Stretch Eyelid Skin Possible After an Aggressive Surgery?

Question

Is it possible to stretch upper eyelid skin or have a skin graft done to eyes that have been operated on aggressively? There was too much skin and fat removed after my Eyelid surgery. I look so odd. I used to have beautiful eyes and a slight hooded upper lid that was very attractive. Now, I barely have a crease with eyelids that feel tight. It does not look right. I already have Juvederm in the upper eyelids, hoping that it will stretch the skin. What else can be done? I'll be most grateful for an answer.

Raffy Karamanoukian, MD, FACS · Answer

The upper eyelid is an important functional and aesthetic element that should only be approached by surgeons who are knowledgeable about eyelid anatomy, function, tolerance, and the limits of surgical resection. Correcting upper eyelid deformity is often more difficult than just restoring upper eyelid skin. I would advise you to seek a consultation with a board certified plastic surgeon.
In the acute period after surgery, the mainstay of treatment should be observation with protection of the cornea. Lubrication is indicated to prevent corneal exposure during the day and during sleep.

Trevor M. Born, MD · Answer

Dear Goldilock
The issue of shaping and functional changes not desired after eyelid surgery can be difficult to manage.  You have waited a good period of time since your surgery which is good from the standpoint of letting the healing resolve and this is commendable.
The function of your eyelids should be checked- to make sure that you do not have any changes related to dryness.
The management of your eyelid shape/function needs to be assessed in consultation as a recommendation via email would be very difficult.
With Warm Regards

Kenneth D. Steinsapir, MD · Answer

Dear Goldilock
Unfortunately it is very hard to unstir the cream out of the coffee.
Whereas there are a lot of great options for helping aesthetically improve the lower eyelid that has been damaged by prior lower eyelid cosmetic surgery, the options for the upper eyelid are much less palatable and satisfactory.
The frame issue that Dr. Seify is referring to is over resection of upper eyelid fat in the central fat pocket exposing the groove created by the reflection of tendon complex of the superior oblique muscle.  
That is not the problem you are describing.  What you are talking about is that someone removed your upper eyelid fold robbing you of an very important facial feature.  
Restoring the upper eyelid fold is an impossible task.  Nothing will bring back the natural gentle fold that is a very important feature of the face that is removed by an aggressive upper blepharoplasty.  
A skin graft does help with eyelid closure when this had been compromised by too much skin removal with the eyelid surgery.  However, this is simply to achieve the ability for the eyes to close.  It is not helpful in restoring the aesthetic upper eyelid fold.  
Fat transfer or filling with Restylane can also soften the appearance of the sub-brow area but this is not the same thing as storing the upper eyelid fold.
I encourage you to find a surgeon who deals with post-blepharoplasty issues and have a personal consultation.
Dr. Steinsapir

William Portuese, MD · Answer

Skin grafts can be performed to the upper eyelids for people who have difficulty closing their eyes. This is usually performed by an oculoplastic surgeon. Fat injections can also be placed on the upper or lower lids if they are too hollow.

Tim Sayed, MD, MBA, FACS · Answer

It can be difficult to restore the eyelid fold with an aesthetic result. The tightness you describe is probably from overresection of the skin, which is likely to be correctable with skin grafting, although the aesthetic outcome will be compromised by the extra skin which may not match in color. However, if you are having functional issues (dry eye, excessive tearing), you may want to pursue having the skin graft as function supercedes aesthetics.
Sometimes, subtle issues with the function of the lids are better handled by oculoplastic specialists (ophthalmologists with added training in functional and cosmetic procedures of the eyelids and orbits). Also, many plastic surgeons have expertise in Asian eyelid surgery, which involves manipulation of the eyelid crease in a way that Caucasian eyelid surgery typically does not. An Asian eyelid specialist may be more adept in addressing your concern about the eyelid fold.
Good luck.

Hisham Seify, MD, PhD, FACS · Answer

Removal of excess fat in the upper lid leads to a condition called "A frame deformity"  this creates a very skeletonized look. the best treatment is reconstruction with fat grafting.Removal of skin from the upper lid could be a difficult problem. Skin grafting is an asnwer but will not yield a good cosmetic result. If there is no corneal irritation and the eye closure is not affected, I would recommend to do the fat grafting first. Best of luck!

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