Severe Under Eye Wrinkles After Blepharoplasty

Question

I had upper and lower blepharoplasty about 4 weeks ago. I am looking for the best possible follow-up treatment to remove or greatly diminish the under eye wrinkles and possibly make that area a bit more taut.   Thanks so much.

Frank P. Fechner, MD · Answer

I assume that you had a transconjunctival ("inside the eyelid") blepharoplasty with some additional wrinkling after the fat was removed. In this case, there are a few options to discuss with your facial surgeon:
1. chemical peel
2. laser resurfacing
3. skin pinch
If you had blepharoplasty with the incision right under the eyelashes, then I would adivce you to wait for further healing to take place before considering any additional treatments.

Brent Moelleken, MD · Answer

Since you are very soon after your surgery, it is best to wait until all the swelling has gone (typically 6 months).  You wouldn't want to reoperate on temporary swelling.  Peels and laser could typically be done much sooner than the six months.
There are several options if the looseness persists beyond that.
If your problem before your last surgery was lax skin, the problem will likely still be there after a transconjunctival blepharoplasty.  The transconjunctival blepharoplasty is designed to reduce fat, and does not typically affect the skin.
Peels and lasers can tighten the skin somewhat, and for a small amount of laxity that technique may be just the thing. 
If true loose skin is present, a skin pinch is an option but can deform the lower eyelid, creating a downward vector on the lower eyelid, that, if uncounteracted with a like pull upward (ie through a cheeklift) can cause lateral orbital pulling down of the eye or rounding of the lower eyelid.  This change in eyelid configuration often takes months to develop as the forces of healing pull down on the lid.
For that reason, we typically perform a USIC, ultrashort incision cheeklift to prevent this from happening in all cases when we perform a skin pinch.

Kenneth D. Steinsapir, MD · Answer

Dear Jen Jen,
At 4 weeks out from eyelid surgery, you are very early from the eyelid surgery. If you are interested in further improving the eyelid skin wrinkling, you should discuss this with your current surgeon. Any plan to rejuvenate the lower eyelids should address the wrinkles of the lower eyelid. This may involve removal of skin during the eyelid surgery or by skin resurfacing which can be done in a variety of ways. These treatments can be performed at the time of surgery or can be separated in time from the surgical procedures depending on patient and surgeon preference.
I think it is only appropriate that you discuss your concerns with your surgeon in whom you trusted your eyelid surgery to. This person should be highly motivated to help you achieve you goals. If for some reason you have decided to not work with this individual, I think most surgeons will want to wait until you have fully recovered from your eyelid surgery before further addressing any residual issues.

Robert W. Sheffield, MD · Answer

Thank you for voicing out your concern. You have mentioned that it has only been 4 weeks since your blepharoplasty surgery and you noticed these wrinkles, which bothered you. Primarily, I would suggest that you discuss this with your board certified plastic surgeon so he or she could evaluate the situation through proper assessment. After that, I would like to assure you that you are still in the healing phase of your surgery. Usually, I advise my patients to wait for at least 3 months for complete healing to take its course.  I understand that you might find this traumatic, but please rest assured that this wrinkling will heal up in time. After a surgery, the skin surrounding the area tends to become a bit loose. However, as time will pass, the skin will shrink back to its initial firmness and state. That said, if after a few months post the healing phase the skin is still wrinkly, your options to fix it back would include chemical peels, lasers, as well as re-operation. You can discuss this directly with your board certified plastic surgeon. Do not hesitate to ask questions if you need to know more. Best of luck!

William Portuese, MD · Answer

Since it has only been four weeks since the blepharoplasty, there is still swelling in the lower eyelids. We can possibly make a final decision as to whether or not a pinch of skin needs to be taken on the lower lids. If a pinch of skin needs to be taken, it has to be done very conservatively so as not to change the shape of the eye or get a pull-down effect.

Carl N. Williams, Jr., MD · Answer

I use the example of washing sheets--You know after they come out of the dryer the sheets are pretty wrinkled. Then you stretch those sheets on the bed and you can still see the creases--- the only way to remove those creases is with a steam iron--the same goes with your skin. If you pull the skin too tightly, you can end up with ectropion or tugging on the lower lid. After about 6 weeks or so, I Fraxel my lower lids and this tightens up and smoooths out those creases.
Talk to your doctor about this.

Jeffrey Zwiren, MD · Answer

Creating taut skin of the lower eyelid can be a difficult task to accomplish without significant risk of lower eyelid malpostion. The position and balance of the lower eyelid is very complex and there are many factors that come in to play when deciding what type of lower eyelid blepharoplasty is appropriate in each individual situation. The lower eyelid is like a clothesline. Too much tension and pull will cause a bowing of the lower eyelid creating the hound dog appearance. The lower eyelid will not support the cheek. Many surgical procedures of the lower eyelid attempt to deconstruct and then reconstruct the lid. In most cases this can be accomplished along wtih a tightening of the lower eyelid support structure known as the lateral canthal tendon. It is a mistake to substitue a taut lower eyelid skin for an abnormal postion of the lid. Your plastic surgeon is in the best positon to understand the individual nature of your soft tissue and eyelid support structures and to advise you on the best operative choices. At 4 weeks you are still very early in the healing period. Give it time, gently massge your lids, and follow up with your surgeon. Once you have fully healed there are alternatives such as surgical revision, chemical pees and laser to get the best result in your situation.

Scott E. Kasden, MD, FACS · Answer

You are still in the early stages of healing.  This is a fairly traumatic operation for such a small and delicate area.  You should do nothing without notifying/consulting with your surgeon, as what you do now may affect the outcome.
A word of encouragement.  Many times after surgery like this, the skin appears loose.  Over time, and with maturation of the site, the skin contracts or shrinks down and redrapes.  
In several months, if there is still laxity of the skin, several options are available including resurfacing with chemical peel or laser,  or re-operation.  All of these options if needed, are not a huge deal, so while you are being patient, don't get discouraged.
sek

Richard D. Gentile, MD - Account Suspended · Answer

We utilize a graduated system of addressing lax skin under the eyes. We usually perform some volume replacement with our lower lid surgery that addresses wrinkles by inflating the lower lid volume. We also perfom fractional ablative resurfacing, peels and skin pinch or excision. As you have addressed, this is severe, and we would look at some volumizing combined with skin excsion.

Brooke R. Seckel, MD, FACS (retired) · Answer

Fractional laser resurfacing can smooth eyelid wrinkles and Botox can reduce crow's feet.
It is important to wait 3 months after your blepharoplasty for healing to occcur and many of the wrinkles you see now may be gone.
You must have good lower eyelid support if you are going to have resurfacing of the eyelid skin. If your lower eyelid is lax, resurfacing can pull the skin and eyelid down.
See before and after pics of laser resurfacing of lower eyelid and botox treatments: Set 1, Set 2, and Set 3.

Severe Under Eye Wrinkles After Blepharoplasty

Answers (10)

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