Has my upper eyelid blepharoplasty gone wrong?

Question

I had blepharoplasty 20 days ago and I am concerned that my eyes sit too deep in the inner corner and eyelid width is uneven. I am posting before and after photos for comparison. I think overall my eyelids are supposed to be the equal width, but they start too wide from the inner corner and then become narrow. Please, advise if I may need a revision. Thank you.

Kenneth D. Steinsapir, MD · Answer

This is Post Upper Blepharoplasty Syndrome (PUBS). This includes a high upper eyelid crease, upper eyelid ptosis, lash ptosis and a compensatory eyebrow elevation. This type of result is all too common. This is caused because most surgeons misunderstand the purpose of upper eyelid blepharoplasty. You needed only a small anchor blepharoplasty with exposure of just a small amount of upper eyelid platform. Instead, you got this. I think it is appropriate for you to ask for your money back.
This is largely fixable but it is not in any sense a revision but an actual reconstruction. Your upper eyelid creases have been made far too high. The internal septal wound used to remove anterior orbital fat contracts. As it does, it pulls up the inferior septal edge which it is attached to the levator aponeurosis at the eyelid crease where these two structures fuse. This disinserts the central levator aponeurosis causing a white line disinsertion. The absence of support for the eyelid platform skin also accounts for the upper eyelid lash ptosis.  The crease can be lowered, and the ptosis repaired.  Orbital fat that is matted down in the septal scar can be mobilized to restore volume to the upper eyelid fold. The lash ptosis can be addressed with an anchor blepharoplasty. Study the attached video.  Regarding timing, you should heal for another 6 or 7 weeks before getting assessed. Reconstructive surgery generally is best after 6 months of healing.  However, for social reasons, reconstructive surgery can be performed at an earlier date if appropriate. My out of town patients spend a week in Los Angeles before returning home.

Thomas A. Mustoe, MD, FACS · Answer

You are only 20 days out and the differences in wound healing, and eyelid asymmetry will even out over time, and probably not need revision, but you need to wait several months to make a final judgement with your surgeon.  You have had significant removal of upper eyelid fat, and it has changed the appearance of your eyes perhaps more than you wanted.  The lateral hooding is often best addressed with a temporal brow lift, with or without a conservative upper blepharoplasty and fat removal. If you are still unhappy with the changes in your eyelids, I have on occasion done fat grafting to the upper eyelids to restore some of the fat that was removed.  At this point you are still early in the healing process, and you need to wait and see.

Mehryar (Ray) Taban, MD, FACS · Answer

Important to communicate with your surgeon and allow more time to heal. It is possible you would benefit from upper eyelid filler injection later.

Sanjay "Jay" Keni, MD · Answer

Hi Mmayka,
It's too early to tell.  You still have healing taking place.  
I will usually recommend to my patients to apply a silicone-based scar product to help the incisions heal nice and smooth so they essentially disappear.
Wait another 5 months and see.  At that point, address your concerns with your surgeon, or a trusted facial plastic surgeon.
Best wishes on your journey,
Dr. Jay

William Marshall Guy, MD · Answer

Hello mmayka1,You are only 20 days out so there is still healing to take place.  However, your before picture shows a little excess skin based towards the outside as opposed to inside corners of the eye.  The after photo shows more hollowing of the inside corner.  With the removal of so much fat the eyes will have this hollow appearance.  I would discuss your concerns with your surgeon.  Depending on your goals a procedure that adds volume such as filler or fat transfer may be helpful to create a more youthful and less hollow appearance.  I hope this helps and good luck.

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