Blepharoplasty 2 weeks ago. I need revision - incision too low, raised big scars, bags. How soon can I get revision? (Photos)

Thank you for your question. You submitted several photos indicating you are 2 weeks after lower eyelid surgery and are considering revision surgery. You add there are visible incisions placed too low, feel there bumps, and you think you still have eye bags.

I can share with you my approach with patients like yourself who come to our practice seeking this type of revision surgery as early as two weeks.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. A big part of my practice is to do revision eyelid surgery for patients who come from all over the world. I’ll give you my thoughts of how I think your surgery was done, and what the potential opportunity to address this,  but immediately I have to say it’s probably a bit too early to consider surgery.



First, I want to make sure the eye is protected. If the eye is in a compromised position so there is an issue with the health and integrity of the eye that’s not responsive to drops and ointments, then early surgery is warranted. There have been many situations where people have come where their eyelids were completely everted called ectropion causing severe dry eyes so they couldn’t put enough drops and ointment, so we had to do revision surgery sooner.



In your situation, compromised eye health doesn’t look like the case, but it’s actually an anatomic challenge. You have relatively prominent eyes which means the lower eyelid is in a relative negative vector. Any procedure done from the outside puts you in a bit of higher risk of eyelid retraction. In addition, because of the anatomy and the position of the lower eyelid, there’s an understandable reason why there is still an appearance of bags. Typically for someone like yourself, I would have chosen in your initial surgery, to do this procedure from the inside of the eyelid called a transconjunctival blepharoplasty. This is a stylistic issue and not necessarily something was done wrong. Operating on someone with prominent eyes if very familiar for an oculoplastic or oculofacial plastic surgeon because we deal with thyroid eye disease and other conditions where the eyes are very prominent. The challenge is it’s technically demanding to operate on someone who has prominent eyes from the inside as well, so it may be a reason why a lot of surgeons prefer to do this from the outside.



As far as the incision being low, often when people are swollen, the incision can look a bit further away from where it was originally placed. You should wait for the swelling to resolve because the incision placement may not as displaced as you may think. In addition, when you have very light skin and you have other lines in that area, very often the incision tends to blend, so even if it is too low, it tends to heal well enough that it doesn’t become justifiable to do anything else.



The bumpiness of the incision is also normal, so two weeks out it is not unusual. I always tell people he first month after surgery is called the proliferative stage when the body is creating a lot of blood supply and collagen, so things can get bumpy. This applies to any incision whether it’s an eyelid, facelift, or any other kind of incision. The bumps will probably resolve with observation.



As far as the bags, most likely you are dealing with a lot of swelling which has to be resolved before differentiating residual fat, redundant skin, and the puffiness caused by swelling. Generally, it’s advisable to allow at least 6 months to heal first. Since the integrity and position of the eyelid are not really issues, and it’s really about the aesthetics, you have time to consider a revision later. I think for now, continue your follow-up care, discuss these issues with your doctor, and let them guide you on managing these issues. If you chose your doctor to do the procedure, you already have established a certain amount of trust. Your doctor may recommend massage to help expedite and fluid sitting in one area that may not move as easily with normal eyelid movement. There are a couple of things you can to do to help enhance the healing process, but understand healing does require time. I hope that was helpful, I wish you the best of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Two weeks after surgery is way too soon to be concerned about the incisions, swelling, bags, etc. It can take at least one month for most of the bruising and swelling to subside. It will take several months for the incisions to fade. Everyone heals at a different pace. I would not consider revision surgery for at least six months. If in three months you are still not happy, you can consider a second opinion. For now, be patient and be in close communication with your surgeon. If you consider revision surgeon in the future, I would go to an oculoplastic surgeon who has experience in blepharoplasty revisions. Good luck!

Your lower eyelids are still swollen.  I would not recommend any surgery until this has completely resolved.  You may want to start gentle upward massage to avoid scleral show that is already happening.  Maybe in 3-4 months time you can be assessed for a revision.  Best wishes, Dr. T.