I'm 3 months post lower blepharoplasty. I look creepy and I don't even like to smile anymore. Is it likely to improve?

Question

I was promised that I would be happy ! My surgeon was a ocuplastic (!!!) . I regret this decision. I initially went for lower and he suggested upper too, upper looks ok except I ended up with a light ptosis on the right eye , easy to notice when I look up . but how about lower?? I don't have a nice smile anymore and it really upsets me . Honestly now, How much change is going to be after these 3 months? I'm very disappointed . I'm sorry I posted my concern all the time ..

Alexander Donath, MD, FACS · Answer

Without a smiling preop view, it's more difficult to determine what portion might be different.  There certainly can still be changes going on in the tissues; wound healing can take a year to show the final results.  One consideration might be Botox for the lower eyelid/cheek junction to relax the orbicularis oculi (around the eye) muscle, but this should be determined by your doctor.  Also, in your before picture it appears you may have had some asymmetry in your upper lid height preoperatively.Hang in there!--Please note that this does not constitute initiation of a doctor-patient relationship in any way and is not a substitute for a medical evaluation.

Eric M. Joseph, MD · Answer

You do not appear to have an "operated" under eye appearance. Your lower eyelids appear a bit swollen still, and your lower eyelid appearance will improve. Best to discuss your concerns with your surgeon or visit another reputable oculoplastic or facial plastic surgeon for an evaluation.Wishing you well.Dr. Joseph

John J. Martin, Jr., MD · Answer

I think your uppers look fine.  Your lowers may still be a little swollen. You do have some creases in the lowers which are probably what is bothering you.  This could be swelling between the muscle layers.  I would do some massage over this to see if you can help to flatten it out.  At 6 months if this isn't better you could think about a revision.

Frank P. Fechner, MD · Answer

From your photographs, it is difficult to decipher what the final goal of your surgery was. Because a little swelling will remain even after three months, it is it is wise to wait for a couple more months before judging the final result (although I would not expect dramatic changes).

Kenneth D. Steinsapir, MD · Answer

This type of lower eyelid post-surgical smile line problem is common after lower eyelid surgery and laser resurfacing.  These procedures cause scaring in the glide planes associated with the lower eyelid and mid face.  Instead of the smile lines we normally expect to see, one can see ridging and bunching that is not consistent with what we expect to see with a smile.  The problem has no technical name and is never discussed in the literature. There is no magical fix.  It does tend to get a bit better over long periods of time like a year or more of healing due to softening of scar tissue.  The right lower eyelid seems to have a slightly different problem.  There is skin just below the lower eyelid lashes that slumps down overhanging the lower eyelid crease.  This also corresponds to a weakening of the right lower eyelid contour.  This is consistent with post surgical paralysis or motor nerve injury to the lower eyelid orbicularis oculi muscle that is responsible for holding the lower eyelid margin in place on the eye surface.  Some of these things are more fixable than others.  The most important thing is to not make more mistakes in correcting this.  The more fixes, the further from normal this lower eyelid will be.  Less is more.  The very best thing you can do for this situation is to give it tincture of time.  Do not make the mistake of rushing into a fix.  No tuck or pinch or other simplistic repair  will unstir the cream from the coffee.  I recommend letting thing heal for 3 to 9 months more before trying to decide with a surgeon who is in the business of fixing other eyelid surgeon's work what needs to be done and what can be done.

Cory S. Goldberg, BSc, MD, FRCS(C) · Answer

Your before pictures look quite good, and I agree I'm not clear on your goals with the surgery. Eyelids can be quite slow to resolve swelling, and so at 3 months you will still need to be patient. It will be about 6 months in total from surgery before it has settled as much as it is going to.

Ross Stutman, MD · Answer

Thank you for your question and photos. At three months post op, you still have some healing to go through before your final result. I would usually recommend waiting a full 6 months before you think about any revisionary surgery. The exception to that would be for any functional problems (for example if you were unable to completely close your eyes).I  certainly recommend that you discuss your concerns with your surgeon. You may want to seek another opinion by a board certified plastic surgeon before you go through with any more surgery.Best Regards,Dr. Stutman

Steven Wallach, MD · Answer

You still look a bit swollen. Best to go over things with your doctor, but you probably need to give yourself more time.

R. Stephen Mulholland, MD (retired) · Answer

Dear Gingirica,

Thank you for your clinical post and photographs.  There appears to have been some significant
improvement since the last photographs that were posted and the lower lid swelling,
creepiness appears to be improving.  The
lower lid tissue is very delicate and depending on the technique that was used
there may be some persistent swelling and edema that can last 6 or even 9
months.  Conservative management at this
point is always warranted including lower lid massage techniques, lower lid
silicone gel strips, as well as bulk heating radio frequency treatments.  The radio frequency treatments can be
alternated with ultrasound to help resolve any swelling.

At 3 months this is difficult to tell what the final result
will be, but certainly patients at this point is still a virtue even though
you’re frustrated and disappointed it’s best to maintain close contact with
your operating physician to ensure that your post-operative care is optimized.

In general, most lower lids do settle.  You appear to have good lower lid marginal
posture, no scleral show and a nice angle at both the medial lateral canthal
area.  Your upper lid blepharoplasty
appears to have healed quite well and should continue to do so.  It is not uncommon to have subtle weakness of
the muscles of the upper lid and have some degree of temporary ptosis that does
improve.

I know it is always difficult at this point to be reassured
and patient that time will generally improve most temporary issues of swelling
and edema.  Following these simple
post-operative instructions can help, however, all certified eyelid surgeons,
both oculoplastic, plastic and facial plastic may have different protocols for
post-operative care.  If you still
maintain trust in your operative physician which is always recommended careful
frequent follow-ups to ensure you’re doing the right soft tissue maneuvers to
rapidly improve this appearance should be undertaken and maintained.

I’m sure you’ll get an excellent result in the
long-term.  Best of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

I'm 3 months post lower blepharoplasty. I look creepy and I don't even like to smile anymore. Is it likely to improve?

Answers (9)

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