Eyes still puffy 90 days after face lift: I am very concerned with the eye bags that I now have. (Photos)

Question

I had a full face lift, neck lift and upper and lower blepharoplasty 90 days ago. A lot of the swelling has gone away, I am starting to have feeling back on the sides of the face (although the edges and top of my head are still very numb). I am very concerned with the eye bags that I now have. These were not there before, but now, they get worse as the day goes by. Is this due to swelling still? Or do I now have festoon or malar bags?

P. Daniel Ward, MD · Answer

Hi FLMom2018,Thank you for the question. I am sorry to hear that you are having this issue. You appear to have decreased lymphatic outflow from the eyelid region. This almost always improves with time. Things that can help improve the situation include lymphatic massage, massage of the area (gentle, but firm massage to help the swelling flow out of the tissue), and steroids (both oral and injected). Stay in touch with your surgeon and hang in there. It will get better!Please let us know if you have any questions or concerns.Dr. Ward

Thomas A. Mustoe, MD, FACS · Answer

The swelling in that area is due to fluid retention in the cheeks. Unfortunately that is not fully preventible or predictable, and is due to impaired lymphatic drainage in that area which some patients are prone to ( the malar area..this is not truly the eyelid). Until the inflammation and swelling from surgery fully resolves which can take many months, some accumulation of fluid in that area can still be an issue.  Sometimes but not always a steroid injection can help, as well as lymphatic massage by compression to that area a few hours a day (with tape or a bandage or a mask), but this should go away with time.   Discuss options with your surgeon.

Carey Nease, MD · Answer

Hello there FLMom18,It definitely looks like you are having persistent swelling of the lower eyelid area. This is pretty common but should be resolving by now. Talk with your surgeon and ask about lymphatic massage and possible steroid injections. Some people do swell longer than usual and I would expect in time this will resolve, even without any intervention. Have a great week!

James H. Rogers, MD · Answer

Although most swelling typically has resolved by three months after surgery, it can sometimes take much longer. The lower eyelids are particularly prone to this problem.Sometimes, a low dose of steriod can be used to assist with this, but must be done conservatively. Continue to followup with your surgeon and follow their guidance on this.

Scott Trimas, MD · Answer

It is likely that the swelling will resolve over time. Sometimes massage and a lower salt diet may help or even steroids. I would discuss your options with your surgeon. Typically, it can take up to six months or so to resolve.

Brian K. Machida, MD, FACS · Answer

This still looks like post op swelling which should improve with time.  Its best to follow with your surgeon.

Sanjay "Jay" Keni, MD · Answer

Hi FLMom2018,Sorry to hear of your frustrations!  This is a rare but known problem after facelifting and eyelid procedures.  It is usually due to interruption of the normal lymphatic drainage pattern of the cheek.  The malar area is thereby susceptible to swelling.Limiting salt intake, massage, and taping the skin flat nightly will help.  A oral steroid taper may help to resolve it faster.  At 6 months but not before, your surgeon may consider a surgical solution.Best wishes on your healing,Dr. Jay

Jeffrey Joseph, MD, FACS · Answer

Sorry to hear about your problem.  You have malar edema, which is usually a lymphatic drainage issue, as well as one of fluid retention.  I would limit your salt intake and consider lymphatic drainage, but only with the consent of your surgeon.  It will resolve, but takes awhile.  Best of luck.

Robert Brueck, MD · Answer

I feel this will go down.It is what we call malar bags and not fat from your lower lids.Why it is still there is unusual.Perhaps a steroid dose pack,heat and massage.

Darryl J. Blinski, MD · Answer

Sorry for the postop issue of residual malaria lower lid edema. Did you have fat grafting or repositioning of the lower lid fat? Best to see oculo-plastic surgeon fir a second opinion. I have rarely seen this event. Usually I recommend iced compresses, steroid regime, diuretics, might try very diluted KyBella drops as test.

Eyes still puffy 90 days after face lift: I am very concerned with the eye bags that I now have. (Photos)

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