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Sagging After Upper Eyelid Surgery

Posted: 6:12 a.m. Sunday, Aug. 23, 2018

By Anita Mandal, M.D.
Question: I’m in my late 60’s and had an upper eyelid lift by another plastic to remove hanging skin and heavy bags. It’s been 6 months and I still have some sagging skin and bulging on the outer part of both eyelids. I feel my surgeon didn’t do a thorough job. Can a revision surgery remove the remaining loose skin?

Answer: While I cannot speak for your particular case without examining you, generally speaking, there are several reasons for residual loose outer eyelid skin after upper lid blepharoplasty. This classic “textbook” error can occur if, prior to surgery, extra outer eyelid skin is not accurately measured before removal. This situation can be avoided by seeking a board certified facial plastic surgeon who primarily specializes in the face and performs a high volume of eyelid lifts. Revision eyelid surgery can also correct residual hanging skin of the outer eyelid.

If, after surgery, there is outer upper lid bulging under the skin, this is not necessarily due to untreated fat. It’s important to be aware that the upper eyelid mainly consists of fat pockets in the inner and central eyelid, rather than in the outer lid. When a lateral bulge is seen after surgery in the upper eyelids, this can very commonly be due to a ptotic lacrimal gland. With age, these tear glands can sag and be mistaken, not only by a patient but also by an inexperienced surgeon, for a “missed” fat pocket. However, a skilled surgeon should, in most cases, recognize this and counsel the patient prior to surgery.

Thirdly, some patients actually have poor skin elasticity which cannot be corrected with eyelid lift surgery. Before surgery, I always measure and mark the excess upper eyelid skin, down to every millimeter, having the patient sit upright with eyes both open and closed. This approach enables me to take out the maximal amount of eyelid skin that can be safely removed, without resulting in an overpulled or surprised appearance. If you have excess outer upper eyelid skin that disappears with the eyes closed and is only present with the eyes open, this finding is likely due to poor skin elasticity. In such a case, removing more skin will only make you look worse.

The key to a successful result includes having realistic patient expectations as to what an upper eyelid lift can and cannot achieve for you. Of course, seeking a surgeon qualified to make the proper diagnosis and one who is skilled in his or her technical expertise is equally important. Consulting with a Board Certified Facial Plastic Surgeon who understands the intricate eyelid anatomy of aging and has extensive experience in performing eyelid lift surgery is the first step.

 

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