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Revising Upper Eyelid Surgery with the Microblepharoplasty Approach

Published on September 20, 2016

Upper eyelid surgery is one of the most popular cosmetic surgeries. It can powerfully rejuvenate and refresh your appearance. You have every reason to expect an amazing outcome from your eyelid surgery. However, if you find yourself disappointed in your results, you don’t need to feel alone. Perhaps you have voiced concerns to your original surgeon, and were reassured that you look “marvelous,” or are being overly “perfectionistic.” Don’t settle for mediocre results, help is available.

Many patients who are dissatisfied with their upper eyelids after cosmetic eyelid surgery are told that they have a great result by their surgeon. That in fact might be your surgeon’s honest opinion. Dissatisfaction with upper eyelid surgery is often caused by unexpected upper eyelid heaviness or ptosis, hollow upper eyelids, and upper eyelid creases that have been placed too high. These are the most common concerns expressed by eyelid surgery patients after eyelid surgery. If you have had upper eyelid surgery and are disappointed with your results, it may be time to seek a second opinion. For many individuals, a reparative microblepharoplasty can greatly improve your outcome, helping you to achieve the youthful, bright appearance that you desired with your original surgery.

Dr. Steinsapir frequently consults with individuals who have previously undergone eyelid surgery, but are unsure about their results. In many cases, he completely agrees that the surgery actually makes a person look worse. While your original surgeon may be happy with your results, that does not mean you have to agree. Seeing another surgeon who is not invested in your prior surgery can be highly validating and empowering. We encourage you to listen to your intuition. Learn about your options. As described in this article and in this intraoperative video, Dr. Steinsapir offers an entirely new paradigm for repairing post-upper blepharoplasty concerns.

Help for “Surgical Eyes”

When a blepharoplasty does not appear natural, this is sometimes described as “overdone” or “surgical,” as exemplified in the before image in this composite photo. The woman pictured here underwent surgery a couple of years ago, and, due to dissatisfaction with her results, she sought several consultations with multiple eyelid surgeons. Some have told her that she had a great result. Some offered her hyaluronic acid filler or grafted fat to fill in the upper eyelid sulcus. However, none of these answers seemed right to her.

In the before picture, we can clearly see that the eyelids appear heavy. The eyelid is thin, and the sulcus is hollow. The fat that is normally present in the upper eyelid fold is missing. In some cases this is because it has been aggressively removed at the time of the original blepharoplasty. In there is fat but it is held behind scar tissue created by the original surgery. It can also retract into the orbit with a disinserted levator aponeurosis tendon, which is also the reason the eyelid appears heavy. We can also see that the upper eyelid lashes are poorly supported, shading the upper part of the cornea and making the eyes look dull.

How Revisional Microblepharoplasty Works

You can view the revisional surgery in our intraoperative video here, but please be aware that some images are graphic. You will have the opportunity to fast-forward through the surgical part of the video if you wish to hear Dr. Steinsapir’s commentary without seeing the surgery itself.

In order to fix the issues that cause the appearance of the “surgical” look, the upper eyelid must be explored surgically. First, a new crease is made lower on the eyelid—in this case, at about 7 millimeters, but the precise position will depend on the individual’s features. The skin removal is limited to just a few millimeters. If possible, the original scar is removed.

This sets the stage to lower the upper eyelid crease. Now the orbicularis oculi muscle is excised, unroofing the junction between the tarsus and the Muller’s muscle. At this point in the surgery, you would normally see the levator aponeurosis, the tendon of the muscle that lifts the eyelid. However, depending upon what was done in the previous surgery, this may not be the case.

In the example here, the levator was completely disinserted, revealing little blood vessels called the peripheral palpebral arcade. Before her first surgery, these would have been obscured by the levator at this point. Next, dissection is directed to identifying this tendon and it is freed from the scar tissue. The upper eyelid tendon is then repositioned into the upper eyelid. Once this is accomplished, the upper eyelid is again properly supported. Next, the anterior orbital fat that retracted into the orbit with the tendon is mobilized and brought forward in order to provide natural fullness to the upper eyelid fold. The repositioned tendon is trimmed so it just meets the upper eyelid platform skin.

After these corrections have been made, typically three sutures are placed to snug the eyelid platform skin to the tendon. Tension between the trimmed aponeurosis and the eyelid platform supports the upper eyelid lashes. This work is also the basis for reforming the hard upper eyelid crease and supporting the upper eyelid lashes. Finally, the skin is sewn closed using a running stitch incorporating the edge of the anterior levator aponeurosis tendon, and again reinforcing the crease. These stitches are removed about 1 week after surgery.

The unretouched after photo shows the results of the structured microblepharoplasty three months after surgery. Notice the natural appearance of the eyes. Now, as a result of surgery, the eyes are bright, and jewel like.

After surgery the brows have relaxed, creating a more youthful brow position. The upper eyelid fold has been reestablished with a natural fullness. There is now a well-defined upper eyelid crease. The upper eyelid is positioned higher on the eye and the lashes are rotated superiorly, which eliminates the shading at the top of the cornea seen in the before picture. The eyes are now bright and jewel-like, exemplifying the features we associate with a youthful eyelid. The dullness seen in the before picture is gone. The thin, droopy, hollow upper eyelid has been corrected in a way that can only be achieved with the precision associated with structured microblepharoplasty.

A Second Opinion

If you have an issue with your eyelids after prior eyelid surgery, you don’t need to live with results that make you unhappy. In many cases undergoing structured microblepharoplasty with Dr. Steinsapir will exceed what you expected to accomplish with your original surgery. Never had eyelid surgery? As you can image, Dr. Steinsapir does amazing primary eyelid surgery. We invite you to schedule a consultation with internationally recognized cosmetic eyelid surgeon Dr. Kenneth Steinsapir, located in Beverly Hills, and learn how it is possible to achieve truly natural results.