1 month post blepharoplasty and I have a large bag under my left eye. Is this normal? Is it swelling? (photo)

Dear Daisy
I suspect that you are unhappy with your surgeon. For certain you are unhappy with your eyelid surgery. It is very important to realize that you are very early from your surgery. Yes you appear to have some issues. The real questions is how will the eyelids look when the dust settles. It is important to not let yourself by driven to distraction while you wait for the paint to dry. God knows this can happen. I have seen pretty level headed people do that way. At this time, there is absolutely nothing to do put wait out the swelling.
How long do you need to wait. Well it is true that most surgeons will be reluctant to try and judge the outcome of your surgery for 6 to 12 months. If you try to have something done before this time, you are basically making your surgeon treat swelling.
The real question is what will the results like once you have healed-is it every thing you wanted or is something further needed to allow you to realize your goal. If there is still an issue, is it significant enough to live through another round of swelling and recovery to achieve this difference and if so, can it be achieved or is the further degree of improvement so small that it is unrealistic to expect to achieve it?
I find that recovery can be very psychologically stressful and often loved ones are not as sympathetic to these feelings because unlike medically necessary surgery, you choose to have this procedure. Of course this lack of support can take its toll. Consider finding a counselor or a psychotherapist to help you deal with you feelings of anger and frustration if these are a significant part of your daily thoughts as you recover. Feeling better may not change how you ultimately feel about your surgery but it will help you channel your energy in a more productive way while you recover.

It's not unusual for patients to develop swelling following blepharoplasty surgery. In some cases this swelling may be prolonged and take time to resolve. Although swelling is the most likely explanation for the puffiness of your lower eyelids, other explanations may also be possible. Since fat wasn't removed during your procedure, retained fat is also a possible explanation.Although, your history and pictures are helpful, it's virtually impossible to make this differentiation without a physical exam. Even a physical examination might not totally clarify the issue.For this reason, a conservative approach is probably indicated in someone who's only four weeks post-op. This should include head elevation, low salt intake and eyelid massage. After six months, if no improvement has occurred, revisional surgery should be a consideration.It's important to maintain close contact with your plastic surgeon. If revisional surgery proves necessary, your surgeon should be able to outline a treatment plan that addresses your anatomic findings and aesthetic goals.

At 1 month the eyelids are still in the healing phase. If they remain puffy or asymmetric at the 6 month point, then an enhancement can be performed. It is MUCH better if your surgeon was overly cautious and under corrected your lids rather than over correcting them, because it is easier to fix. 

Maximum swelling is usually at about 3-5 days and goes away over a few months. You should sleep with your head elevated and cut back on salt to help the swelling. Please see your surgery regarding the suture, which should be removed if it hasn't been absorbed at this point.

The swelling that you have experienced following your blepharoplasty is normal.  I advise my patients that after surgery they will most likely experience some noticeable swelling that will subside within two to six weeks.  Patients should know some minor swelling can remain for as long as six months, and their lid contours may continue to change.  Final results may not be seen until the six month mark. There are several exercises that you can do to assist with healing as well. You may also want to massage the lower lids.  I suggest discussing your concerns with your surgeon.  Best of luck, Dr. Clevens

As you are relatively short post operatively, many of the concerns you have written about will continue to improve. Lower eyelid surgery continues to be among the most challenging aesthetic procedures we do and the time for the results to mature also take proportionately longer to achieve the final result. The lower eyelid is quite dynamic and the constant motion of the lid gives rise to some of the appearances you are noticing. I agree with lower lid stretches and tincture of time.

Your result will improve with time as the swelling resolves and the tissues settle. It looks like you need to massage the lower lids - especially your left lower lid. However, you should discuss this with your doctor first. Some patients have also found that Arnica Montana cream is useful to help resolve the swelling and bruising faster. Good luck with your recovery.

Since it has only been one month since your blepharoplasty, there is still some swelling left in the eyelids although rather minimal at this point. With respect to the muscle, the operative report from your surgeon would delineate the extent of any muscle surgery that was performed. Any dissolvable stitches should be removed because they are not doing any good at this point. If there are still large bags under the eyes, these can be removed at three months after the surgery.

I may see that the left eye is slightly larger in the bottom part of it where the white is showing. This is sometimes due to the skin being taken which can cause contraction of the skin downwards making the eye larger appearing. The bags can be due to a number of things. When it is located right under the eyelid margin it is likely coming from the fat within your orbit of the eye. This fat can be easily removed. When it is lower it is likely due to the eye muscle that surrounds your eye socket and that helps you close your eyes that is causing the bag. This is called the malar crest and it usually is due to the eye muscle hanging over the smiling muscles.
That is what I see in the picture. Midface lifts can improve these malar crests but volumizing this whole area can improve the appearance of this cheek region. The larger appearing left eye can also be due to ptosis of the right eye or swelling. Ptosis is when the eyelid margin becomes droopy in relation to the iris. Ptosis can be temporary and can last months if caused by the procedure. Other times, the ptosis can be due to an actual injury to the muscle that opens up the eye (the muscle that pulls up the eyelid margin). This can require a more formal repair and is very difficult.

Most of my patients have postoperative swelling, some greater than others. This is particularly true if I'm doing a lot of procedures such as lifting the cheek fat pads, elevating the muscle, repositioning fat, or performing a canthopexy (lifting the lateral aspect of the lower eyelid).

I encourage my patients to actively blink and hold the squinting position for five seconds. They repeat this five times and repeat this maneuver three times a day.

In addition, I have my patients massage from the middle aspect of the bone below the eyelid in a lateral sweeping direction.

Both of these maneuvers will help mobilize fluid and increase muscle tone.