Do your eyes look or feel weird after blepharoplasty (cosmetic eyelid surgery)? An eyelid lift or blepharoplasty can rejuvenate your appearance. However, the eyelids are very delicate and complications from eyelid surgery are often difficult to repair. When can revision blepharoplasty be performed? How does surgery on the upper eyelids differ from surgery on the lower eyelids?

What is Revision Blepharoplasty?

Individuals unhappy with eyelid surgery seek revisional eyelid surgery to resolve concerns associated their original blepharoplasty procedure. Problems can occur after upper lid surgery as well as lower lid surgery but, as a general rule, problems with the lower eyelid are more difficult to repair.

Upper eyelid complications

Problems with upper eyelid surgery are usually easier to improve than complications of lower blepharoplasty. If too little skin was removed, it is quite simple to remove more. It is uncommon to have too much skin removed from the upper eyelids but if it happens then addition of skin in the form of a skin graft is necessary which may leave unsightly scars. Two more subtle problems are:

• -Removal of too much fat. Removal of too much fat can result in hollow upper eyelids which can actually make a person look older, not younger. Revision involves grafting of fat from the abdomen or other parts of the body.
• -Unrecognized brow ptosis. Some patients have an upper blepharoplasty and are still not happy with their upper eyelids and that may be because they needed elevation of the outer part of the eyebrow along with their upper lid skin excision. Performing a brow lift rather than manipulating the upper lid itself is the best treatment in this situation.

Lower eyelid complications

As we get older we almost all get excess, wrinkled skin in the lower eyelids. So we just have it removed, right? Well, it’s not that easy. The lower lid margin, where the lashes are, is not very strong and if too much skin is removed the lid may sag causing an unsightly and uncomfortable situation that may be tricky to fix. Some of the complications of lower blepharoplasty are as follows:

• -Residual fat. If insufficient fat was removed, usually from the outer part of the lower lid, that can be fixed with a revisional procedure
• -Deep indentation at the lid cheek junction. Some people have a deep indentation where the lid meets the cheek. Even after blepharoplasty that transition from the lid to the cheek may not be smooth. Addition of fat in extremely small amounts can be helpful but is tricky. Too much fat or inappropriately placed fat can cause lumps that MORE surgery.
• -Persistence of wrinkled skin. We really don’t have a great operation to get rid of wrinkled skin in the lower eyelids. A resurfacing procedure such as a croton oil peel may help. The patient and the surgeon must resist the temptation to treat wrinkled skin with more skin excision because of the risk of pulling down on the eyelid (lid malposition).
• -Lower lid malposition. The patient’s pre-op anatomy or the type of surgery they had may cause the lid to be everted (ectropion) or pulled down (lid retraction) or pulled away from the eyeball. These are the trickiest problems to fix and usually require moving the corner of the eye (canthoplasty) and/or addition of tissue to lengthen or strengthen the lower eyelid. The best treatment of this complication is to avoid it by making the correct assessment before the original procedure, but these lid malposition problems can usually be improved and it is worth seeing an expert

How long do I have to wait before Revision Blepharoplasty?

The swelling and bruising around your eyes can linger for a few weeks following the original procedure. It is recommended that patients should wait until the swelling has healed before seeking revisional eyelid surgery. You can expect the swelling to resolve by 3 months after the initial procedure. 

Schedule a Consultation to Fix the Results of Your Bad Eyelid Surgery

While it is always important to work with an experienced surgeon, it is particularly true when it comes to eyelid complications. Dr. Charles Thorne has been practicing plastic surgery for more than 30 years and is happy to provide advice about your situation. Schedule a consultation today.