Eyelid Puckering After Upper Bleph. Any suggestions? (photos)

Question

Approximately 7 years ago, I had an upper bleph for saggy eyelid skin. It was an improvement, but I think it could have been better. My eyes ended up rounder. I lost the almond shape I had before. I also ended up with "puckering" to the inner half of the lids. It was immediately apparent. It's as if a purse string was pulled too tight. It wasn't bad enough that I was motivated to undergo more surgery. I'm wondering if this would be a relatively easy fix. Thank you.

Soheila Rostami, MD, FAAO, FAACS · Answer

This happens when there is more than 10 mm of excess skin  THere are ways to avoid it but sometimes is very difficult to not to get this if the large amount of skin removed. The surgeon may be able to repair this with performing special procedure in the medial canthal area.

Edwin Ishoo, MD · Answer

Based on the limited view of the photo you've posted, I believe a fractionated non-ablative (e.g. 1550 nm) or ablative Erbium or CO2 LASER treatment would improve the skin laxity and irregularity.

Daniel M. Calloway, MD · Answer

Blepharoplasty, or eyelid surgery, is designed to restore the natural appearance of the eyelids.  For some individuals, excess skin and bulging fat of the eyelids are the only age related changes present.  However, for most of us, there are other related changes that occur with the eyelids.  One of the most common changes is the onset of laxity of the tendon at the outside corner of the eyes, known as the lateral canthal tendon.  When this tendon begins to stretch, the outside corner of the eye will begin to loose the sharp angle which creates the almond shaped eye.  In addition, if eyelid surgery is performed, this laxity can result in further rounding of the eyes.  In more severe cases, drooping of the lower eyelid may also occur.To correct this problem, tightening of the lateral canthal tendon, known as a canthoplasty, will restore the natural almond shaped appearance to the eyes.  At the same surgery, the puckering of skin of the upper eyelids can be revised.  These procedures are often performed under local anesthesia with mild sedation.Good luck with your revision!

William H. Bearden III, MD, FACS · Answer

If this is simply redundant skin, additional excision should help. If this is more of an anatomic lid fold, changing could be more complicated. Happy to take a look at it.

J. Charles Finn, MD · Answer

It looks like you have collagen depleted skin - from the limited view (can't see the scar itself), I suspect a fractionated CO2 laser would give the best results. Good luck!

Eyelid Puckering After Upper Bleph. Any suggestions? (photos)

Answers (5)