Revision for uneven results over 1 year post-op, or will Botox fix it? (photo)

Question

I had upper blepharoplasty more than 12 months ago and have been left with a fairly uneven result. When I went for the 8 week follow up, my surgeon said it will probably need a revision but to see how it heals. Then when I went back for the 6 month follow up, he seemed suprised when I said I would like to go ahead with the revision, suggesting instead that Botox would likely fix the issue which is due to my uneven eyebrows. I disagree - opinions needed!

Kenneth D. Steinsapir, MD · Answer

I would not go back to your current surgeon for help. It is highly unlikely that they know how to approach this. To answer your question, no botox will not fix this. For that matter, filler will also not fix this. For the purpose of discussion here, I will assume you have not flipped this photograph and that the eyelid that appears to have a fold is your right upper eyelid and the eyelid without the fold is the left eye. The photograph shows that you have left upper eyelid ptosis with central levator disinsertion. There is a compensatory left eyebrow elevation. The effect is a very high sulcus with essentially no upper eyelid crease. On the right side you have a fold but this fold does not contain preaponeurotic fat.  It also hides the fact the sulcus is actually very high on the right side. It is not accurate the information you are being provide in the answer of another doctor. It is possible in many of these eyelids, but not all, to reconstruct the missing upper eyelid fold. However, many eyelid surgeons are not familiar with this surgery. Instead they are likely to offer removing the right upper eyelid fold. This would make you appear more symmetric but also the upper eyelids would be skeletonized. A physical examination would determine if you have sufficient preaponeurotic fat to undertake a reconstruction of the upper eyelid folds. On the right side the crease could be lowered and preaponeurotic fat advanced to the lowered crease. Provided you have this fat, this would give volume in the upper eyelid fold. On the left side, repairing the upper eyelid ptosis, lowering the upper eyelid crease, and advancing the preaponeurotic fat can reestablish a fold in many eyelids. I am attaching a link and a video reference. There is no substitute for a detailed in person assessment.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment regarding the outcome of any plastic surgery procedure, we need to see a complete set of proper before and after pictures.
If you don’t have it before, and after pictures, then ask your surgeon to forward the pictures they took.
Consider reposting with proper before and after pictures.
You do have some asymmetry in your upper eyelids and your eyes are asymmetrical as baseline as well.
The left eye socket sits higher in your skull in the right side.
This is pretty common.
On your right side, you have Slight hooding of your upper eyelid on your left side you do not.
Without seeing before pictures, we don’t know if you had significant hood of your upper eyelids to start with.
You’re not going to be able to create hood of the left upper eyelid so the best you can do is remove more skin from the right side making it match.
I don’t see how Botox is going to help anything.
I don’t understand how weakening the muscle is going to make your eyelids even?
You may want to ask your provider to explain how that would work?
You need to either go back to your provider and ask them to do a revision for you or find another plastic surgeon to do with the revision if you want to improve the outcome.
 me doing a revision removing slightly more skin on the right upper eyelid seems pretty straightforward and is something that could be done in the office under local anesthesia.
While it’s not the most desirable thing to do from the plastic surgeons perspective, I think it’s indicated and would be appropriate.
All of that said, we can’t really make a good assessment without seeing before and after pictures so there are a significant degree of assumptions in my response.
Best,
Mats Hagstrom MD

Revision for uneven results over 1 year post-op, or will Botox fix it? (photo)

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Revision for uneven results over 1 year post-op, or will Botox fix it? (photo)

Answers (2)

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.