Not happy w upper/lower bleph (Photo)

Question

I had upper/lower bleph on my eyes in March of 2022. My main concern was the bump on my left under eye. Told him (Dr Nick Rana,Plano TX) if my left eye looked like my right, I would not be having surgery. I am looking for ways to fix this that don't include lasers or injections if possible. I believe I may have Lymphatic drainage issues and have had numerous sessions for lymphatic drain as well as acupuncture.

Kenneth D. Steinsapir, MD · Answer

Are all your photos after images? It is very helpful to have photos that are taken looking straight ahead. In these photos you are looking down. Your issues have nothing to do with "lymphatic drainage." The lower eyelid bag on bag is from chronic skin and connective tissue from sun and oxidative tissue damage. These do not respond well to standard lower eyelid surgery. In some patients an extended transcutaneous  skin flap is needed to allow resuspension of the lower eyelid orbicularis oculi muscle to the lateral orbital rim periosteum. In some cases a phenol 89% chemical peel is helpful. Generally a detailed in person assessment is helpful to formulate the best approach. What is not helpful here is fat grafting, threads, or a temple lift. I understand your concerns about fillers and I suspect that you will need revisional surgery. However, don't throw the baby out with the bathwater. There may be a limited role for hyaluronic fillers in the future.

Camille Cash, MD · Answer

You can consider further revision to remove excess skin or perhaps Morpheus8 treatments to tighten the skin and improve overall tone and texture. See your surgeon or another board certified plastic surgeon near you for an evaluation.

J. Renee Booth, MD · Answer

Unfortunately, topical medications such as tretinoin will not help much. You could try oral bromelain which helps with swelling, however I think the improvement will be limited. For persistent peri-orbital edema, radiofrequency microneedling (like Morpheus8 or Matrix RF) is a nice option with less downtime than laser. It can tighten skin and is second only to laser in its ability to tighten the skin (the laser settings must be appropriate to address skin tightening). Laser requires attentive care afterward, but it improves the quality of skin significantly and the newest studies show that laser actually reverses DNA damage due to aging. Aside from those, nanofat injection uses stem cells to promote the self-healing capability of the body.

Kenneth R. Francis, MD, FACS · Answer

Dear mgc,
The most recent photograph that you provide is almost a full year ago.  It is difficult to opine on your results without something more recent.

Mats Hagstrom, MD (license on probation) · Answer

I think your lower eyelid blepharoplasty was going to be challenging, regardless of who did the procedure.
There appears to be laxity in the lower eyelid, and you were beginning to develop an ectropian or at for having an ectropion if skin and orbicularis muscle was removed.
 To make an accurate assessment on the outcome of a plastic surgery procedure we generally need to see a complete proper set of before and after pictures as well as access to your operative report to understand exactly how the procedure was performed.
There are many different ways of doing a lower eyelid blepharoplasty.
It can be done Trans conjunctively or open. Skin and orbiularis muscle can be removed or left intact.
There’s also a loss of midface volume.
I think the procedure gave you an improvement, but your candidacy was inherently limited, and this was going to be a difficult procedure. No matter who did the operation.
Sometimes there are simply inherited limitations in what can or cannot be achieved based on each individuals candidacy for the procedure.
If you want, proper second opinion consultation, then schedule those as in person consultations with other providers in your community.
For second opinion, consultations come prepared bringing with you a complete set of proper before and after pictures and copies of your operative report.
These can be obtained from your current providers office if you request them.
Best,
Mats hagstrom MD

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