Revision to trim the muscle? (photo)

it's been 6 months after lower bleph with fat grafting. I've had acouple of steroid injections to reduce some of the excess fat but at this point my dr feels that what is left is muscle and it rolled up causing the fullness .. ?? my question is do I have him do a muscle trim or try fillers. and if I don't do the trim ..say in 10 years time will that muscle get more saggy .. my appreciation of your time is beyond words

Doctor Answers 4

He is not correct here.

By way of disclosure, I hate fat grafting to the lower eyelid. I see one or two new patents each week who need to have grafted fat placed by a well meaning surgeon removed from their eyelids. The fat heals irregularly. Some survives, some dies, and in both cases, scar tissue is formed. Steroid injections also damage the native fat tissue. Generally, I think that grafting fat into the lower eyelid is a big problem. The issue is predictability. I think rather than have the surgeon who made the problem stir up more trouble, you are far better off doing the service that should have been done in the first place: fillers. Fillers are also fussy so make sure the physician doing the fillers knows what they are doing.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Revision to trim the muscle?

After reviewing the statement and posted photos as best one can via the internet, I have to agree with Dr Neinstein as to the acceptable result obtained.. With that said any additional surgery, i.e. muscle thinning/trimming has a very high risk. And should ONLY be considered "if you can not live with the present look". As for issue of fat grafting, here I strongly disagree with Dr Steinsapir, if done using the Coleman micro droplet techniques the fat grafts can appear very natural. I see more lower lid filler issues monthly than fat grafting by far. But in your case I might try Belotero Balance as the filler of choice... Good luck.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews


I think you have a nice result, like the other doc it is really hard to go in there now and make things "perfect". If your doc thinks you have excess muscle try a little botox to thin it out

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
4.9 out of 5 stars 71 reviews

You do not appear to have an excess of fat here.

If anything, you need some volume in the lids. You are noticing the band of muscle that runs directly under the lashes. Because of the lack of volume underneath that, you notice this muscle more. Fat is tricky but can be a great filler to the lower lids. If you have already had trouble with fat, you should stick with fillers such as restylane or belotero.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

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