Lower bleph concern - is this how it should appear around my eyes? (Photo)

Question

Several years ago I had lower blepharoplasty done to reduce what I perceived as a tired appearance around my eyes. After having the surgery and giving it plenty of time to heal I noticed I still had two puffy areas around the outer edges of my eyelids. I asked my surgeon if it was possible this fat was missed during the procedure and was told it was not the case. I'm asking for another professional opinion based off the photo I'm providing. Is this how it should appear around my eyes?

Camille Cash, MD · Answer

It's difficult to give an opinion without more information.  You stated that the procedure was several years ago.  Was the contour like this since surgery and has it changed at all over time?  Before photos would also be helpful.  If you are considering a revision I encourage you to visit with a few board certified plastic surgeons to review options.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment, we need quality information.
To make a good assessment regarding the outcome of any plastic surgery or procedure we usually need to see a complete set of proper before and after pictures.
If you don’t have a full set of before, and after pictures, then contact your provider and ask them to forward the pictures they took.
 The quality of the responses are going to be a reflection of the quality information provided.
Based on the single picture you’ve put up it looks like there may be some visible fat in the left lateral lower eye lid fat pad. 
It would be helpful to know the exact type of procedure you had.
I’m guessing you had an open lower blepharoplasty with some skin and possibly some orbicularis muscle removed.
I personally I’m not a fan of removing skin of the lower eyelid because it leads to premature ectropion development.
Lower eyelid, aesthetic surgery can be a bit tricky.
Often there are two different variables contributing to the aged appearance.
Bulging of the lower eyelids is one part and a natural loss of midface volume is often the second.
These two tissue changes happen immediately adjacent to each other and sometimes the best treatment options need to Address both variables.
I don’t see any issue with how the procedure was performed.
Removing all the fat from the lower eyelids can cause irreversible undesirable outcomes with a hollow appearance.
The whole procedure is a balancing act, and the problem is rarely based on excessive volume.
In reality, volume loss is a more contributing factor.
It’s the position of the fat pads that is the true issue not the size of the fat pads. Lower eyelid blepharoplasty is a less than perfect procedure.
It doesn’t address the primary cause which is weakness in the peri-orbital septum.
Based on the information provided, I think your surgeon did a fine job with your procedure and I don’t see a strong indication for having revision surgery.
Your surgeon is going to be biased about the outcome so consider getting a few in person. Second opinion consultations if your outcome bothers you enough that you’re willing to have a revision surgery.
,Based on the information provided, I think your surgeon did a fine job with your procedure and I don’t see a strong indication for having revision surgery.
Your surgeon is going to be biased about the outcome so consider getting a few in person. Second opinion consultations if you’re outcome bothers you enough that you’re willing to have a revision surgery.
Best,
Mats Hagstrom MD.

Lower bleph concern - is this how it should appear around my eyes? (Photo)

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Lower bleph concern - is this how it should appear around my eyes? (Photo)

Answers (2)

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