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Revision Eyelid Surgery FAQ Beverly Hills

FREQUENTLY ASKED QUESTIONS ABOUT REVISION EYELID SURGERY

For your convenience, Dr. Steinsapir has compiled a list of the most commonly asked questions about cosmetic revision eyelid surgery (blepharoplasty). If your question is not answered below, please do not hesitate to contact our private practice facility, located in Beverly Hills, California. We look forward to speaking with you, and are always available to answer any questions or concerns you may have.

How do I know when I need revisional surgery?

If you have already had an eyelid surgery such as blepharoplasty, give yourself time to heal. It is natural to experience some anxiety regarding whether you will like your results, but remember that worrying doesn’t help and that your final results may take time to become apparent, as lingering swelling subsides and the tissues fully heal. If you are confident in your doctor, you have good reason to expect the best.

If you experience any complications during your recovery, talk to your original surgeon. Post-operative concerns are often the result of insufficient follow-up communication. Never assume that your surgeon is too busy for what you perceive as a minor concern. It is always a good idea to communicate your concerns so that they may be addressed promptly.

Significant health complications after eyelid surgery are unusual—a more common concern is that patients do not see the improvements they were hoping for, or feel that their recovery is taking longer than expected. Although this technically isn’t considered a complication, it is something to address with your surgeon. If your original surgeon does not feel that anything further can be done, it is time to seek a second opinion.

Too much of my upper eyelid folds were removed at the time of my upper eyelid surgery, leaving my upper eyelid sulcus hollow and the eye skeletonized. What can be done to correct this problem?

Schedule A Consultation with Dr. SteinsapirThe upper eyelid fold is an important anatomic feature. Failure to conserve the upper eyelid fold during an upper blepharoplasty surgery contributes to an unnatural, ‘surgical’ appearance. Eyelid surgeons were previously instructed that it is impossible to remove too much upper eyelid skin during eyelid surgery; however, this is not the case. It is essential to consider the position of the eyebrows when assessing how much spare skin exists in the upper eyelid. A conservative approach is to position the eyebrow anatomically before determining how much excess skin to remove from the upper eyelids.

When too much skin and underlying tissue is removed from the upper eyelid, the upper eyelid fold is compromised, resulting in a hollow space below the eyebrow where the upper eyelid fold once existed. In the past few years, Dr. Steinsapir has developed a new break through approach to these type of eyes. By lowering the upper eyelid crease, repairing damage to the upper eyelid anterior levator aponeurosis, and marshalling anterior orbital fat often displaced by scar tissue, Dr. Steinsapir has been able to provide many patients with a degree of improvement in the upper eyelid that previously was considered impossible. Call the office and schedule your personal consultation with Dr. Steinsapir to determine if you are a candidate for this break through method.

I think my upper eyelid creases were made too high during my original eyelid surgery. Is there anything that can be done to fix this issue?

The surgeon performing the eyelid surgery is responsible for setting the height of the upper eyelid crease. Unfortunately, many plastic surgery textbooks present erroneous information about the appropriate height for an eyelid crease, which is why many surgeons fail to realize that as the incision heals, the eyelid crease tends to creep up another one or two millimeters. This lack of understanding leads to incisions being placed too high above the eyelashes, often 10 millimeters or more above the eyelashes. In these cases, the upper eyelid crease will ultimately heal at 11-14 millimeters above the eyelashes, which contributes to a hollow appearance in the upper eyelid.

Dr. Steinsapir advocates making creases much lower, and typically marks the upper eyelid incision at about 6.5 to 7.5 millimeters above an eyelid margin. It is relatively straightforward to raise an eyelid crease. It was once said that it was impossible to lower an upper eyelid crease. However, Dr. Steinsapir using his micro-blepharoplasty approach has develop an new approach to lowering the upper eyelid crease. The success of this approach very much depends on what previous surgeons have done to the upper eyelid. However, Dr. Steinsapir can assess your upper eyelid and determine if the method is likely going to be successful for you. This new approach makes what was previously impossible now achievable. Contact the office to schedule your personal consultation with Dr. Steinsapir.

The skin on my upper eyelid platform is wrinkled and loose, and I can’t seem to keep makeup on without it smudging. Is there anything that can be done to help with this?

Simply removing extra skin is not enough to produce beautiful blepharoplasty (eyelid surgery) results. Optimal eyelid surgery outcomes require what Dr. Steinsapir calls a “structured micro-blepharoplasty.” During a structured micro-blepharoplasty, the eyelid crease must be made at the perfect height and the eyelid platform skin must be anchored to the levator tendon, thereby raising the upper eyelid and placing the upper eyelid skin on a slight stretch, resulting in a smooth platform for makeup.

Crepe-like upper eyelid skin after unsatisfactory upper blepharoplasty surgery can be corrected with a carefully planned re-excision of the residual excess skin on the eyelid platform. With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator. Recovery from this procedure is usually shorter than with standard upper blepharoplasty and this type of revisional procedure can generally be performed in an outpatient setting with local anesthesia.

I had eyelid surgery years ago and was initially very happy with my results, but now my formerly full upper eyelids are very hollow and seem to hang down. Can this be corrected?

Some surgeons focus on removing as much tissue as possible during eyelid surgery, even to the point of making it difficult for the patient to close their eyes. In contrast, Dr. Steinsapir looks to preserve as much of the natural eyelid structure as possible. Although restoring fullness to the upper eyelid is typically very difficult, in this case, it sounds like the tendon of the upper eyelids may be disinserted, causing a drooping of the upper eyelid. During the original eyelid surgery, the tendon may have been accidentally cut and never repaired, causing the eyelids to slowly sag down over time. On the other hand, the upper eyelid heaviness may be unrelated to the prior eyelid surgery and may simply be developing as a result of the natural aging process. A consultation with Dr. Steinsapir will help to address these issues and determine the best course of corrective treatment.

My upper eyelashes point down. It bothers my vision and makes my eyes look dull. Is there a corrective solution for this?

This condition is called eyelash ptosis and it is related to poor levator fixation of the upper eyelid platform skin. A structured micro-blepharoplasty, whether performed as an original or revisional surgery, can be utilized to correct this issue. During a revisional structured micro-blepharoplasty, a carefully planned re-excision of the upper eyelid platform ensures that the platform skin will be on slight stretch when the platform is reattached to the levatortendon. This puts slight traction on the skin of the eyelid platform and gently rotates the eyelashes upward to a more youthful position. Recovery from a structured micro-blepharoplasty is usually shorter than after a standard upper blepharoplasty, and this type of revisional procedure can be performed in an outpatient setting with local anesthesia.

Since my upper eyelid surgery, the inner corners of my eyes look heavy. What causes this and what can be done to correct it?

When blepharoplasty (eyelid surgery) is performed as a solo procedure, relaxation in the position of the eyebrows after surgery can crowd the upper eyelid space, causing the inner corners of the upper eyelid to appear heavy or full. The solution to this cosmetic concern is to perform a forehead lift, or a forehead lift in combination with an upper blepharoplasty. Not everyone with a degree of brow heaviness needs a forehead lift.

During your initial consultation, Dr. Steinsapir will carefully assess your facial structure to determine the degree of brow ptosis (sagging, drooping), because when brow ptosis is significant, there is usually compensatory activity of the forehead lifting muscles. If you do not present with severe brow ptosis, you may be a good candidate for a simple upper blepharoplasty; however, when the heaviness of the forehead is bothersome after eyelid surgery, the best solution is usually a forehead lift.

My eyelids seem very heavy since my blepharoplasty. What causes this and what can be done?

Eyelid heaviness is actually a common concern after eyelid surgery, and is the result of slippage or disinsertion of the upper eyelid tendon that connects the upper eyelid edge with the muscle that raises the upper eyelid. The resulting heaviness is referred to as ptosis or blepharoptosis. Post-blepharoplasty eyelid ptosis can be caused if the tendon is cut during surgery or slips on its own, which is then exacerbated by the post-surgical swelling of the eyelid.

Correcting post-blepharoplasty eyelid ptosis first entails determining if one or both of the eyelids is drooping. Although one eyelid may be worse than the other, if both sides are not fixed at the same time, the side that was not repaired will end up looking heavy by comparison. The exact procedure needed to fix the droopy lid is determined by how heavy the eyelid is and its response to the instillation of neosynepherine eye drops. Based on the results of this test and several other diagnostic measurements, Dr. Steinsapir will determine the most appropriate treatment plan to correct the ptosis.

Since my eyelid surgery my eyes seem very dry, and at night I don’t think I fully close my eyes. What can be done about this?

Dry eye is a common occurrence in adults; however, the persistent swelling of the eyelid tissues after eyelid surgery can contribute to a worsening of dry eye symptoms. Additionally, overaggressive eyelid surgery techniques that remove too much upper eyelid skin do not allow the eyes to fully close at night, causing dry spots to develop on the cornea, exacerbating the dry eye symptoms.

Depending on the design of the original blepharoplasty procedure, the nerves supplying the muscles that help close the eye can be damaged, weakening the blink reflex with insufficient speed or force to cause the upper and lower eyelids to meet during the blink. This is problematic because the eyelids move tears around the eye surface—without proper blinking and eyelid functionality, the net result is surface drying and uncomfortable dry eye symptoms. In many cases, there is recovery of function over time.

The first line of approach to the treatment of dry eye symptoms is to increase the frequency of artificial eye drops and, when indicated, ophthalmic ointment at bedtime. If necessary, the tear drains in the eyelids can be closed temporarily with plugs to see if symptoms improve. When these measures fail, consideration may be given to reconstructive surgery. The nature of the treatment protocol is very much directed by the severity of the symptoms and the degree of dryness seen on the surface of the cornea. A range of options is available; however, the key objective is to help the eyelids meet and to create sufficient force of eyelid closure to spread the tears over the corneal surface.

Since my lower eyelid surgery the area under my eyes seems hollow. What causes this and what can be done about it?

Lower eyelid surgery is performed to address skin wrinkling and lower eyelid fullness resulting from surplus orbital fat that has bulged forward into the lower eyelid. By carefully sculpting lower eyelid fat, a proper balance can be struck, leaving enough volume in the lower eyelid to eliminate the bulge while preventing deflation and hollowing of the lower eyelid, which can contribute to the appearance of under eye circles.

The under-eye circle is actually the result of a gradual fall in the cheek fat over time. There are several options to address concerns about under-eye circles. For the right patient, a conservative lower blepharoplasty performed with a transconjunctival (behind the lower eyelid) technique is often an excellent choice, particularly for a relatively young patient with thick lower eyelid skin and lower eyelid fullness.

Other approaches to correct and/or mask the appearance of under-eye circles that have become more prominent after surgical removal of lower eyelid fat include:

  • Conserving the lower eyelid fat by positioning it into the top of the cheek
  • Chemical peel to firm the skin of the lower eyelid
  • Restylane® to fill in the under eye circle
  • Vertical midface lift over an orbital rim implant

Restylane® treatment for the lower eyelid is non-invasive and produces results that can last a year or more, many patients faced elect to have Deepfill™ Restylane® administered to fill in the under eye circle. A personal consultation with Dr. Steinsapir is the best way to ascertain the optimal approach to address your under-eye circle concerns.

Since having lower eyelid surgery my lower eyelids look pulled down. Can this be corrected?

The gentle almond shaped curve of the lower eyelid is created by a delicate balance of forces, including:

  • the ligaments of the lower eyelid
  • the force generated by the orbicularis oculi muscle
  • the prominence of the eye itself
  • the projection of the cheek
  • the weight of the cheek

Essentially, the lower eyelid position defies gravity. It is little wonder that lower eyelid surgery can permanently alter this balance and cause the lower eyelid to become pulled down after surgery. Surgery also causes scar tissue to form in the lower eyelid, weakens the ligaments of the lower eyelid, and damages the muscle that helps hold the lower eyelid against the eye.

Correcting these issues is challenging because of the careful analysis needed to determine the best options for a given individual. Restoring the optimal lower eyelid contour requires taking into consideration all of the potential contributing factors. Correction may require structural reinforcement of the lower eyelid with the placement of graft material and possibly an orbital rim implant to support the lower eyelid. This approach has the power to address lower eyelid contour problems that have not responded to multiple prior approaches.

I had lower eyelid surgery and there seems to be residual fullness in the outer third of my lower eyelids. Is it possible that my doctor missed some eyelid fat?

There are three fat pockets associated with the lower eyelids. The two central pockets are easily accessed during lower eyelid surgery; however, the outer fat pocket is more challenging to access and sometimes overlooked. Residual lower eyelid fullness responds well to revisional lower eyelid surgery performed by an experienced eye surgeon with the necessary skills and knowledge to access the elusive third fat pocket.

I had a fat transfer to my lower eyelid in the hopes of treating my under eye circles, but my circles are still visible and now I have lumps under my eyes—can revisional surgery correct this problem?

The under eye circle is a very common cosmetic concern resulting from the natural fall in the top of the cheek fat that takes place during the natural aging process. Transferring fat to the face has become an increasingly popular treatment to address under eye circles. However, although facial fat transfer is generally a good option for restoring volume to the face, this technique can only produce desirable results when the transferred fat is deposited in locations that already possess a sufficient amount of fat to hide any irregularities created by the newly transferred fat. The area around the lower eyelid circle contains almost no fat, which means that there is no place for the volume of the fat transfer to hide, resulting in visible lumps and bumps.

Correcting post-fat transfer complications has proven to be very difficult, as the fat tends to be found in planes that do not correspond to standard surgical approaches, and attempts to melt the fat with steroids can lead to unpredictable fat loss. The best corrective approach is to remove the most noticeable of the visible fat deposits and fill in around the others with a hyaluronic acid-based filler (i.e. Restylane®). This approach evens out the lower eyelid irregularities, and in some cases, suffices to correct the problem without requiring surgical fat removal.

Since having midface surgery, the skin in my lower eyelid bunches up when I smile. Why is this happening and can it be corrected?

Midface anatomy is highly complex. Several of the midface tissue planes act as glide planes, and certain midface and lower eyelid treatments seem to change the nature of how these tissues glide over each other. Surgical midfacelifting may stimulate an inflammatory response in these same glide planes, leading to the type of skin heaping and “bunching” you described. Avoiding overly aggressive skin and midface lift procedures is the best way to prevent this issue from occurring; however, as you are currently struggling with lower eyelid bunching, a consultation with Dr. Steinsapir is the best way to determine whether there are any corrective measures to enhance the appearance of your lower eyelid.