What can I do about the rounded droopy shape of my eyes post-bleph? (Photos)

Question

I had upper/lower blephs done in 2018. Eye shape has changed from almond to droopy and rounded mid lower lid and angled upward in the outer corners. I went for a revision consult with a Dr who specializes in bleph revisions. He didn't want to go the canthoplasty or pexy route. Suggested maybe a brow lift/another upper bleph. Not sure that will cure lower lid issue. Cheek lift/Fat transfer? What would be safest and most effective? Better with smile/squint but looks like face is melting off at rest

Kenneth D. Steinsapir, MD · Answer

Don't get more harmful surgery. You need surgery that will make you look better. An isolated canthoplasty will not fix you. you have significant issues in both the upper and lower eyelids. Grafted fat to the midface is popular with surgeons but a disaster for patients. It is like injecting scar tissue and will make the post blepharoplasty lower eyelid retraction much worse. You are vertically short (pulled down) in the lower eyelid. You also have midface ptosis. Isolated canthal surgery does not have the strength to support the eyelid margin and the weight of the cheek even if you drill a hole in the bone. The lower eyelid reconstruction must address the lack of soft tissue and the contour of the lower eyelid. The eyelid margin in now coupled to the cheek. A vertical midface lift recruits skin and soft tissue accomplishes this. I am providing a video below that shows how I repair these aesthetically. The other issue you have is your upper eyelids. You have uncorrected upper eyelid ptosis with a significant compensatory eyebrow elevation. You do not need a brow lift, what you need is anterior levator resection ptosis surgery and anchor blepharoplasty. Don't waste time with surgeons who mean well but do not know what they are doing. Your eyes can be your best feature.

Zoran Potparic, MD · Answer

It appears, at least based on these photos, that lateral canthopexy may improve lower eyelid asymmetry. Unilateral brow lift may address brow asymmetry. Second opinion consultation with a board certified plastic or oculoplastic surgeon should be considered.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of any plastic surgery procedure we generally need to see a complete set of proper before and after pictures.
If you don’t have it before, and after pictures, then ask your surgeon to forward the pictures they took.
Without seeing before pictures, we can’t really begin to make quality assessment.
From the pictures you included. It looks like you have a mild ectropion slightly worse on the right side compared to the left.
It would be helpful to understand if you had skin and or orbicularis muscle removed from the lower eyelid or if it was a fat only lower eyelid blepharoplasty.I think your upper eyelids look fine, and they should probably be left alone at this point.
Your brow, position looks high to me, and I see no clear indication for doing a brown lift.
I think the main issue is mostly related to the lower blepharoplasty.
My best guess is that skin and or muscle was removed when it shouldn’t have been.
To make a recommendation we really need much better information and really, that means having an in person consultation with an examination.
I think it would be inappropriate for us to recommend a revision operation without having access to full information.
 There are definitely procedures that could improve your outcome but first you have to get a quality assessment and secondly you need to find the right provider.
As you already know, at this point, you’re going to get different recommendations from different providers.
That is often the case when there is no one single clear solution.
That often comes from an ill defined problem.
The first step is always to make an accurate diagnosis.
In cosmetic surgery which generally call it an assessment.
Until you understand the problem, you can’t begin to prescribe the solution.
I’ve seen midface lifts do nice things for people who had similar problems. That procedure may or may not be appropriate for you.
Tightening your lower eyelid (canthopexy, or canthoplasty )could also be a potential source of improvement.
For now I suggest getting a complete set up before and after pictures and a copy of your operative report.
You should always bring those for any second opinion consultation.
Best,
Matt Hagstrom, MD

What can I do about the rounded droopy shape of my eyes post-bleph? (Photos)

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What can I do about the rounded droopy shape of my eyes post-bleph? (Photos)

Answers (3)

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