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When Eyelid Lift Surgery Isn’t Enough

Posted: 9:29 a.m. Sunday, August 5, 2018

By Anita Mandal, M.D.

Question: I had heavy skin on my upper eyelids and fat bags under my eyes. A plastic surgeon performed an upper and lower eyelid lift to remove the excess skin and fat. I was left with hanging skin in the outer part of my upper lids. My surgeon then said I needed a brow lift. Also, while my lower lid fat bags are gone, I now look sunken in and even more tired. Why do I look worse after eyelid surgery?

Answer: When it comes to rejuvenation of the upper and lower eyelids, it’s important not to use a “cookie cutter” approach. Extra skin of the upper eyelids does not automatically mean that upper eyelid surgery is for you. A skilled and knowledgeable surgeon must first look at the cause of excess skin over the upper eyelids.

Sometimes, the hanging skin is due to a sagging eyebrow and not from aging of the upper eyelid. Performing an upper eyelid lift in these cases can worsen the appearance of hanging eyelid skin and pull the eyebrow down even further. Proper treatment options include an eyebrow lift or Botox rather than upper eyelid surgery.

The residual sagging skin on the upper part of your eyelids could also be due to the fact that not enough outer eyelid skin was removed as this is a common error in upper eyelid surgery. Another cause would be an unrecognized droopy outer brow. In the latter case, a brow lift may not be effective since brow surgery tends to lift the central and middle brow to a greater degree than the outer brow. Treatment of a sagging outer brow may include Botox. If the temples are narrow or sunken in, this can suggest temple fat loss. In such cases, injectable fillers in the temple can lift the brow, open the eyes and restore facial proportion.

When assessing the lower eyelids for fat removal, it is important to look at the relationship between the lower eyelid fat and the lower eye socket. Excess lower lid fat does not automatically mean a lower eyelid lift is needed. In some cases, removal of too much lower eyelid fat can make a patient appear more hollow and more aged, making it important to have conservative fat removal of the lower lids. In other patients with excess fat that co-exists with hollowing of the lower lids, filling in the hollow areas of the lower lids can improve the appearance of bulging fat to the point where no surgery is needed. Bellafill and Restylane are options for filling of the lower lid hollows.

Consulting with a Board Certified Facial Plastic Surgeon who is not only skilled in surgery of the eyelids, but is also an expert diagnostician with a great deal of experience in non-surgical treatments is the first step in tailoring recommendations to your unique facial rejuvenation needs.


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