Too Much Skin Removed After Blepharoplasty

Question

Too much skin was removed from my upper lid. I have white dots, a visible line, an extra skin fold. It looks like a web Is there a solution to my problem that is not likely to make things worst?

Kenneth D. Steinsapir, MD · Answer

Dear Jazseh
It is interesting that you feel that too much skin was removed and yet you say you have an extra skin fold.  This suggests that your original eyelid surgery was not well structured.  The cysts you are describing are possibly skin inclusions caused by the suture material used to close the original blepharoplasty.  These are easily removed and your original surgeon should be will to address the these.
However, if you have had a breakdown in your relationship with your surgeon, I would recommend that you consider consulting an oculoplastic surgeon.  ASOPRS,org has a directory by location for eyelid plastic surgeons.  In Los Angeles, there are a number of us who specialize in repairing unsatisfactory eyelid surgery.  I see 5 to 7 new consults a week concerning these types of problem.

Richard D. Gentile, MD · Answer

The observation of excessive skin removal would only be an issue that would come to mind if eyelid closure is a problem more than two weeks after your surgery. This rarely occurs. The other observations you mention are side effects of the surgery including the white dots and some persistent eyelids skin creases.

Robert Schwarcz, MD · Answer

Hi Sharl:
I am sorry to hear of your unhappiness with your recent eyelid surgery.  Asymmetry can be a common complication after eyelid surgery and can be devastating to the patient.  How long ago was your surgery?  I would give it a little time, and if you still have ptosis, perhaps the levator (eyelid lifting muscle) was injured and would need to be repaired to raise up the eyelid again.  I would first go back to your surgeon to see what can be done, and if necessary consult an Oculplastic surgeon for this problem.
Dr. Schwarcz

Robin T.W. Yuan, MD · Answer

The white dots are probably milia or tiny epithelial cysts. They can be lanced with a small needle. This is not uncommon after upper eyelid surgery or things like peels. A scar is inevitable with incisional surgery but is usually minimally perceptible with upper eyelids. However, the part of the scar that extends to the crow's feet area can produce more noticeable scar and also medially toward the nose can produce webbing if it goes to close to the inner corner of the eye. FInally, sometimes the scar itself is near invisible but what can be perceived is the transition between one type and color of skin on the lower eyelid and the type and color of skin of the upper eyelid, soft of like when a thick carpet of a certain thickness and color is joined to another carpet of different thickness and color.

Philip Young, MD · Answer

The most important thing to consider when you think about too much skin being removed is whether you have enough skin for your eyelid and eyebrow to function separately. Usually, it requires at least 1 cm of skin from your blepharoplasty incision to your eyebrow and 1cm from that incision to your eyelid margin. 
In some people, 1.5cm is needed from your eyelid crease to the bottom of your eyebrow. The visible line will get better with time. That's why I mentioned that it depends on when your procedure was completed.
The white dots are likely inclusion cysts which very easily happen in the eyelid. All you have to do with this is to unroof the cyst with a needle and express the contents. They may reoccur, which could require a small excision of the cyst. The web usually occurs in the middle part of your eye. This is a little more trickier to fix. Steroid injections help.  More complex procedures can also alleviate the presence of this web.
Consulting a Board Certified Facial Plastic Surgery would be something that I recommend. We specialize in the face and are highly qualified to help you with this.

Christopher L. Hess, MD · Answer

All of us that answer questions on RealSelf have to do the best we can with the information we're given.  Usually it's enough but in your case I think we all need more information.  If too much skin was removed you would either be left with an open wound or be unable to close your eyes.
No sure what the white dots refer to unless they are small stitch abscesses.  If you are Asian then a visible scar is more likely depending on the depth of the fold.  Where is the extra fold and how long ago was surgery?
Help us to help you.

Keith Denkler, MD · Answer

All of these need a checkup and exam by your doctor.
White dots (millia) are somewhat common after blepharoplasty in the suture line and can easily be expressed.
Skin tightness (too much skin removed) can be stretched and massaged in the early stages and outlying skin can be mobilized and recruited to help the tight area.
Small bands or webs in the scar can easily be opened or released in the office.
Excess folds can also be trimmed under local anesthesia.
All of these can be helped with a recheck.
Good luck

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

It is impossibe to address your question without an exam to see exactly what the problem is.
Revision Blepharoplasty can be done to remove scars and correct webbing, but if too much skin has been removed that is preventing adequate lid closure, you may need skin grafting.
See your doctor for an exam and discussion. Revision blepharoplasty is complex and requires an expert surgeon.

Too Much Skin Removed After Blepharoplasty

Answers (8)

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