Would revision be recommended for unsatisfactory upper bleph? (Photos)

I am 11 months out from upper bleph., and I am not happy with the results. My rt eye has a bumpy scar line, which is worse when there is tension on my eyelid (like raising my brows.) My lt lid has a white scar from the center towards the corner. Additionally, I had "herniated medial fat pads," and it seems that those area are still puffy looking, especially in comparison to the rest of the lid. Yes, I have spoken with my surgeon. I am looking for opinions. Thank you in advance!

Doctor Answers 4

Upper Eyelid Surgery

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Revision of upper eyelid blepharoplasty can be done easily and very well in the office setting using local anesthesia. However, one needs to be extremely conservative if the patient has dry eye symptoms or has been told that he/she sleeps with his/her eyes open, in which case the secondary procedure must be cautiously weighed against the risks associated with worsening the symptoms. And if performed, it must be done conservatively, not removing as much skin as a surgeon would do in patients who are symptom free.

Hollow upper eyelids after blepharoplasty

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The main problem now is hollowness in the upper eyelids, with deflated balloon effect, which can be improved with filler or fat injection. Revision upper blepharoplasty may be needed too. See an oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Essentially your eyelids have been skeletonized by your surgery.

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What is wrong here is that the preexisitng ptosis was left unaddressed.  The surgeon also made a very high upper eyelid crease. Your natural upper eyelid creases were at about 8 mm.  The surgeon placed them at about 13 mm.  The platform skin was not controlled so as a result the platform skin is crepey which makes it very difficult to apply makeup and hold it there. This also affects the support for the upper eyelid lashes. Because your eyelids are ptotic, you have a compensatory eyebrow elevation that highlights the poorly designed upper blepharoplasty.  Correcting the upper eyelid ptosis will raise the upper eyelid margin and permit a lowering of the upper eyelid crease.  Correcting the ptosis, will allow your eyebrow to relax.  Study the accompanying video and the cited free ebook on eyelid surgery.  You have waited long enough for the eyelids to recover.  Things are not going to get better on their own.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

When to revise upper lid

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Overall your photos look pretty good.  Eyelid incisions usually fade to an almost invisible white line, but this can take as long as 18 months.  Without feeling the incisions it is hard to determine if there is any thickening of the scar, I expect your surgeon has addressed this with you.  I would lean toward giving this a little longer before considering revision.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

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