Is excessive swelling 3 weeks after a lower bleph normal/permanent? This was reconstructive surgery to fix Botox damage. (PhotO)

Question

3 weeks ago I had a lower bleph by a U of M surgeon, Dr. Mindlin, whom I adore. This was to correct muscle atrophy & stretching from having Botox 3 years ago (per his diagnosis, not my own). I'm now swelling worse than when I first had the surgery. I'm devastated. Dr. says Botox made my muscles like a "stretched rubber band" and he's not happy this is happening now. He encouraged me to seek opinions & set me up with a consultation with 2 of his colleagues. I am 30 & had NO bags before Botox.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for the question and sharing your photos.It is clear that you are swollen still, but this is not unusual 3 weeks post op lower blepharoplasty. On occasion I consider use of a quick taper of oral steroids to hasten recovery. At this point, you should not become stressed. Give the healing process more time (a couple of months) and then make a judgement, because you look like you are on the right path to recovery.Good luck.

John J. Martin, Jr., MD · Answer

Your surgeon is totally incorrect in saying that one injection of Botox would cause irreversible damage to the muscles.  Even years of Botox doesn't cause this.  You have some edema of the lower lids which is not unusual especially if you have a prominent malar fat pad pre-op.  This should all improve with time.

Kenneth D. Steinsapir, MD · Answer

The description of the problem makes no sense.  Botox does not permanently damage muscles.  Most likely you had a preexisting issue.  You are only 3 weeks out from what appears to be a transcutaneous lower blepharoplasty.  Please do not rush from on thing to another.  It is critical that you let these eyelids heal form many months before considering what to do next.  Unfortunately cheek festoons are not corrected with standard blepharoplasty.  You issue is unusually and almost any surgeon you see will lack the surgical tools needed to correct the issue.  Take your time in deciding what might need to be done next.  The swelling can take months to fully resolve.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures.  In my opinion it would be unusual to have weakened muscles secondary to BOTOX that cause festoons without causing total weakness and lack of tone to your lower eyelid.  Edema from blepharoplasty (cosmetic or reconstructive) may take months to resolve. The pathways that normally drain swelling need to reestablish themselves and this takes time.  Continue close monitoring for the next 2.5 months.

Edwin Ishoo, MD · Answer

Your surgeon's diagnosis is incorrect as Botox won't do that. Also, are you sure Dr. Mindin is a Univ. of Michigan faculty? I don't know what you looked like before but I see deep tear trough deformities that could have been addressed with proper fat repositioning during a blepharoplasty. Finally, some edema 3 weeks after subcilliary blepharoplasty with likely significant dissection and muscle tightening or canthopexy/plasty or tarsal sling is not unusual. I'm not sure where Botox was being injected that you thought it contributed to "bags"? were you having Botox injected by a qualified doctor?

Patrick Simon, MD · Answer

The swelling around your eyes is typical at 3 weeks after a blepharoplasty.  I'm not sure why your surgeon is referring you to his colleagues at this stage in the healing process.  You didn't provide any preop pictures, but I imagine as the swelling subsides those areas will flatten and normalize.  Patience is key.

Ira Vidor, MD · Answer

Hi. Your photos certainly show lower lid edema (swelling). You also have malar edema as well (swelling of the cheek). This can be common after lower blepahroplasty and can sometimes last even longer than 3 weeks.  I am not familiar with your case, but the technique used for lower blepahroplasty can also have an effect of the length of time it takes to heal. For example, patients that have fat repositioning can have swelling for longer than those that don't (although the final result is often better with fat repositioning). Basically, give it time and hopefully things will settle down. I would also look at your pre op photos to see if you had any malar edema present prior to surgery (some people mistake that for a lower eyelid "bag"). As as far as Botox causing atrophy of the lower lid muscles and stretching, that would be very unusual. Botox has a temporary effect and should be gone in 3 months, let alone 3 years. Bottom line, is that you are still hearing, and swelling at 3 weeks can certainly be part of a patient's "normal" recovery process. Follow up with your surgeon and seek a second option, but try to avoid any revisional surgery for several months unless something unusual is going on. Best regards, Ira Vidor, M.D.

Is excessive swelling 3 weeks after a lower bleph normal/permanent? This was reconstructive surgery to fix Botox damage. (PhotO)

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