Remaining Eyebag and Slight Asymmetry After Lower Blepharoplasty

I had a lower Blepharoplasty done 2 1/2 weeks ago where the incision was done on the outside corner of my lower lids. Before the surgery, I had a bigger eye bag under the left eye but my eyes were symmetrical. Now, 2 1/2 weeks later, I still have the bag under my left eye (some slight bruising still showing) and the left lower lid is slightly higher than the right (probably because of the skin that was excised). How can I tell if the left eye bag is still there or if it's just residual swelling?

Doctor Answers 22

Need to give it more time

Unfortunately it is common to have swelling and mild asymmetry that early after surgery, particularly when a lower lid incision on the skin rather then on the inside of the eyelid has been performed. It is impossible to achieve complete symmetry in any plastic surgery procedure, but if you notice some mild asymmetry it probably will resolve. It will take several months before knowing the final result and any potential long term asymmetry that may result. Hopefully you will have an excellent result.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Eyelid healing takes time

After a blepharoplasty, like any surgery, there will be some swelling and bruising.  The swelling and bruising may not be the same on each side, so you will see differences.  Expect 3-6 weeks for most all of the swelling and bruising to go away - one side may clear up faster.  Be patient and discuss your concerns with your doctor!

Randy J. Buckspan, MD
Austin Plastic Surgeon
4.6 out of 5 stars 9 reviews

Too early to tell final Blepharoplasty results

Sue,

As most of the other partcipants have suggested, it's far too early to know what your final result will be. Fluid accumulation and bruising can often be noted for weeks to months post-op. Communicate your concerns with your surgeon - most surgeons welcome an open honest dialog.

I often suggest light massage to the area of concern. A low-salt diet may be helpful with the fluid retention. The scarring along the incision line often takes months to soften up and mature, and the scar may feel somewhat rigid until this happens

Wilfred Brown, MD
New York Plastic Surgeon
4.7 out of 5 stars 13 reviews

Time will tell

At only 2.5 weeks after surgery, there is still substantial swelling present so it won't be possible to know the answer to your question for another 3-4 months. Stay in close touch with your surgeon and be patient and give it some time. It's too soon to be worried.

Give it some time, communicate with your surgeon

Hi Sue,

Like you've seen in most of the answers, the main thing here is to wait a couple of months and see how the swelling settles down.

Very likely some of the differences you see from one side to the other will settle down.

Obviously your anxious about the situation. The best way to overcome this is to communicate your concerns openly with your surgeon. He should have made clear prior to the surgery that there's a lot of variation in the healing process in different people, especially the resolution of swelling. He can help you now by listening closely to your concerns, explaining normal variations in healing, and following up with you closely.

Hope this helps

Paul L. Leong, MD, FACS
Pittsburgh Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Patience is the toughest thing to have

Since your surgery was just performed, it is way to early to assess the long term results. Usually the 6 month timepoint is a good final result timepoint. Your doctor will likely have massage exercises for you to perform and may suggest injections, taping, etc. Once the final result has been achieved, hopefully you will be very satisfied with your result. If asymmetries are present, then the really tough decisions start.

Revisional lower eyelid surgery is one of the hardest of all areas in plastic surgery. Conventional lower eyelid surgeries involve removal of skin and fat from the lower eyelids. in some patients, this can cause characteristic patterns of hollowness or pulling down of the lower eyelids, often asymmetrically. The challenge for the revision is then to elevate the corners of the eyes, restore a healthy eye shape, and restore lost volume. All this and meet the patient's expectations!

This often involves a combination of midfacial advancement techniques (cheeklifts), LiveFill for volume restoration, canthal reconstruction, and scar revisions.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 138 reviews

Give it some more time

This is a good question. After any surgery, you are bound to have swelling and bruising that can last for several weeks to months. Blepharoplasty is not an exception.

The skin around the eyes is some of the thinnest in the body. Likewise, these tissues are even more susceptible to prolonged swelling after any trauma or surgery. It is not surprising that after two and half weeks you still are experiencing these issues. In fact, you may have to wait several months to see the final result.

Since you were asymmetric to start, It is not surprising that you are asymmetric after surgery - a different amount of surgery was likely required on either side to try to fix this asymmetry. Likewise,you may have differential swelling or bruising on one side compared to the other.

At this point you are early after surgery. I know it is hard, but please be patient and try not to spend your days looking in the mirror waiting for things to change. Just go about your usual activities and you will see changes week by week, not day by day.

Also, the next time you are in your surgeon's office, ask to see the pre-operative photos. Often after surgery, you analyze your face much more critically than previous. During this time you may notice asymmetries that you had not noticed before. I hope this is helpful.

David Shafer, MD Shafer Plastic Surgery

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 74 reviews

After blepharoplasty surgery asymmetry

This key thing is to give it some time at this point. I would wait atleast a full 3 months after surgery. When the eyelids are operated on, you can have swelling and bruising on the skin but also inside in the eyelid. Though the skin bruising disappears, the inside swelling and bruising can continue resulting in an asymmetrical appearance. This should resolve with time. Most surgeons would not do anything for 6 months on average for a small amount of asymmetry. You are in the very early phase of healing right now. Give it some time and it should get better on its own.

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon
4.9 out of 5 stars 7 reviews

Wait for 4-6 weeks for evaluation after Blepharoplasty

I would recommend that you wait long enough for the swelling to resolve. Evaluation could be done following 4-6 weeks from surgery if necessary a revision could be done but not before 6 months.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

The lower eyelids take several months for full healing

The lower eyelids take several months for full healing to settle in so that some residual edema, swelling, and bruising can be in effect for several weeks after the surgery. The goal for lower eyelid surgery is to remove fat bags, which are composed of fatty tissue underneath the eyelids.

There are three fatty tissue bags in the lower lids and two in the upper lids. The bags are removed through an incision made inside the lower eyelid; this is referred to as transconjunctival approach.

If there is excess skin, which is typical of patients over 50 years of age, a small strip of “pinched” skin can be removed just below the lash line. This should be done symmetrically so that there is no asymmetry created.

Lower lid blepharoplasty needs to be performed conservatively. If too much fat is removed the lower lids will look too hollow, and if too much skin is removed, then a pulled-down, sad-eyed appearance will result (hound dog eyes).

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 133 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.