Unsure About Lower Bleph Results - 3+ Years Since Surgery.

I had big bags for a young guy and finally had them removed about 3.5 years ago. Although the bags are gone, there is a lumpiness and asymmetry to my lower lids that I feel self conscious about. I wear glasses, and I can live with it with them on. But I'd really love to wear contacts instead - I'm just not comfortable with the results. At the last followup with the doc he said, "Maybe you're just looking too close." What do you all think, am I? Can I do something to improve the lids? Thank you.

Doctor Answers 11

Fat injections can rejuvenate eyelids

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Your surgeon removed the fat, which is traditional, but can make the lower lids look a little flat.  I don't see the bumpiness, but maybe I can't if it's something can has to be felt..  However, I do see the muscle bulges just below the lashes on each side; if that's what you are looking at, it is normal anatomy.

You can have fat injected to fill out the skin a little and relieve the flatness. This surgery is VERY technique-dependent, so find an experienced surgeon whom you trust.

Nashua Plastic Surgeon

Video on Lower eyelid bag treatment: Removing eyelid fat is not always the best option

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This is the classic presentation. The lower eyelid lift not resulting in actually making the lower eyelid look more youthful. The bags are decreased but there is something just doesn't look natural about a lower eyelid lift. Go to my website for more information. There I discuss my theory on facial beauty, fat injections for lower eyelid bags (seems strange to some), and the Young volumizer.
Thanks for reading, Dr Young

Philip Young, MD
Bellevue Facial Plastic Surgeon

Results from blepharoplast can look worse as we continue to age

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A lot of times after blepharoplasty the results may look good initially and then worse as we continue to age and lose volume as this can cause hollowness or unevenness.  A lot of times additional surgery is not indicated, but filler can even it out.  The lumpiness looks like it may be from a fat pocket that is now coming out.  From the picture, putting filler in the area by a real expert (which is off-label), if done correctly, can give a nice result.  I would use a hyaluronic acid product like Restylane.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

Uneven lids after lower blephs

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From looking at your pictures it would appear that there are some structural elements that may help the appearance if adjusted.  It is more than likely a combination of fat and muscle elements.  Revisions after lower lid surgery are seen in approximately ten per cent of cases.

All teh best,

Talmage J. Raine MD FACS

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

Bumps in lower lid

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your result is excellent, any bumps you see were there before only now visible because the big bags are gone. they can be trimmed but not without an incision and some risk of lower lid malposition. I think your doc is right. live with it, it's really a good change all in all.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Muscle bulge after Blepharoplasty is causing puffy eyelid look

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I agree with the other doctors. Your bags have been removed but you have a bulging left lower eyelid muscle called the Orbicularis Oculi  Muscle.


This can be reduced by surgical excision but I would try a tiny amount of Botox or Dysport first

Lower eyelid surgery can have two approaches

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I think you have a great result if your surgery was done transconjunctivally (incision made on the inside of the eyelid) because the fat excess is gone. The photos suggest that you had this approach. This approach cannot deal with heavier eyelid muscle (orbicularis oculi) that sits infront of a type of cartilage support that strengthens the eyelid  (this is just inferior/below the edge of the lower eyelid and is called the tarsal plate). That muscle "roll" needs to be reduced carefully by an exterior surgical approach with the incision just below the lash line. I think the persistent bulge is this muscle and it is too big and presents as a roll. A fine surgical scar will result from the external approach but there is no other way to reduce the muscle roll that you seem to have. This should be able to be done by an oculoplastic or well trained plastic surgeon.

Harlow Hollis, MD
Victoria Plastic Surgeon

Eyes look good after lower eyelid surgery

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  Your lower eyelids look good and you have a nice result from your lower eyelid surgery.  The bags, seen in your before photos, are gone and the lumps that you see just below the lower eyelid lash margin is the normal shape of the lower eyelid muscle...which is normal.  You need nothing further IMHO.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Bulge After Eyelid Surgery Due to Muscle

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The fat removal from the previous surgery did remove the lower "bag" that you see in the pre-op photo.

The bulge in the lower eyelid that persists is the muscle of the lower eyelid that holds the lid against the eyeball and squeezes the eyelid shut.

Attempts to thin this muscle are met with varying degrees of success and run the risk of weakening the muscle to the point of functional impairment (inadequate motion of the eyelid, incomplete closure of the eyelids, change in the shape of the eyelid or lower eyelid droop).

A single treatment with BOTOX is unlikely to make much of a difference in the size of the bulge, even if the muscle is weakened to the point of impairment. Multiple tiny doses over a year or so may result in shrinking the muscle to produce better appearance, but as soon as you stop the BOTOX, the thickening is likely to recur.

Using a filler (like Restylane) that flows well can offer a good way to smooth and blend the contours, but will require replacement or touch-up about once a year.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

Don't let people treat the muscle roll.

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First, you have had a very nice lower eyelid surgery result.  It is a procedure that can be fraught with issues especially with such a big eye and you appear to have done great with this.  Weakening the muscle roll along the lower eyelid will immediately compromise its function.  The muscle is there to hold the eyelid against the eye so it acts to protect the eye and move tears around.  BOTOX or surgery to debulk this muscle will create immediate functional (comfort) problems.  Don't do this.

The best option for you does not involve surgery.  Restylane fillers to address the lower eyelid hollows will make a world of difference for you.  Treatment can cause lumps and bumps which can be adjusted should they occur.  There is also a risk of bruising which can even cause a black eye.  The benefits of service last about a year provided you get enough filler at the time of service.

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