Still Excess Skin After Upper Bleph? (photo)

Question

Well hello. So i had upper bleph 6 month ago and i had posted here before 3 month after surgery because wasnt happy with the results and now 3 month later I am still very disappointed. when eyes closed there is still skin drooping down especially on the inside of my eye and when my eyes are open there is still not much eyelid visible (open eyelid is what i was going for) I had bleph without muscle or fat removal, so I was wondering if those should have been removed or if i need another bleph...

A.J. Amadi, MD · Answer

You have full eyebrows and eyelid which is a sign of youth! A bit of redundant skin is necessary for you to be able to close your eyes. If you are not happy with the appearance of your eyes at this point, your other option may be a brow lift to elevate the brow away from eyelids.

	I doubt that removing any further skin would achieve the more "open" look you are going for. An in person examination would be required. Removing fat from the upper lid is something we shy away from because we now understand that will lead to hollowing later on in life which is much more difficult to treat.

Kurtis Martin, MD · Answer

It appears from your picture that your brows are elevated appropriately so this is not a problem. It does look like you have some excess skin now versus a swollen scar. I would get other opinions as it is hard to tell just based on pictures.

Sam Speron, MD, FACS · Answer

Hi! Thank you for your question,

	
	I am Dr. Speron, a proud member of both the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).  I am also certified with the American Board of Plastic Surgery.

	
	To answer your question, it is very difficult to tell based on the photograph you have provided. I highly recommend you schedule a follow up appointment with your board certified plastic surgeon and see what options are best for you.

	
	Below are some links for additional information and before and after pictures.

	
	If you have any further questions, please feel free to call us at 847.696.9900.

	
	Best of luck and have a great day!

	
	Regards,

	
	Dr. Speron

Imtiaz A. Chaudhry, MD, PhD, FACS · Answer

Your photos shows that you do have minimal skin fold when your eye is closed. When your eye is open you do have mild lower eyelid retraction which makes your eye fissure appear more wider than it is.

	One may consider removing the upper eyelid skin fold if it causes significant concern. On the other hand you may consider awaiting couple of years before resorting to re-do. In my opinion, you are better off having less skin removal than having too much at one time. I am sure your doctor made the marking based on how much extra skin you had to be removed. In some patients, there is more relaxation of the skin after the procedure and that can be addressed in future. I believe that it is better to remove less and remove more if needed rather than removing too much and then using skin graft to help with complications of eye exposure.

Jeffrey Zwiren, MD · Answer

With your eye open you look perfect.  There will always be a bit of redundant skin of the upper eyelids after surgery after all you wan to be able to close your eye after surgery.

Geoffrey J. Gladstone, MD · Answer

Without examing you I cannot say for sure, but from your photograph it appears that there may be a little residual skin which could be removed.  However, you don't want a surgeon who is too aggressive with skin removal because this can lead to serious eye complications, such as dry eye and corneal exposure.  If you are conservative to start, you can always go back and remove a little more skin.  

	Doing a ptosis repair (which involves the muscle) would not help what you are seeing with the eye closed.  As far as fat, again I would need to exam you to be sure, but it does not appear from your photograph to be a big issue for you. 

	In your case I might also discuss the option of a browlift with your physician.  This is because you are expressing a desire to have “open eyelids”.  Removing skin alone will often not provide any visible upper eyelid the way raising the forehead can.  I use an endoscopic technique so that small incisions can be hidden in the hairline.  I have seen very good results in patients with a desire to have visible upper eyelid, which is probably what you are envisioning when you say ‘open eyelid’.

Sean Freeman, MD · Answer

Inie, this question cannot be answered well without a personal exam. I have been doing nothing but facial plastic surgery for 25 years and I can give you some generalities. The majority of patients that complain of a tired look to their upper lids it is due to inferior to medial migration of the brow into the upper eyelid area. In these patients an endoscopic brow lift gives the best result. Over the years I have developed a sequential approach to brow lift surgery and will, in general, do one of three different lifts depending on the preoperative anatomy of the forehead. A lateral brow lift is done for patients with heaviness of the lateral brow but a normal medial brow. A 3/4 brow lift is done for patients with a heavy lateral brow and a pinched look to the medial head of the brow. A full brow lift is performed for patients who have a heavy lateral brow, pinching of the medial head of the brow and inferior migration of the medial head of the brow. This approach yields a natural appearance to the post operative patient without that surprised look.For the less common patient who has brows that are in the correct position and yet has excess skin and muscle in the upper eyelid area, an upper lid blepharoplasty with supratarsal fixation is all they need. 

	Should you have a combination brow ptosis or sagging and excess upper eyelid skin I prefer to get the brows done first and the eyelids done 3-6 months afterward. That is the approach I take and the majority of patients that I see get the brows done and are happy, they leave the upper lid alone. More is not always better. For those who decide to proceed with an upper lid bleph afterwards, I can be more precise doing it secondarily.
	See a plastic surgeon that specializes in facial aesthetic surgery, get two to three opinions and go with the one you feel most comfortable. Experience is great teacher so typically find someone with a few years under their belt!

Darryl J. Blinski, MD · Answer

Best to obtain an IN PERSON evaluation so the amount of excess skin can be determined. Best of luck.

Devinder S. Mangat, MD, FACS (retired) · Answer

Based purely on the photographs you submitted, it doesn't look like you need more skin removed but only an examination would determine that accurately. Your brow is a little low which makes it look like you have excess skin. The solution may well be a brow lift and again an examination will determine that.

Still Excess Skin After Upper Bleph? (photo)

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