One Eye Barely Changed After Blepharoplasty

I had Blepharoplasty done 5 weeks ago, and I immediately noticed post-surgery that the incisions were not the same. However, I didn't worry. Now, one eye looks wonderful and awake, but the other still has overlapping skin and looks tired. What could have happened? Is this result common with the procedure? I'm not sure if I should call my doctor prior to our next appointment (at the 10th week), or just wait and let it heal.

Doctor Answers 15

See your doctor about asymetry of eyelids after blepharoplasty

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We always attempt to get perfect symetry between the eyes during blepharoplasty surgery. Sometimes we fail. The reasons can be several:

  • Uneven design of the incision
  • Uneven skin resection
  • Significant asymetry of the eyelids before surgery
  • Asymetrical healing after surgery

Whatever the reason in your case, it is important that you see your doctor and discuss the result. If more skin needs to be removed this can usually be accomplished but i would wait at least 6 months.

If the incision was placed asymetrically repair can be more difficult.

In some cases, if your eyelid folds were very asymetric, a procedure called a supratarsal fixation can be done to corrrect the problem.

Asymmetric excision or Ptosis both are not hard to fix.

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Five weeks after surgery is a little early to consider revisions. The cause of asymmetric eyes after blepharoplasty includes:

1-Asymmetric incision or removal of less skin on one side.

2-Droopiness of the upper eye lid due to weakness of the muscle (Ptosis)

In any case small revision would fix the problem. I would still wait for few more time and a close follow up with your surgeon is key. We published a paper in 2007 regarding the treatment of the same condition (Ptosis) especially when it is diagnosed before surgery.Transblepharoplasty ptosis repair: three-step technique.McCord, Seify, Codner.

I hope this will be helpful.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Sometimes asymmetrical eyelid surgery will result in a more symmetrical result

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Sometimes asymmetrical eyelid surgery will result in a more symmetrical result; when eyelid skin and fat is asymmetrical, surgery can be done to improve symmetry. It is always easier to go back and take more skin and fat out than to try to put it back in.

An additional single eyelid blepharoplasty procedure can be performed as a touch-up procedure to further balance the asymmetry that is currently present to improve the look of the eyelids. This should be done approximately three months after the procedure to make sure all swelling has subsided.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Don't forget about the brows!

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One of the most overlooked contributions to excess upper eyelid skin is the postion of the brow. Interestingly, it is common for one brow to be lower than the other, creating more extra eyelid skin on one side. This is something I point out to patients before any eyelid procedure, and I will often recommend a brow lift with blepharoplasty. If there was no difference in brow height before surgery, asymmetric skin removal is another possible cause of your concern. Undetected eyelid droop (blepharoptosis) or inadvertant muscle tendon injury during the procedure itself are other unusual causes. Swelling as a cause of this difference would be uncommon after 1 month. Overall, blepharoplasty is a very high-satisfaction procedure.

Brett S. Kotlus, MD, MS
New York Oculoplastic Surgeon
5.0 out of 5 stars 63 reviews

Uneven eyes after blepharoplasty (eyelift)

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There are many factors which make operating on the eye difficult.

  • One is the interaction with the surrounding areas. For the lower eyelid we look at the cheek. For the upper eyelid we look at the forehead an brow
  • The activity of the muscle surrounding the eye are complex and can vary
  • The medications used during surgery can stimulate the eye or relax it causing uneveness during surgery

It sounds as if you may have a degree of blepharoptosis (droopy or sleepy) eyelind. If you do this can cause the eyelid creases to be uneven. This is occasionally missed prior to surgery or can be concealed by excess upper eyelid skin. Correcting this condition can result in a more symmetrical eyelid crease and incision.

You may want to discuss this with your surgeon or seek a second opinion. I would first ask about your concerns. However, it is most likely that any revisional surgery would be delayed so I am not sure if there would be any benefits to going in earlier than your scheduled visit.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

The eyes have it

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Five weeks following a blepharoplasty is still quite early. You may have different amounts of swelling on each side causing the asymmetric appearance. Have patience and trust your surgeon, especially if he/she is a board certified plastic surgeon. I'm sure that your plastic surgeon would be more than happy to discuss your current appearance with you before the 10 week proposed visit if you are really concerned. He/she may also offer some helpful hints as to how to manage your swelling. Good luck!

Earlier follow-up recommended

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Dear Bronte,

Your concern is not uncommon after blepharoplasty. Most healing and swelling should be resolved after 6 weeks, although it usually takes months to reach the final result. There is not much that can be done until healing has finished, to avoid "chasing your own tail" at surgery. Your surgeon should be able to explain what might be unique about your case to help you understand the assymetry. Careful evaluation of preop photos is essential. Hopefully you have at least discussed your concerns with your surgeon by phone by now. If necessary, a revision might be possible under local anesthesia in the office. Good luck to you.

Edmund Fisher, MD, FACS

Facial Cosmetic Surgeon in Bakersfield, California

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
4.6 out of 5 stars 13 reviews

Yes, call your physician who did the surgery

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It is always best to keep in contact with the physician who performed the procedure. I would suggest you call the office. It is always helpful for the surgeon to see exactly what you are talking about when it is happening. Instead of waiting. So call the office and see what they say.

This way you don't have to sit and worry.

Hope this helps,

Andrew Y. Kleinman, MD

Board Certified Plastic Surgeon certified by the American Society of Plastic Surgeons Westchester, New York

Andrew Y. Kleinman, MD
Westchester Plastic Surgeon

Post-operative Eyelid Asymmetry

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It's not unusual for patients to have significant asymmetry in the immediate post-operative period following blepharoplasty surgery. This asymmetry is often related to swelling which takes time to resolve. When this situation arises, patients are often upset with their result. After all, they had surgery to look better, not worse.

In your particular case, it's hard to evaluate your situation without pictures or a physical exam. In someone who's only five weeks post-op, your findings are probably related to differential swelling.  Unfortunately, there's probably no quick fix for this problem. It may take two to three months for your swelling to resolve.

Once these issues have resolved, your aesthetic result can be evaluated. It's still possible that you'll be happy with your surgical result. If you're not happy, secondary surgery may be a consideration. Revisional surgery shouldn't be performed until you're at least six months post-op. In the interim, it's essential that you maintain close contact with your plastic surgeon.

If asymmetry is still present after six months, secondary surgery may be necessary. Possible causes of asymmetry may include baseline asymmetry, scarring and uneven skin resections during the original procedure. All of these problems can be corrected with relatively minor surgical procedures.

Close contact with your surgeon is critical

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During the healing process, it is critical that you stay in close contact with your surgeon. He will be able to assess your concerns and let you know how he feels you are progressing. A few thoughts to consider, and some of these have already been mentioned.

We are all somewhat asymmetrical, and this means that not only can your incisions be different, but one side can heal differently that the other and at a different rate that the other, so patience is very important. The brow may or may not be an issue of concern, and I often see patients who have had eyelid surgery in the past, but really require a browlift.

Ask your surgeon if he thinks you may require this at some point, but not right now. Most likely, the two sides will approach a symmetrical result over time.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.