Which procedures would help me achieve my desired eye shape? (photos)

Question

Unhappy with previous blepharoplasty, it’s really affecting my confidence. I feel less eyelid symmetry, some lower eyelid retraction, and a light ptosis on one side. Also the eyes are now smaller and more narrow, the corners were sort of pitched too agressively. I really wanted almond shaped eyes with symmetric eyelids . One side of my face is also more droopy, one eyebrow is lower and one eye corner too. Someone told me online that I don’t have enough skin, and might need fat graft around eye.

Kenneth D. Steinsapir, MD · Answer

Inevitably you need a very detailed, in-person consultation to define precisely what you need in a reconstructive surgery. This cannot be Zoomed. Cosmetic orbital decompression is associated with a host of post-surgical changes that are often not well appreciated even by surgeons. The same can be said for blepharoplasty. You are left with both lower eyelid retraction and what I have described as post-upper blepharoplasty syndrome (PUBS). Lets talk about the upper eyelid findings first. I do not agree with a prior post suggesting a forehead lift and grafted fat is the answer to your concerns. Your surgery has left the eyes looking round and skeletonized. If the lateral canthal angles sat in their proper positions, it is likely you would manifest upper eyelid ptosis. In the first photo, assuming you have not flipped your images (try not to post flipped pictures-it is not how we surgeons analyze faces), the left upper eyelid is slightly more ptotic than the right. There is more left upper eyelid tarsal platform show and an apparently high upper eyelid crease. The left upper eyelid is less full than the right side. The left eyebrow is slightly higher than the right eyebrow. Resetting the lateral canthal angles will have an effect on the upper eyelid. I am attaching a web link to my article on post-upper blepharoplasty syndrome. The fix is to repair the latent ptosis, make a lower eyelid crease, fluff up the upper eyelid pre-aponeurotic fat and reconstitute the upper eyelid folds using an anchor blepharoplasty fixation at the new lower crease. I think both upper eyelids will need this work. For the lower eyelids, you have bilateral post blepharoplasty lower eyelid retraction. Canthoplasty alone will not fix this. I am adding a video link for how I perform the reconstruction of these lower eyelids. It is somewhat complex but the method addresses many of your issues. The lower eyelid needs to gently rest just at the level of the inferior limbus (where the white of the eye meets the colored part of the eye at 6:00. The lower eyelid margin needs to gently rise to the lateral canthal angle which needed to be repositioned to the orbital rim. That means vertically recruiting cheek soft tissue into the lower eyelid space and then shaping the lower eyelid contour with a hard palate spacer graft. The outer canthal angle can be negative, neutral, or above the medial canthal angle. That is something that needs to be a point of discussion at the time of consultation. Generally it is helpful to understand what the eyes looked like before any eyelid or orbit surgery. I do actually think you could have much more reconstructive benefit that you have illustrated in your photoshopped after image. Study my website and my papers. I also have a YouTube channel (search under Dr. Steinsapir). Feel free to reach out to Faith in my office--she is a wealth of information regarding these issues. Your eyes can be your best feature.

Randal Haworth, MD, FACS · Answer

Based on your photos, it looks like you would be a good candidate for a brow lift and fat transfer around the eyes. (It is possible to change the shape with fat as you can see in the link below).

Best of luck !

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment on the outcome of a plastic surgery procedure, I suggest, considering posting a complete set of proper before and after pictures. If you don’t have before, and after pictures and ask your surgeon to forward the ones they took.
At this point, I suggest giving yourself as much time as possible before, jumping in to revision surgery.
I continue to encourage people to be careful and hold off on having surgical intervention until there is a clear and obvious need for surgery 
At this point, I suggest focusing your efforts on finding senior experienced ocular plastic surgeons to carefully guide you through the decision, making regarding any potential revision procedure
Best,
Mats Hagstrom, MD

Which procedures would help me achieve my desired eye shape? (photos)

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