame to the patient when it does not happen. The lash roll is a different issue.  It is a type of lid margin ectropion.  It effectively exposes the eyelid margin and contributes to dry eye.  This lid margin should be perpendicular to the corneal surface rather than turned out.  The reconstruction requires a number of anatomic factors to be controlled at the same time.  I have developed a highly successful approach to this that vertically lifts the cheek to provide skin into the lower eyelid and also takes the weight of the cheek off of the eyelid. A spacer graft is also used behind the eyelid to control the shape of the eyelid.  My ebook cited below describes this approach in more detail.  I am also attaching a video of the surgery.

Unfortunately, it appears your lower eyelids are pulled down a bit, giving your eyes more rounded (as opposed to almond) appearance, with sclera show. See following link for possible treatment.

Your lower lids are pulled a little after the surgery. If you haven't been massaging them upwards, this can frequently make this resolve. The fullness that is visible in the before photo (from fat) is better in the after. If you are having fullness with smiling, that can be the muscle, or it can be related to residual swelling. At six months, I'd be surprised if you have swelling. I'd discuss your concerns with your surgeon and if you aren't getting anywhere, consider a second opinion from a specialist.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Surgery on the lower eyelids will always have scar tissue as part of the healing process and therefore the lower eyelid may end up in a lower position, called ectropion, that can make the eyes look bigger and even cause tearing and dryness of the eyes.  In the immediate post operative period (first weeks to months) this can be combatted with aggressive massage of the lids to prevent and fight scar.  You are 6 months out so the scar has likely settled already and the lids are now in their new position.  If you would like this fixed, see your surgeon about a canthopexy.  Good luck.

Dr. Z

Thank you for sharing your question and photos.  I'm sorry that you are unhappy with your results after lower blepharoplasty.  The shape of your eyelids have changed because you have a small amount of lid retraction.  This causes rounding of the tendon that holds your eyelid in place.  Luckily, the condition can be treated and fixed by an eyelid specialist.  Consider a consultation with a board certified oculoplastic surgeon to discuss your condition and goals.  Good luck!

The round-eye appearance - lid retraction - can be a complication of blepharoplasty through a skin incision. This problem can be corrected. You may want to seek a second opinion prior to having additional surgery. Please see an oculoplastic surgeon who can give you a detailed description of the repair options and what to expect. Best wishes.