Seeking repair for effects 20 years after full lower bleph (Photo)

FULL Lower bleph 19 years ago, now sagging lower lids. Restylane in tear troughs not good. Week ago Radiesse injected under muscle in cheeks 1" below bone to fill from below plus botox on crows feet. Wonder about better options. Considering fat transfer or skin pinch, but wonder if problem warrants either.

Doctor Answers 4

"Post-Blepharoplasty syndrome"

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Your non-smiling photo demonstrates the after effects of an aggressive lower eyelid blepharoplasty that used to be the standard back a couple decades ago.
Our approach has changed significant to minimize volume loss as well as the pulling downward affect of the lower lid and outside corner of the eyes which give the patient a sad appearance.
Volume addition [whether fat grafting or hyaluronic acid fillers] certainly can help, but lower lid retraction repair with support of the corner of the eyelids with a canthopexy is indicated to give your eyes the more natural and aesthetically pleasing almond shape to the eyes.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Revision eyelid surgery?

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It is unclear from your questions what your goal is.  If your goal is to rejuvenate your lower eyelids, then revision surgery, including surgery on the canthus would be helpful.  A pinch method could be used as part of this procedure.  If your goal is to increase volume in your cheeks, then there are several options.  These procedures can be performed separately or together, again, depending upon your goals.  A consultation with a board certified plastic surgeon would be helpful for you.  If you limit your choices to non-surgical options, then your results will be limited because these options cannot correct all of the issues that may exist, based upon your photos.  An exam is crucial for your to get the best advice.

Mark P. Solomon, MD
Philadelphia Plastic Surgeon

Sagging lids and cheeks 20 years post blepharoplasty

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Sagging lids and cheeks 20 years post blepharoplasty can be repaired with a cheeklift with or without fat grafting or small combined cheek implants. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Sad appearance

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I would recommend to do  fat transference to your cheek bone and a bit to nasolabial fold. 
Your upper lid could be improved with an upper blepharoplasty without fat pads removal, or something a bit more invasive like an eyebrow lift which would help to lift the brow and the eyelid.
Dr. Cardenas. 

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.