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Hanging Skin and Sunken Eyes after Eyelid Surgery

Posted: 6:00 a.m. Sunday, Aug. 12, 2018

By Anita Mandal, M.D.
Question: I’m 54 and a plastic surgeon did an upper eyelid lift for the hanging skin of my upper lids and lower lid surgery to remove the fat bags under my eyes. It’s been 6 months and while most of the upper eyelid skin is gone, I still have extra skin on the outer part of my upper eyelid. The fat in my lower lids is also gone, but I look too hollow under my eyes. I don’t look much better and maybe even more aged than before. I went back to my plastic surgeon and he said nothing can be done. Is this really true?

Answer: While I cannot speak for your particular case without examining you, what you describe is not an uncommon finding after blepharoplasty or cosmetic eyelid surgery. Hanging skin of the outer upper eyelids is typically referred to as lateral hooding. Lateral hooding can be treated as long as the surgeon recognizes it and marks off the skin that needs to be removed in this outer upper eyelid area prior to surgery. If it was not taken care of at your previous surgery, a revision surgery specifically focused on removal of the hooded skin over the outer upper eyelid can be performed.

In some patients, the appearance of lateral hooding is actually not due to excess outer eyelid skin but instead caused by a droopy outer eyebrow. An experienced surgeon will recognize this in advance and inform the patient that such a problem cannot be corrected with an upper eyelid lift and that a brow lift may be needed.

As far as your hollowing after fat removal from a lower lid blepharoplasty, it’s possible that too much fat was removed and a more conservative approach was needed to prevent hollowing. Another possibility is that you had excess lower eyelid fat co-existing with hollowing of the lower eyelids. In such a case, it’s important for the surgeon to tell you in advance that injectable fillers such as Bellafill – the 5 year filler or Restylane may be needed for the hollowing. Sometimes placing filler in the hollow lessens the appearance of bulging fat such that lower lid surgery is not needed at all. In other patients, combination therapy with lower lid fat removal and injectable filler for the hollows is the treatment of choice.

Careful consultation and a thorough examination with a Board Certified Facial Plastic Surgeon who understands the intricate facial anatomy as well as the anatomic changes that occur with age is the first step.


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