Dr. Paul L. Leong, MD

It's Your Face, Trust it to a Specialist

Revision Blepharoplasty

shutterstock_55354480With every cosmetic surgery, no matter how skilled the surgeon there is an element of risk. Unfortunately, after investing ample time and money, some patients find that their surgical expectations have not been met (for cosmetic or functional reasons) and that revision surgery is necessary. I often recommend that patients wait a full year after their initial surgery (when swelling and healing resolves) before rushing into another surgical procedure. Flaws or defects present after surgery may resolve on their own within a couple months. Also, the true surgical results is often not seen until six months or more down the line when inflammation has resolved and healing has occurred. Often times, problems that occur after blepharoplasty surgery are from too much or too little skin taken off. In either case, it is crucial to find a specialized surgeon with years of experience and expertise to repair the problem. Operating on previously incised skin and tissue (especially in a tender area such as around the eyes) can be more challenging and presents more risk and complications.

The following will give you some additional information on Blepharoplasty revision surgery. If you would like to schedule a consultation to talk about this procedure, please contact Sistine Plastic Surgery.

Over and Under Correction

As one might imagine, it is usually much easier to correct an under corrected or less aggressive surgery then it is to correct an overly done or aggressive surgery. Once tissue or skin is deficient, revision surgery can become more difficult, requiring reconstructive surgery. Fat grafts (in which fat from other areas of the body) are transferred into the upper or lower eyelid may be required. In patients who have had multiple surgical procedures, it is sometimes best to refrain from operating at all due to a high risk of there being no improvement or an even worse result. Each case is evaluated in depth to determine the best possible outcome for the patient.

During an under corrected blepharoplasty surgery, one can more easily make corrections and remove additional skin and tissue to attain the desired result. This is why I favor being more conservative rather than being overly aggressive. However, when operating a second time, it is even more important to stay conservative and leave an ample amount of tissue and skin.

Revision blepharoplasty surgery can result in higher rates of complications so it is important to avoid rushing into surgery and consider whether your expectations are realistic. Attaining perfection is nearly impossible and the risks of revision surgery are higher. Once excess scar tissue has formed, manipulation becomes more difficult. In addition, healing time may be increased, multiple surgeries may be needed and the result may be limited.

Possible complications after Upper Eyelid Surgery

A common problem following blepharoplasty surgery is ptosis – when the upper eyelid droops due to muscle injury during surgery. In some cases, ptosis restoration may require additional surgery to shorten or tighten the levator muscle. However when ptosis occurs from the placement of sutures, drooping normally corrects itself in a matter of a few weeks.

The placement of the eyelid incision is critical because when the incision is made too high a scar will be visible. When this occurs, it is often due to a surgeon lacking experience or skill. For most Caucasian patients, an incision created approximately 8-10mm beyond the eyelashes will create a well hidden scar. The risk of having a higher eyelid crease increases if brow or eye lift surgery is performed along with upper eyelid surgery. During browlift surgery, the forehead area is lifted to create a more youthful and awake appearance.

When skin is aggressively removed, the skin becomes tight and constricted and will stretch out. When a disproportionate amount of fat is removed, the eyelid may appear hollow and unnatural looking. Aggressive removal of skin and/or fat may cause the eyelid crease to lift, making the surgical scar evident. This may be apparent immediately after surgery or years down the line. Fat grafting may be necessary in order replenish fat loss and improve the cosmetic appearance.

Lagopathalmos is a serious complication that occurs if too much skin was removed or from excessive scarring. If this is not taken care of, it can lead to medical complications from the inability of the eye to fully close. Correction for severe cases may involve skin grafting, while minor cases may resolve with massage or the implantation of an eyelid weight. The healing time after a surgical eyelid skin graft is usually between 6 months to a year.

Another serious complication from eye surgery includes blindness from the blood accumulation in the back of the eyes. Hemorrhaging may occur after visual impairment and the sensation of pain. If any of these symptoms occur, it is vital to be seen by a doctor right away. Removing the stitches or creating a slight tear in the tendon might release the accumulation of blood gathered in the back of the eyes. The goal is to take the tension off the eyeballs and repair normal blood flow. If all else fails, detaching the socket bone may help. If blood continues to accumulate behind the eyes, a blood clot may form which can change the appearance of the eyelid. Once incised, this blood clot may be removed to encourage recovery and healing.

Possible complications after Lower Eyelid surgery

Under eye bag removal is a common request of many patients, but there are a number of potential issues that could lead to a problematic or unsatisfactory lower eyelid result. This includes eyelid retraction (when the skin hangs below the eyeball), entropion (eyelid position turned inward) and/or ectropion (eyelid position turned outward). Lower eyelid retraction can occur when too much skin and/or tissue has been removed from the lower eyelids or because the patient had significant facial drooping and/or hollowness. To correct lower eyelid retraction, a number of different methods may be used such as cutting off scar tissue, performing a cheek lift, an ear or fat graft, canthoplasty or an orbital implant. When using a lifting procedure such as a cheek or mid facelift it is important to note that results may only be temporary due to the aging process and loss of gravity over time.

Entropion occurs when the eyelid folds inwardly near the eye. Causes may include previous trauma, aging and loss of muscle strength. Since the eyelashes brush up against the eyeballs, the eyes may be red, delicate and easily irritated. More serious problems may occur if the condition is not treated properly. Eye infections, a scratched cornea, mucous discharge, visual impairment and/or ulcers can all permanently damage and reduce the effectiveness of the eyes. Wind or light may become extremely sensitive to the eyes. Your doctor will decide which surgical technique would work best to repair your eye condition. Depending on the severity of your eye deformity, your procedure may occur in the hospital or in the office. If an incision is required to tighten the lower eyelid, a hospital visit may be required. On the other hand, if sutures are used to non-surgically tighten the eyelid area, your surgery will most likely be done in the office. Regardless of the location, surgery to repair entropion is a relatively minor procedure with a quick recovery time.

Ectropion occurs when the eyelid folds away from the eyes, making it difficult for the upper and lower eyelid to close properly together and protect the eyes. Since the skin sags and exposes more of the eye, the eye tends to dry out more often. The eyes can also become red, tear more easily, develop mucous and crusting, damage the cornea and eventually lead to vision loss. Causes of this condition may include trauma, a prior surgical procedure, aging, a facial nerve disorder or skin cancer. Surgery performed by a board certified facial plastic surgeon or ophthalmologist is required to repair a turned out eyelid and restore its proper functioning. Most patients experience immediate relief and little down time.

In conclusion, blepharoplasty revision surgery can be a challenging procedure with an array of risks, but offer a substantial improvement at the hands of a skilled and educated surgeon. It is important to voice any concerns you may have with your previous surgeon, but if you feel that you are not on the same page with your doctor and are really unhappy with the technique and results you may want to consider finding another reputable doctor in your area. Reading patient reviews, reviewing blepharoplasty before and after photos, speaking with past patients and researching credentials are all important steps in selecting the right doctor.

Contact Sistine Plastic Surgery

To learn more about Blepharoplasty Revision Surgery or to schedule a consultation with Dr. Paul Leong to talk more about this treatment, please contact Sistine Plastic Surgery today.

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