Uneven Eyelids After Surgery? Why this is happening, and whether it is a call for concern and what actions can be taken? (photo)

Question

It has been 6 months after I have done my upper eyelid blepharoplasty, and I have begun to notice unevenness. The lids have certainly fell quite a fair bit, and the left eyelid is starting to look less deep than the right. May I know why this is happening, and whether it is a call for concern and what actions can be taken? You may find pictures before surgery, 5 days after surgery, and 6 months after surgery attached. Thanks.

Kenneth D. Steinsapir, MD · Answer

This could be consistent with latent upper eyelid ptosis. If is difficult to be definitive without a personal consultation. Consider seeing an oculoplastic surgeon with great expertise in cosmetic upper eyelid surgery.

Leo Kim, FRACS(Plast), MS(Plast), MBBS(Hons) · Answer

First of all, its excellent that you've put up before, 5 days after and 6 months after, it gives us a better understanding.
First thing to say is that your eye were uneven to start with- this is almost a rule rather than an exception. No 2 ears, eyes and breast are the same. The reason they're different now could be combination of factors, your anatomy, the surgical technique used and sometimes whatever technique we use it can come undone and this would have been discussed with you before the surgery. The reason for your unevenness could be one or all of these possibilities but if it comes undone before 12 months you should really be offered a revision by your surgeon and be looked after as part of your routine aftercare.
Wish you the best in your journey.
Dr Leo Kim, Specialist Plastic Surgeon in Sydney

Victoria Yongsook Suh, MD · Answer

Our eyes open when the Levator Muscle contracts(LM). The extension of the LM is known as Levator Aponeurosis(LV). When the LV is connected to the eyelid skin, as the eye opens the skin is pulled in, causing a skin dimple known as the eyelid fold. In natural folds, the connections between the LV and the skin are intertwined as that of a basket weave. However, when the connection is made surgically, it is just a one point connection along a line. Therefore, if the balance between the muscle and the skin thickness or the pulling force of the muscle to the thickness of skin is not right, then partial or complete loss of the fold may occur. In your case, you have partial loss of fold definition on the left eyelid. In addition, the fold extension is too short. The fold needs to be extended more laterally. Both may be corrected by reinforcing the folds with intermittent sutures placed at the lateral edge, at the center, and the medial corners. If you desire larger folds or increased fold width, then open revision of both eyelids must be done. However, I would caution against widening the fold too much. The current width is very natural at this time. It is very important to consult with a Board Certified Plastic Surgeon experienced with Asian Eyelid surgery. Best Wishes!

Uneven Eyelids After Surgery? Why this is happening, and whether it is a call for concern and what actions can be taken? (photo)

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