Revisional Surgery for Brow Lift and Eyelids Worth It?
Doctor Answers 11
It gets alot harder the second time around.
I am sorry to hear of your disappointment. I will tell you that the key to optimizing surgery gone wrong lies in the appropriate preop evaluation by your next surgeon. As I understand it, you had a browlift and a blepharoplasty. It would be helpful to know if you had your upper or lower eyelids worked on. In terms of fixing your browlift, if you had only your upper lids done, then your surgeon must be very careful to re-pull only moderately (or not at all!) or you may not be able to close your upper lids from a skin shortage creation. If you had only your lower lids done, then a revision browlift is safe to perform if the brows still sit to low. If the brows are actually in good position, then you may just have excess upper lid skin that was never addressed giving you that crepey look to the upper lid.
In terms of revision upperlid surgery, it is usually straightforward. It is revision lowerlid surgery that is very difficult because of the risk of lid function problems. In my practice, I will usually send the difficult lower lid to an oculoplastic surgeon (an ophthalmologist who specializes in eyelid plastic surgery) to make sure a patient gets the best chance at a good outcome.
Revision surgery will carry greater risks because the surgeon has to go back through scarred tissues. Numbness and nerve injury are more possible. You may need other facial procedures to support a lowerlid redo and this should be discussed with your surgeon.
Revisional eyelid surgery is complex and often requires canthal reconstructive, cheeklift or midfacial advancement techniques, which are highly specialized.
During your consultations to see if a revision is necessary or recommended, it is helpful to see if the doctor has published articles on these topics, and to see if his artistic style in before-after pictures meets your expectations.
As difficult as your decision to have your first surgery was, the decision to have revision surgery is even more difficult.
You are absolutely correct! Every face is uneven.
I am sorry that you are disappointed with your results. I think I speak for all my colleagues when I say that we strive to achieve excellent results with satisfied patients. It is a matter of pride as well as essential to being successful. That is why all the previous responses suggest that you go back to your first surgeon whose goal it is to satisfy your desires.
The real question is whether surgery should be done and whether it will achieve your goals.
Unfortunately sometimes the enemy of good is better. This means that if you have a good result, it is possible you good end up with a worse result in an effort to make it better. No one has a crystal ball and no one can predict the outcome of surgery with 100% certainty. There is clearly an element of risk. Furthermore it is possible to overcorrect.
When you say that you swear that your face is uneven you are absolutely correct! Every face is uneven. The real question is it more uneven than before surgery.
The forehead and upper eyelids are complicated by the fact that there is an element of movement that can affect the results and change what you can observe at the end of the operation.
It is not uncommon for some eyelid procedures to require a second procedure to refine the result. This commonly occurs in what we call blepharoptosis surgery (droopy or sleepy eyelids). Anesthesia, medications, and swelling can all effect the level of the eyelid during surgery and wear off later causing a change in the final result.
I would suggest that you go back to the first surgeon to discuss your concerns prior to seeing another physician which I would also recommend for a second opinion prior to undergoing any additional procedures.
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Communication and Planning are Critical
Unfortunately, complications and unsatisfactory results are a part of cosmetic surgery, as much as we surgeons try diligently to avoid them. Occasionally, this leads to a loss of confidence on the part of the patient towards the original surgeon, which is natural as well. The subsequent treating surgeon takes on the burden not only of the more urgent expectations of the unhappy patient, but the difficulty of correcting a problem not of his making. There is a high probability that the results will not be "perfect" under the best circumstances, and that there will be some lingering disappointment on the part of the patient.
In order to maximize the chances of a favorable secondary surgery, it is critically important that the patient clearly communicates the present details of what she finds unsatisfactory about the first surgery, and what are the goals she would like to achieve with the next surgery. It is very helpful as well to obtain the pre-operative photographs and medical records, including the operative note, from the first surgeon. This need not be done in a confrontational fashion, but simply as a request for information.
If the subsequent surgeon has confidence that he can improve your surgical outcome with a secondary procedure, careful planning is critical. It is equally important that the surgeon communicates with the patient both the best-case and worst-case scenarios of what he expects to accomplish for the patient, since the patient and her problems now belong to the second surgeon.
Finally, there is a big difference between "botched" and "not a lot of improvement", and some asymmetry is not only normal, but is expected and natural, and may only now be more apparent to you. Communication between surgeon and patient will go a long ways towards closing the gap between these two descriptions of the surgical outcome.
Revision Browlift and Eyelids
When you say you had eyelid surgery I'm assuming you had upper eyelid surgery. Often people who have browlifts are disappointed with the results. In order to fully achieve a noticeable browlift all of the connecting ligaments and muscles of the brow must be released appropriately. If you had any asymmetry prior to surgery then it is very difficult and nearly impossible to correct that with surgery. It is normal to have a small amount of asymmetry. Your individual situation depends on where you feel you may have asymmetry or fullness of you upper eyelids. If it is only laterally then just a browlift may correct your problem.
Complex anatomy and situation...
I understand that you have decided to not have your original surgeon perform any revision procedure.
In this case in order to get the best care, and advice, I suggest you obtain from your prior physician a set of the before and after pictures. If you can also get a copy of the operative report that would be very useful for any future physician to best understand your situation. Also it is important that if you have any visual, and or, other eye complaints (such as “dry eye syndrome”) an examination by an eye surgeon/ophthalmologist may be helpful.
Keep in mind that in general terms, the procedures you are referring to (especially eyelid area surgery-blepharoplasty) involves anatomy that can be somewhat unpredictable upon redo procedures; particularly if performed within the period of one year as you describe.
As far as seeing a set of before/after images for what you are describing you may find what you need by going to the American Society for Aesthetic Plastic Surgery web site, and search for the procedure. The link is www.surgery.org/public/photos .
S.P. Maggi, M.D., Austin Plastic Surgery Center
I am sorry to hear about your disappointment. Surgeon selection is key for the success of cosmetic surgery especially revision surgery. Consult with 3 - 4 surgeons to find one that best meets your needs. Frequently, revision surgery can be trickier than the original surgery.
A tough situation
I assume you have compared your pre and post operative photos to assess the amount of assymetry. Conferring with another doctor or two is not a bad idea. Realistic expectations on the amount of improvement are necessary to ultimately get an outcome that everyone wants. I have done revisional surgery for brow and eyes on my patients as well as other platic surgeons' patients. I have also had my patients go elsewhere for further consultation and treatment. Be careful and choose a reputable , board certified plastic surgeon. All the best.
It is importnan to discuss your goals with your surgeon. Also it is helpful for the new surgeon to know what procedures you had performed. Revisional surgery can be toughter because sometimes you have to work within the confines of the previous results.
Look at the anatomy carefully
There is so much variation in brow and eyelid surgery, as well as in a patient's normal anatomy, that it is hard to answer your question specifically. Most people's faces, and especially eyes, are asymmetric. Surgery itself is not an exact endeavor. If your original surgeon is reputable and skilled, you are almost always better off going back to him or her because the original surgeon always has a more complete fund of knowledge about what was done or not done. A new surgeon is always guessing or interpreting to some degree. However, if you have lost confidence, that would preclude you returning to your surgeon.
Revisional surgery can be a simple matter or a very complex one. Or it may not help at all if your anatomy dictated a certain imperfect result. The key is in the anatomical analysis and I would ask the surgeon you go to to explain in detail the anatomy and rationale of the problem and treatment. Every patient and every surgery is a little bit different. Good luck.