Dear Dr Seckel, I got blepharoplasty done about nine years ago. Can lower eyelid Blepharoplasty be performed again? Now I have some loose skin under my eyes at 39 and my doctor wants to use restylane. Is it possible to have the extra skin removed surgically which will last longer than fillers? The baggy skin is slightly moreprominent in one eye than in the other. Are there any procedures that will help me look better and not tired and overworked all the time? The rest of my face is in excellent condition contrasting with my under eyelids. Please help me find answer. Harmohan
Dear Harmohan,
Your question involves a very complex issue- secondary Blepharoplasty – which requires consultation with an expert physician who is very experienced in Blepharoplasty surgery. I will be happy to offer some important information, but you need to consult with and be examined by an expert.
A repeat or secondary blepharoplasty using a traditional scalpel incision on the eyelid is a risky procedure because if too much skin is removed the eyelid can be pulled downward causing a “sad eyed look” called an ectropion. Another option to correct excess skin following a Blepharoplasty is to do a laser resurfacing of the eyelid, which avoids the scalpel incision but also can pull the eyelid down.
To avoid these complications it is very important for your doctor to test the tightness of your eyelid-that is how tightly does the eyelid rest against the eyeball. To test this I do a “snap back test”. I gently pull the lower eyelid away from the eyeball and release it. If the lower eyelid snaps back against the eyeball immediately then this is a normal test.
If however the eyelid does not snap back quickly, but rather goes back against the eyeball slowly, then this tells me that the lower eyelid is lax, or loose. If the lower eyelid is lax or loose, then a scalpel blepharoplasty will very likely cause an ectropion or sad eyed appearance.
A lax eyelid can be corrected and the loose skin you are concerned about also improved by a complex procedure called a canthopexy or canthoplasty. This is a complex oculo-plastic procedure that tightens the eyelid, but many plastic surgeons are not comfortable doing it.
It is impossible to know without examining you, but from your description it sounds like you could be helped with a canthoplasty or canthopexy to tighten your eyelids and a laser resurfacing to tighten the excess skin, but I would have to examine you to be certain.
I do not think injection of a soft tissue filler such as Restylane® would be of any use to correct loose skin and personally I do not inject these fillers around the eyes.
Please seek consultation with an expert Board Certified Plastic Surgeon who is very experienced in eyelid surgery. Doing a second operation on the lower eyelid can be done, but should be done only by an expert with experience in secondary surgery. An ectropion if it occurs is a very serious complication that can lead to damage to the eye.
For further information read Save Your Face or contact me.
Sincerely
Boston, Massachusetts