How can this bleph surgery be corrected, please? (Photo)

Question

It has now been a full month since my Blep surgery. I have included before and after pictures and seek your professional opinion. My incisions are too high, I cannot close my eyes completely, when forced closed skin under eyes wrinkle and lift. I have very little lid left if any and eyes keep watering and are very tight.

Kenneth D. Steinsapir, MD · Answer

Either this is a forum for the advocacy of consumers or it is not.   Certainly there are post-surgical situations where the issues are not very significant and patients just need to have reassurance and follow up with the original surgeon is very appropriate.  This may not be one of those circumstances.  Advising you to follow up with your surgeon may be like advising an abused spouse to return to their abuser.  Yes you have had an over aggressive blepharoplasty.  I am not in the head of your surgeon.  They obviously were concerned  about getting you a result where you were not likely to have residual lateral hooding.  My personal approach is to educate my patient about trade offs and I find it is better to do less than perform over aggressive surgery.  It is far easier to take a bit more skin than to have to use a skin graft to deal with over-resection.  Now if your relationship with your surgeon is basically ok, yes of course, follow up with your surgeon.  On the other hand, if your surgeon has a circle the wagon mentality and they are telling you that you look "marvelous," when you are actually having a problem, it is very hard to trust that person.  Your incisions are too high but recognize that some surgeon actually advocate this type of aggressive incision placement as a way to reduce the appearance of the lateral hood after surgery.  Again I personally do not agree with this approach because, while it solves one problem, it makes many more problems.  If you are having dry eye symptoms, seek management with an ophthalmologist who can actually examine the eye surfaces and recommend appropriate treatment.  Generally it is best to let the eyelids heal 6 to 12 months before considering reconstructive surgery.  However there are situations were earlier surgery is needed because medication such as drops, ointment and other measures are not compensating for the inability to properly blink and close the eyes.  It is not possible to restore the natural upper eyelid fold that was removed by this surgery.  It is not possible to restore the force of the blink mechanisms in the upper eyelid if it has been damaged by upper eyelid surgery.  If you are short of skin and this is limiting the blink, then yes, skin grafting into the upper eyelid can be helpful but it is not cosmetically appealing.  It is done to treat severe dry eye and the compromise in appearance is tolerated for the sake of comfort.  This can be a very hard pill to swallow.  For this reason, it is best to see what type of recovery you have simply medically managing the dry eye if this is possible and then deciding how to proceed. I am sorry you are in this situation and yes, there is real help out there.

Eric M. Joseph, MD · Answer

Email photos rarely tell the whole story, but based on what I see, your eyelid appearance may improve with time. Your incisions are red, but that will fade and become less noticeable. You do not appear to have significant corneal irritation. You should certainly liberally use eye lubricants for dryness and consult an ophthalmologist if you're experiencing dry-eye and discomfort. You could also get a second opinion from another reputable facial plastic surgeon. My hunch is that your eyelid appearance will improve spontaneously, and revision surgery may not be necessary.Hope this helps you.Dr. Joseph

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures. The height of your incisions can not be changed. It sounds like too much skin may have been removed because you can not close your eyes. If this does not improve with time then a skin graft would be required. Earl Stephenson, Jr, MD, DDS, FACS

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.Yes, this may correct itself. It has only been one month after surgery and the scar tissue may soften and loosen over time.  It takes about 3 to 6 months to completely recover from blepharoplasty.Lubricating eye drops or eye ointment can and will protect your cornea from drying out. Use day and night.

It is important for you to follow up with your surgeon on a frequent and regular basis and follow all instructions closely.If you are dissatisfied, see two or more board
certified and experienced surgeons in your area for a second opinion.

I hope this helps.

Neil Modi, MBBS · Answer

Protecting the surface of the eye is the priority as if the ocular surface dries, it can become damaged and compromise vision. If your surgeon was an Oculoplastic/Ophthalmic specialist then they should be able to advise about this, other wise it would be worth consulting one regarding the ocular surface. Lubricants would be worth taking and perhaps try taping the eyelids shut at night to protect the eyes. The eyelid surgery looks to have been done recently given the bruising. Further treatment depends on the ocular surface in the short term rather than the cosmesis. Best of luck! Neil

Michael Law, MD · Answer

Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients. Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

George C. Peck, Jr, MD · Answer

The incisions are higher than usual but the incisions are not that important at this time. Your ability to close your eyelids is MOST important. Obviously using natural tears and eye lubricants at night may help. Over time the eyelids will relax and you should get better closure. However based on your history and concern, you may want to see your opthalmologist to have an eye examination.Excessive tearing may be a result of over-exposure of the cornea to air. This situation can dry out the cornea, leading to corneal ulcers and infections. Please consult your surgeon or opthalmologist asap.Best wishes!

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