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.
