Unhappy with results of lower blepharoplasty 11 months ago. What can I do?

Question

11 months ago I was promised amazing results .lower blepharoplasty, with laser resurfacing ,skin under eye wasn't removed , Not happy about my lower right eye, I was advised to wait but the results aren't what I wanted . My left eye looks more natural, the right eye drives me crazy when I smile does not look good, It wrinkles and looks like there maybe isn't enough tissue under, just a touch less but it makes a big difference:( Please advise ! Is there anybody that can help me ?Thank you .

Mitesh Kapadia, MD, PhD · Answer

Based on the photos you provided, it looks like you have a very reasonable result. There are no preop photos for comparison and we do not know what your expectations were for the surgery or what you were promised.Lower blepharoplasty surgery is great for improving puffiness under the eyes. The amount of skin that can be removed from the lower eyelids is very limited. Search this website and you will find lots and lots of patients who have ectropion of their lower eyelids when too much skin was removed. There is no way to eliminate all the fine lines in the lower eyelids. If the main problem is that you dont like the way your lower eyelids look when you smile, botox may help. That being said botox in the lower eyelid can sometimes make the eyelid look droopy, as the botox will decrease muscle tone in this area. If it drives you crazy, this might be worth a try. Typically it will wear off over 3-4 months and go back to how it looked before botox.

Nelson Lee Novick, MD · Answer

So sorry, you are having difficulty after your lower eyelid surgery. Without photos of your undereye area prior to going under the knife, nor more detail about the surgery itself, it is hard to know whether you might have better profited from some nonsurgical eyelid rejuvenation procedure, such as a filler to a tear trough or to camouflage a bag or some volume to the cheek immediately below to provide a scaffold. What I can say is that crinkles, such as are present under the eyes now, while difficult to treat and often not completely "erasable" might be improved by a series of superficial chemical peels (e.g. Jessner's solution, glycolic acid) coupled with the injection of a microdroplet or two of Botox (or Dysport or Xeomin). I have been underwhelmed with the often inconsistent and variable results from the use of relatively expensive fraxel and radiofrequency treatments, finding them to be supported far more by device manufacturer backed marketing hype than hard science. So, as with surgery, a healthy dose of buyer beware of promises of amazing results should be in order, especially now.It might be wise to seek a second opinion consultation with a board certified aesthetic physician with experience and expertise in nonsurgical eye rejuvenation techniques. Make sure to check out his/her before and after photos.

Jamil Asaria, MD · Answer

Sometimes a skin pinch (to remove a bit of skin) can help to reduce the persistent wrinkles under the eyelids.

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

Thank you for sharing your concerns and photos. I am sorry to hear you are unsatisfied with your results. Lower eyelid blepharoplasty removes the fat bags, but not the wrinkles of the lower eyelids. Without before photographs, it is difficult to make an accurate judgement. Repost your concerns with before pics so better review can be done. Good luck.

David S. Felder, MD · Answer

It would be helpful if you had posted before photos to compare before and after surgery. However, it appears as though the result is what you would expect after the procedure. You will always have some wrinkling after lower eyelid surgery especially with smiling. Options include Botox and re-lasering of the lower eyelids to further tighten the skin.

Tanveer Janjua, MD · Answer

It is very difficult to completely eliminate wrinkles from the lower eyelid.  Any attempts to achieve that can lead to ectropion which can be a devastating problem to treat.The best solution is a combination of small amounts of Botox and Thermismooth to tighten the skin in that area.  This is a safe technique the long lasting results.RegardsDr. J

Steven Wallach, MD · Answer

Lower lid skin has wrinkles in it after a blepharoplasty. Fat is often removed or rewrapped and skin can be excised but fine lines and wrinkles usually persist.

R. Stephen Mulholland, MD (retired) · Answer

Dear Gingirica,Thank you for your clinical post and
photographs.  Over the past 11 months
there has not been much progression from your pre-operative view as there is
persistent horizontal lower lid wrinkling when you are at rest and not
animating or smiling.  Occasionally, this
can occur with laser resurfacing when there are more wrinkles than the laser resurfacing
device can manage.  In general, in these
circumstances a skin pinch blepharoplasty performed expertly along the lower
ciliary lash line can heal extremely well and resolve the lower lid wrinkles
that you are frustrated by.  You’ll
always have some lines on smile, but there should be significant improvement in
your resting lower lid appearance.

I would seek out a certified plastic
surgeon, oculoplastic surgeon or facial plastic surgeon with significant lower
lid blepharoplasty experience.

I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Unhappy with results of lower blepharoplasty 11 months ago. What can I do?

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