Upper Lower Bleph/now Have Scleral Show & Asymmetry Uppers? (photo)

Had upper/lower bleph 3/5/12. Since swelling subsided, I have white under my irises (scleral show?), noticible scars & left upper lid still touches my lash line. The dr. wants to do a revision with no general anes. just local. He says the under eye is an easy fix. Is this true? What is involved? He's not an occuloplastic surgeon but head of plastic sx at a hospital & board cert & not charging me. Guess some money back & going to a specialist is out of the question.

Doctor Answers 5

Revision blepharoplasty

Correction of minor asymmetry of the upper lid under local sounds fine, but revision of the lower lid for scleral show we feel is more difficult than your original procedure and the local 'easy fix' might be a challenge for you and the surgeon. Saving money is nice, but shortcuts taken, especially when things have taken a wrong turn might be regretted. Bit of a red flag here.

Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews


As a cosmetic oculofacial plastic surgeon, I will tell you that the appearance that you have is a common reason for people to come to me from all over the world. Although for many plastic surgeons, the appearance of having the eyes as open as yours is considered a desirable look, judging by your pre-operative photo I would suspect you would prefer more of the original shape of your eyes. With a limited assessment based on your photos alone, I don’t believe that your procedure would be “easy”. This is based on my experience with patients over the past 20 years who have had lower eyelid retraction and scleral show from a combination of anatomic factors which results in the change of the lower eyelid position.
My approach to this kind of surgery involves a combination of procedures for restoring the vertical support of the lower eyelid as well as the support of the lower eyelid from the point of connection to the orbital bone (lateral orbital rim). It is common for many plastic surgeons with patients who are not happy with their lower eyelid appearance to perform various types of limited “tuck” procedures. In my opinion, most of these procedures are not likely to be successful. If a procedure that involves more extensive support of the lower eyelid involving the lateral canthal tendon is performed under local anesthesia, there can be some benefit. My recommendation is that you get a clear understanding of what your plastic surgeon is planning for you before you undergo additional surgery. It is also advisable that you consider another opinion as one procedure may not be enough to accomplish your goals.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Be patient

Lower lid retraction is one of the more common complications of lower blepharoplasty, and as indicated by the other experts in this forum, it certainly is NOT an easy fix. Having said that, I would recommend against early revision. Time and massage will often improve the lower eyelid position.

In mild to moderate cases [your situation], where the health of the eye is not in question, I recommend waiting for up to a full year to allow all the scar evolution to take place. In the meantime, for a second opinoin,  I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website. Revision eyelid surgery is one of the more common surgeries that we do.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

You may want to get several opinions from other experts if you are uneasy about the plan.

I do recommend first going back to the doctor who did your procedure.  You may want to get several opinions from other experts if you are uneasy about the plan.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Scleral Show

I agree with Dr. Johnson of Chicago.  Let's be honest, scleral show & asymmetry repair after your 3-5-12 four eyelid blepharoplasty is no "easy fix."  However, there is no reason to become angry, just obtain a second opinion from an experienced Occuloplastic or Facial Plastic Surgeon.  You will likely be best served by careful consultation.  

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 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.