Suggestions for Revision Eyelid Surgery?

What can be done for revision on Eyelid surgery? I had mine 7 years ago, I also had the almond eyes, but now they are round, wide and hollow.

I would do anything to have some resemblance of my old eyes. Even though it has been 7 years since my Eyelid surgery, the pain will never leave, nor the face it left.

Attached are pictures. My face has aged, I have lost volume in 10 years. You can plainly see this surgery changed my appearance from attractive, to unattractive. Hollow,sunken looking face.

It is hard to see a stranger looking back at you in the mirror, if you dare look. Any suggestions? Any help?

Doctor Answers 9

Rounding of the eyelids after lower eyelid surgery

The most common cause of rounding of the lower eyelids is a subciliary blepharoplasty, a surgery where an incision is made below the eyelid. When skin is removed in an attempt to tighten it, the weak lower eyelid pulls down, causing a rounding of the eyelid with a loss of the almond eye shape. If you look closely at many subciliary blepharoplasties, there is some alteration in eye shape. this typically shows as rounding of the eyelid or pulling down in the corners, producing a downward cant or sad appearance.

This problem can actually get worse over time as the natural weakness of the lower eyelid increases over time.

Fortunately, in most cases, this condition is treatable. It is best in my opinion not just to perform a canthopexy (or canthoplasty, depending on the looseness of the lower eyelid), but also to do an advancement of the cheek tissues (a cheeklift). This "gives" tissues to the lower eyelid which can then be used for reconstruction of the lower eyelid. Our version of the cheeklift is the USIC, or ultrashort incision cheeklift (R). Often volume replacement with autologous tissue (or even with Restylane) helps as well.

A canthopexy alone can give a severe upward sweep to the lower eyelid that looks artificial. Likewise some cheeklifts, perticularly when they are performed from inside the mouth (subperiosteal) with a second incision in the temple tends to give an increased distance between the cheekpads (intermalar distance), so this should be anticipated before it is incurred. The lateral bunching of the eye must often be dealt with as well.

These surgeries are highly technical, so choose your surgeon accordingly. A special interest in the lower eyelid and the midface is a plus.

There are several articles and a book chapter in the textbook Mathes on this topic referenced below.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

You look great!

There are some things that can enhance your natural beauty such as Restylane or Juvederm to fill the naturally occurring volume loss that can occur over time especially in the lower lids and cheek areas as well as the brow region as well. You look fabulous though and these are just some small things that can enhance your appearance if you'd like.

Charles Perry, MD
Sacramento Plastic Surgeon
4.6 out of 5 stars 24 reviews

You have both a surgical issue and post traumatic stress

Dear Vickisue

You clearly have legitimate concerns regarding your appearance after eyelid surgery. The fact that you have waited so long to address these issues is quite common. It is very difficult to bring one's self back to consider surgery after what is an unexpected and often devastating loss. Many of the patients who consult me after they have had disappointing eyelid surgery have chronic depression or a type of post traumatic stress syndrome as a result of the bad surgical outcome. After all the last thing anyone expects is to be made worse by a cosmetic surgery. As important as surgery is to restore the appearance, it is not a substitute for psychological support to help deal with the loss that is caused by this type of surgical outcome. I hope that you have sought and found this type of help also.

Regarding surgery, this should be approached with caution. There are only a handful of surgeons like myself who specialize in addressing these types of issues. A personal consultation should involve a detailed history and a through and detailed examination followed by a full discussion of your options.

I have numerous patients who travel to see me from all parts of the world. However, it is always best to first come for a personal consultation with the idea of just gathering information and figuring out which surgeons make the most sense.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Some Restylane might help.

I certainly don't think you look unattractive, but I understand that you are not happy with the changes in your face.

It is not possible to get all of the information needed with one photo, however I agree that at least part of your problem is loss of volume. Little things often make a big difference. I would consider replacing some of the volume loss with Restylane. The advantage is that, while it is likely to last a long time around your eyes, it is also reversible if you are unhappy with the result. Your problem is complicated, so having the extra insurance of reversibility is a big advantage.

The issue is that you need to see somebody who is experienced with injections around the eyes as well as dealing with complications of eyelid surgery.

I believe that there are excellent cosmetic surgeons from many specialties. However, in your particular case, I would suggest that you see an oculoplastic surgeon who is also experienced in filler treatments.

Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Options for revision eyelid surgery

A revision blepharoplasty can be done to improve round, wide, and hollow eyes. A canthoplasty and/or canthopexy procedure could give your eyes more of an almond shape. Occasionally fat injections can be placed deep into the orbital septum to create a little bit of volume in the lower lids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Numerous possibilities and choices for correction

You are obviously very distressed about the appearance of the area around your eyes. There are numerous possibilities to improve this area from injectables to surgery, but it is 1) difficult to tell from the pictures you sent exactly what I would recommend, and 2) very important that you and the surgeon you choose come up with a plan together to meet your goals - this is best done in a face to face setting, in my experience.

Good luck and rest assured, there are numerous ways that we can improve the areas that are bothering you.

W. Tracy Hankins, MD
Henderson Plastic Surgeon
4.9 out of 5 stars 299 reviews

Canthoplasty and open composite fat grafting can help round wide hollow eyes after blepharoplasty

Wide round eyes with downward slant and hollow eyes are common after aggressive external incision blepharoplasty with excessive fat removal.

Transconjunctival open composite fat grafting can plump the hollow looking eyelid. A procedure called a canthoplasty can often elevate the outside corner of the lower eyelid and reduce the round wide eyed look.

These are complex procedures so you will need to find an experienced plastic surgeon who does a lot of eyelid surgery.

Revisional Eyelid Surgery

As we age, we loose volume. This volume loss is worsened by removing skin and fat from our faces at younger ages. The only way to restore this youth full appearance is to add fat. This is now commonly done. By removing fat from our abdomen or thighs, we can then inject this fat into the eyelids. One must realize that fat injections are not permanent and that re injections may be necessary.

Robert M. Wald, Jr., MD
Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

You're not playing fair

Now Vickisue,

You are being much too hard on your eyelid surgery and you are NOT comparing apples to apples, or cheeks to cheeks, in your case. The photos that you have provided are AT LEAST 7 years apart, one is professionally done, lighted and probably airbrushed (photoshop), you are made up in one and not the other, and I would bet ten pounds heavier in the earlier picture. In fact, with these factors taken into account, your eyelid shape is well maintained. I would bet that in a similarly professionally done, more recent photo you would look fairly close to the first. We all age. The natural aging process calls for volume loss, hollowing and eye rounding. Plastic surgery can set you back a few years in the process, but the process does continue. Stop blaming the surgery and shouldering the guilt for choosing it.

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

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.