Outer lid heavier after revised upper bleph (1 year post-op) - What needs to be done to make this better? (photos)

If you have had two upper blepharoplasties and there is still some heaviness/hooding especially in the outer corners, then it is probably your eyebrow that is overhanging your eyelids. Your eyebrow also "droops" with time and gives the appearance that there is excess eyelid skin. However, your surgeon removed the maximum amount of eyelid skin without giving you issues of closing your eyes. So I would consider brow lifting procedures if you are still bothered by the appearance.

At this point, is possible that brow descent is causing fullness in the lateral brow. A lateral brow lift can correct this.

I would recommend an ablative laser to address the skin component; it is the best option to treat eyelid skin "crepey-ness".

Your photograph is somewhat limited. However, it appears you may benefit from a brow lift. It appears your brow has actually moved down and may be giving the effect you do not like. I would need better photographs to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Many thanks for question with photos. If you are only several months after eyelid surgery, especially your second eyelid surgery, the heaviness and more aged appearing skin may be swelling. Tissue of the eyelids and around the eyelids sometimes remain swollen at a very low level for months. Allergies, poorly maintained indoor ventilation systems, environmental dust or pollen, and/or low humidity can all prolong swelling, redness, and dryness after eyelid surgery. Best to ask your surgeon about these observations. If you are over one year after your blepharoplasty revision and still have these issues, additional micro- skin removal may improve the appearance. Temporal browlift also lift outer brow and tightens outer upper eyelid skin.

I'd consider a brow lift. A blepharoplasty removes excess skin and perhaps some fat. In your after picture the brow looks lower than your before photo.

We can see in the photo that there is some heaviness of your upper eyelid, by the tail of your eyebrow. Frankly, this does not look unusual or post-surgical in nature. Based on this singular photo, I would not recommend additional surgery. And examination would be necessary to determine what might be best for you moving forward. I hope this helps. Sincerely, Dr Joseph

Unfortunately, on average an upper blepharoplasty by itself actually decreases the distance between the brow and upper eyelid and does not correct lateral hooding which is what you have : because the brow is lower the hooding at least in the pictures you posted is worse. The corrective procedure is a temporal browlift which I often do as an office procedure: it is straightforward and will correct the problem. In my practice more often than not I combine an upper blepharoplasty with a temporal browlift to stabilize the brow position and correct lateral hooding. If properly done it doesn’t affect eyelid shape or shake if the brow.

Based on, these is very limited photographs, your eyebrow has decreased in height from the original position, therefore you might consider a brow lift procedure.

It’s hard to know for sure without having been present during surgery.
My best guess is that you have what is in a sense a “dog ear” of your upper outer eye lid.
This is not a term that is typically used around the eyelids. I think your surgeon limited the length of your scar in relationship to the amount of skin removed. There was probably a good reason to limit the length of the scar since having a scar extending beyond your lash line may also be undesirable.
I don’t know how much skin your doctor removed but I’m guessing it was maybe a bit much for the length of the scar. Asian eyelids can be tricky and other than “your problem” it looks like your surgeon made correct decisions. (The crease was kept low and the scar does not extend beyond the lateral canthus) which is technically correct for some asian upper eye lids.
My best guess is that you will need another revision extending the scar.
There are also a few things that come to mind from looking at your pictures. Are these the before and after pictures your provider took?
Your brow looks lower and there are differences in your lower eyelid in the after picture which makes me think there may be a significant time difference. Age can change outcomes and we really need proper before and after pictures to make a good assessment.
To get a quality assessment, I suggest having in person second opinion consultations with oculoplastic surgeons in your community.
For second opinion consultations, come prepared bringing with you a complete set of proper before and after pictures and a copy of your operative report.
These are all part of your medical record that you can request from your current provider.
You had a very good looking eyes, which makes me wonder a little bit why you chose to have surgery or why your doctor though it was indicated.
Best,
Mats Hagström MD