Can a second upper blepharoplasty rectify a high and irregular crease with some scar
tissues?
My upper and lower blepharoplasty was done 9 years ago.
The incisions on the upper eyelids were too high.
My Asian almond shaped eyes were turned into rounded ones.
The creases are also irregular and there are some indented scars in them.
Now that my eyelid skin is looser with some hooding & wrinkles, can a 2nd blepharoplasty
be done?
Will this remove the irregular crease lines, scars and the wrinkles (some lateral)?
Can the eyelid crease be lowered?
My eyebrows are at the orbital bones.
Thanks.
Thank you for your question!
You submitted a question with concerns with revision eyelid surgery and you mentioned
in your question that you feel like you have skin over the eyes as well as that you’re
almond-shaped Asian eyes were turned into more rounded eyes.
As a cosmetic oculofacial plastic surgeon for 20 years and specialist in revision eyelid
surgery, I can certainly share with you a lot about this particular issue and I’m
going to focus more on the lower eyelid situation because we see this problem a lot.
We have patients who come from all over the world and the common issue is that the lower
eyelid is retracted.
The term is lower eyelid retraction.
In other words, before the surgery, a natural almond shape where the lower eyelid was at
the same level with the colored part of the eye called the iris.
After surgery, it gets rounded and it’s called scleral show or lower eyelid retraction.
Unfortunately, enhancements are typically not that successful unless proper anatomy
is restored.
So let me help you learn a little about this.
The lower eyelid is actually a very complex structure.
It’s position is balance of several factors: one is the lateral canthal tendon which is
what attaches the lower eyelid to the inner aspect of the bone.
The other factor is the vertical support of the lower eyelid.
In other words, there is anatomy underneath that’s like a suspension bridge in a way
where there are pillars below that are keeping that area up.
And then of course is the integrity of the skin and orbicularis muscle.
The orbicularis muscle is like a support muscle and is like a hammock that pulls the eyelid
in position.
Very commonly, well-meaning surgeons will do this procedure from the outside, take away
the fat and place the skin back and trim off skin without doing anything to restore the
integrity of the lateral canthal tendon and appreciating that there may have not been
enough skin excess which they initially believed because what happens during surgery is, when
a person is lying down, there is a shifting of everything upwards.
It can appears that there’s more skin than there actually is.
And so what happens is there’s a skin shortage.
There is a loss of the pillars that I described early which has the lower eyelid to skink
and the lateral canthal tendon is not properly reinforced, everything sags.
You’re revision procedure for your lower eyelid is likely to be more involved than
doing just a simple tuck up procedure or limited procedure.
A lot of our patients had multiple revisions before they came to see.
Very often, they end up more skin shortage, wider scars and we have to do a lot more surgery.
this includes grafting of tissue on the inside of the eyelid, grafting skin in the outside
of the eyelid and even doing something called drill hole canthopexy where we drill holes
on the bone in order to restore the integrity of the tendon.
I’m not saying that you will need all those things but it is important to understand that
these three elements of balance is very important for lower eyelid position and restoring of
the anatomy.
So, I think that you have a lot to discuss with your doctor.
It is very important that you and your doctor have a meeting of the minds.
One of the things that I also describe in terms of tempering this concern of postoperative
results is that a lot of people actually like that rounded look and in the Upper East Side
of Manhattan, that type of look is walking around all over the place.
And so, the people who have that look feel really good.
So, it’s the meeting of the aesthetic values of the patient and the doctor that ultimately
defines the success of the procedure but when it comes to eyelid surgery, it is also a critical
factor that the health and integrity of the eye itself be maintained and protected.
I think that once you have an understanding of what your doctor is recommending, if you
feel comfortable that things will work out with any type of revision surgery that your
doctor is suggesting, then you can certainly move forward of having that done.
It may be helpful for you to be comfortable to get additional opinions if you still have
that feeling that you’re not that sure.
Do more research about what I described, the lower eyelid retraction after cosmetic eyelid
surgery, then you’d appreciated more about what others experiences have been who are
in a similar situation so you can understand what you’re options are a little bit more.
Without the editorialization and unfortunately, a lot of the emotional that comes from people
being upset, just looking at the anatomy and what your ultimate desired look will hopefully
help you take the appropriate steps to get the results that you want.
So I hope that was helpful, I wish you the best of luck and thank you for your question!