Can a second upper blepharoplasty rectify a high and irregular crease with some scar tissues? (Photo)

My upper and lower blepharoplasty was done 9 years ago. The incisions on the upper eyelids were too high. My Asian almond shaped eyes were turned into rounded ones. The creases are also irregular and there are some indented scars in them. Now that my eyelid skin is looser with some hooding & wrinkles, can a 2nd blepharoplasty be done? Will this remove the irregular crease lines, scars and the wrinkles (some lateral)? Can the eyelid crease be lowered? My eyebrows are at the orbital bones. Thanks.

Doctor Answers 3

Your eyelids were affected by too much skin removed. Some highly specialized procedures can restore anatomy, health and function

As a cosmetic oculofacial plastic surgeon for 20 years and a specialist in revision eyelid surgery, I can certainly share with you a lot about this particular issue. I’m going to focus more on the lower eyelid situation because I see this problem a lot. We have patients who come from all over the world and the common issue is that the lower eyelids are pulled down called lower eyelid retraction. In other words, the patient had a natural almond shape before the surgery and the lower eyelid was at the same level with the colored part of the eye called the iris. However, after surgery, it gets rounded where more of the white of the eye (sclera) is shown in a condition called scleral show or lower eyelid retraction. Unfortunately, enhancements are typically not that successful unless proper anatomy is restored.

The lower eyelid is actually a very complex structure. Its position is a balance of several factors: one is the lateral canthal tendon which is responsible for the attachment of the lower eyelid to the inner aspect of the bone, the other factor is the vertical support of the lower eyelid which is keeping that area up, and the integrity of the skin and orbicularis muscle. The orbicularis muscle pulls the eyelid in position.

Very commonly, surgeons will do this procedure from the outside, take away the fat, and trim off skin without doing anything to restore the integrity of the lateral canthal tendon. They initially believed that there is extra eyelid skin. This is because during surgery, when a person is lying down, everything is shifted upwards which makes it appear as if there’s more skin than there actually is, so after the surgery, there is a skin shortage. In addition, the lateral canthal tendon is not properly reinforced so everything sags.

You’re revision procedure for your lower eyelid is likely to be more involved than doing just a simple tuck up or limited procedure. A lot of our patients had multiple revisions and they end up more with skin shortage, wider scars and we have to do a lot more surgery. This includes grafting of tissue in the inside of the eyelid, grafting skin on the outside of the eyelid and even doing a drill hole canthopexy where we drill holes on the bone in order to restore the integrity of the tendon. I’m not saying that you will need all those things, but it is important to understand that the three elements of balance are very important for lower eyelid position and restoration of the anatomy.

It is crucial that you and your doctor have the same aesthetic values so that both of you can define the success of the procedure. A lot of people in the Upper East Side of Manhattan have retracted eyelid look and they feel really good about it. When it comes to eyelid surgery, it is important to maintain and protect the health and integrity of the eye itself. If you have an understanding of what your doctor is recommending, and you feel comfortable that things will work out with any type of revision surgery that your doctor is suggesting, then you can certainly move forward to have it done. Do more research about lower eyelid retraction after cosmetic eyelid surgery so that you can appreciate more about what others experience in a similar situation. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Revision Asian eyelid surgery

I do think you can be helped but it may require more than a simple incision surgery.  You may need fat grafting to the upper eyelid area and orbit to get a more complete correction.  All that being said he could still be less than perfect but likely better than what you have.  The healing time would probably be anywhere from 2-3 weeks for you.

Chase Lay, MD
Double board-certified facial plastic surgeon
Asian eyelid surgery specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Eye lid surgery

Based on the pictures posted, one might be able to correct the high incision you have. there are some fat bulges that need redistribution of the fat and some removal of the fat. Evaluate the position of the brow and need to be very cautious about the lowering of the incision on the brow and the need for a brow lift. Need thorough analysis and then a plan can be presented

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

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