Lower transconjunctival bleph, w/ fat grafting 15 weeks ago, why is my left eye still so swollen and asymmetrical? (photos)

Question

Has been nearly four months since surgery and left eye remains persistently swollen even after dilute steroid injection of kenalog 10 at 12 weeks post op. Appears as though fat took too much on left side and not enough on right side. Swelling or fat under left lower lashline is pushing up lower lid and blocking significant portion of iris. Right eye looks same as pre-op photos. Can anything be done to resolve this? When should I consider revision? Scared at thought of this being permanent!

Brian K. Machida, MD, FACS · Answer

You need to give it more time to allow the swelling to go down.  Swelling after fat grafting in the lower eyelid can take months to go down and you should give it al least 6 months after surgery.  Be very cautious about further kenalog injections in this area.  Give it more time before doing anything else.

Kenneth D. Steinsapir, MD · Answer

Here is the thing though, you should let this heal 6 to 12 month before having a surgical revision.  Persistent swelling associated with the fat graft can persist for many months. On the other hand, kenalog injections have proven highly unreliable for resolving issues with fat grafting. The steroid can kill your native fat and cause skin atrophy.  Consider reposting in 2 more months.

Shoib Myint, DO, FAOCO · Answer

Hello KinT.O.,It is not unusual to have swelling this far out from lower transcon bleph with fat transfer. Sometimes steroids can ring the swelling down. This is a discussion you will need to have with your surgeon. Remember that the lower eyelid is the thinnest skin in the body with increased vasculature and compromised lymphatic system. Edema is very common from your surgery. Hope this helps. Patience for another 2-3 months.Cheers

Michael Elam, MD (retired) · Answer

Swelling is common with this procedure and I am not a big fan of fat grafting directly under the eyes. With that said, I would be very cautious having steroid injections in this area it may cause atrophy to your normal tissues. Best regards, Michael V. Elam, M.D.

Lower transconjunctival bleph, w/ fat grafting 15 weeks ago, why is my left eye still so swollen and asymmetrical? (photos)

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Answers (4)

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