I had an upper blepharoplasty two years ago where only skin needed to be removed. Now I'd like to remove underlying fat as well. Must my incision site (scar) be re-opened for this to occur?
Second Blepharoplasty Incision?
Doctor Answers 14
There is a procedure known as a "stab blepharoplasty" which can be used on the upper lid. Basically, there are two fat compartgments in the upper lid. Small "stab" incisions are made in the old scar and a measured amount of fat removed from the appropriate compartments. The incisions are so small they can be closed with either a single stitch or no stitches.
I have had excellent results in fine-tuning any minor fat adjustments with this procedure. Best of luck.
Secondary upper Blepharoplasty can use smaller incision for fat removal
If you are very happy with the scar from your previous upper blepharoplasty then you may not want a full incision.
If the puffy area of fat is primarily near the nose, a tiny puncture incision can be made through the old scar and the fat removed.
If you have diffuse puffy swelling across the entire upper lid, excess skin, or an unsatisfactory upper eyelid scar, then re-excision of the scar and fat removal will be required.
It is optimal, if you have residual fat in the upper eyelid, to make small slits in the same incision site so there is not another scar just to remove the fat.
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Use same incision
A second blepharoplasty incision should completely remove the previous incision. The scar is excised through the very same incision and fat is removed from underneath the eyelid.
Upper lid scar usually doesn't need excision
The upper lid heals so well that the scar does not need to be excised. In other areas, we completely remove the old scar. But in the upper lid, this isn't necessary. Because only fat needs to be removed, only two small areas of the scar need to be opened. This should be a very fast and relatively uncomplicated surgery.
Small incision best unless there is skin laxity
If we are performing a revision for fat reduction we would utilize a small incsion so as to to not create more scar tissue. If there is a noticeable bulge this would provide aesthetic improvement. Filling of the later rim and lid area above the incision with fillers or micro fat transfers can also add aesthetic improvement
Only minimal fat removal during secondary Blepharoplasty
Fat is only removed from the medial and middle compartments of the upper eye lid. The lateral compartment is occupied by the lacrimal gland. Only conservative removal is needed. Too much fat removed will create a deformity called a frame. This could be difficult to treat. If needed, your old incision will be used. This incision heals vey well. I think that good exposure is every thing during surgery, it is important to open enough distance to allow good exposure of anatomical structures. Hope that helps
If you already have the incision, use it again
As you have seen from the other answers, fat removal from the upper lids is much less common than it used to be. But if you need it and already have the incision, I would logically just reuse it.
I would recommend going through the old blepharoplasty incisions to remove fat. The upper eyelid skin usually heals very well, so re-cutting the old incisions is not a problem. Going through the old scar is the safest, most effective way to remove upper eyelid orbital fat. If additional skin needs to be removed, this can be done at the same time.
Fat very seldom should be removed from the upper eyelids
Hello again. We used to make upper eyelids hollow. Full upper eyelids are attractive (look at models). So be careful.
But if you are sure that fat needs to come out, it can be done from the INSIDE of the lid (transconjunctival approach). We do this in the lower eyelids routinely. So your scars don't have to be touched.