Thank you for your question.
You submitted 2 photos and you state in your question that it has been 4 months that since
your eyelid surgery and that you don’t see much of a difference that you are considered
that the results are not as you desired.
And your surgeon states that it is about a year to see the final outcome.
And you also comment that your friends don’t notice a difference either.
Well, certainly I can give you some guidance on how I approach Asian eyelids surgery and
what may be of benefit to you is how I determine if and when I do revision surgery.
A little bit of background, I’m a board certified cosmetic surgeon and fellowship
trained oculofacial plastic and reconstructive surgeon and practicing Asian eyelids surgery
has been a significant part of my practice in Manhattan and Long Island for over 20 years.
So I think that at first you have to look back at you initial consultation and subsequent
discussion you had with your surgeon and I’ll go through the sequence that we go through.
First, we want to determine if someone has a well developed crease or partially developed
crease or just nothing at all.
Then we determine what would look the most natural and sometimes it just means taking
a little instrument and pushing the skin in and seeing the eyelid and what shape it forms.
There are certainly branching points in the decision making process.
So we first start with the question is there any extra skin?
If there is no excess skin then I gently use a non-incisional approach.
Non-incisional basically means making little openings in the skin to pass stitches in the
skin and the levator muscle which is the muscle that lifts the eyelid to create an anchor
point for the skin to fold when the eyes are open.
If there is excess skin then I take away the skin.
Then there is a decision point that is typically for me consistently, one that I prefer which
is a nasal taper and that means going towards the epicanthal fold or a parallel crease which
is parallel to the epicanthal fold.
I feel like my goal is to try to create a natural look as if nature created the crease
and usually that means a nasal tapper fold.
Now the next question is how to determine the success of the procedure.
When we see our patients, we see them actually during the surgery.
I will actually have my patients open their eyes just to make sure that the crease is
anchored well and looks as I anticipate.
In addition, sometimes I’ll sit somebody up and look at them and make sure things look
good.
Now, if initially you noticed and unfortunately partial limitation of Asian eyelid surgery
is that the initial appearance can look exaggerated.
In other words, the swelling between the crease and the eyelashes can be elevated that can
result an artificial high crease.
Yes, there is a certain amount of time that we allow for natural swelling to diminish.
As far as your difference in perception with your surgeon, and the question really is there
swelling?
Is there scar tissue that’s not necessarily healed the level that it needs to be?
The reason why I can’t give you a definitive answer is that in the absence of physical
examination, it’s very difficult to just answer your question yes or no.
I am sure you chose your surgeon after having done your research and homework and then choosing
someone that you felt had more than enough experience performing Asian eyelid surgery.
And I would state that amongst colleagues that people who do Asian eyelid surgery are
generally very knowledgeable and are very experienced enough and can anticipate what
would happen in any given scenario.
So the question you have to ask yourself is what is your ideal outcome, what is missing
right now, do you want the crease to be deeper?
Do you want to see the skin fold over more?
Is it just that you ended up with a surgery where a settle crease was created but you
didn’t have that much skin so you didn’t have that much of a fold?
I think that the majority of concerns that people have when they come to see me for second
opinion, as a cosmetic oculofacial plastic surgeon, I do get my share of second opinions.
I would say that it is often miscommunication between the doctor and the patients from the
word go.
So I think you need to sit down with your surgeon and there is no reason to rush unless
there is a significant issue.
There doesn’t have to be.
And if your surgeon is comfortable with waiting a year, certainly that is not unreasonable.
My feeling is once the swelling has diminished, I think it is reasonable to do a revision
so that can be as early as 6 months but there is a range.
So meet with your doctor again and try to get definitive ideas and ask what would happen
after one year.
What exactly would be the doctor to do to revise the result and is there a likelihood
of success.
I think this dialogue is very important and you can certainly get some other opinion by
having other doctors examine you and that might be necessary for you to feel assurance
about this path in terms of waiting.
So once again meet with your doctor, get additional opinions and see what kind of outcome is visible
given that you already had a surgery.
So I hope that was helpful, I wish you the best of luck and thank you for your question!