The look you describe, also called the sad eyed look, hound dog eyes, ectropion, or scleral show, is the most common problem after traditional scalpel blepharoplasty of the lower eyelid. Modern Blepharoplasty usually avoids these problems. During the traditional lower eyelid blepharoplasty when the incision is made on the outside of the lower eyelid and through the supporting muscles, the support for the lower eyelid is damaged and frequently the lower eyelid turns down and creates the “sad eyed look” or “hound dog eyes” you write about.

There are several new techniques which, when combined together, I call the “modern blepharoplasty” which avoid the sad eyed look or hound dog eyes after blepharoplasty.

First, I use the transconjunctival laser lower blepharoplasty approach. I make my lower eyelid incision on the inside of the eyelid, the pink conjunctiva instead of on the outside, thus I do not cut through the muscles and supporting structures of the lower eyelid. This avoids damage to the support of the eyelid caused by the external incision and helps prevent the sad eyed look, technically called an ectropion.

The other maneuvers I use during a modern blepharoplsty are called a canthoplasty and an orbiculopexy. Canthoplasty involves tightening the supporting ligament of the lower eyelid, the canthal ligament by suturing it to the bone of the orbit or eye socket during the blepharoplasty. This tightens the lower eyelid and restores the natural youthful shape of the lower eyelid. A smaller procedure called a canthopexy can be used in many cases.

The orbiculopexy is a procedure which tightens the eyelid muscle which overlies the cheek and actually tightens and lifts the cheek during the blepharoplasty. Both the canthoplasty and orbiculopexy are done through the upper eyelid incision of the upper blepharoplasty, which is done to remove hooding of the upper eyelid or eye hoods.

These maneuvers comprising the modern laser blepharoplasty create a youthful eyelid appearance, removing eyelid bags, loose skin, dark circles under the eyes, and eyelid hooding, while preserving the beautiful eyelid shape and avoiding the sad eyed look or hound dog eyes.

The canthoplasty, if done correctly by an experienced blepharoplasty surgeon, should correct the basset hound look you complain of. The canthoplasty should tighten the lid and should not be pulled down by the cheek. It is a strong repair and done properly is a permanent correction.

Thank you for your question.

For more information on blepharoplasty eyelid rejuvenation,and plastic surgery read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Unfortunately a weakened lower eyelid is a common problem after a traditional “cold scalpel” lower blepharoplasty in which a scalpel is used to make an incision on the lower eyelid to remove loose skin and fat as part of the blepharoplasty procedure. The weakened lower eyelid, called an ectropion, gives a sad eyed look also called hound dog eyes, and is more common when laser resurfacing is done on an already lax lower eyelid.

To avoid this I do a transconjunctival laser lower blepharoplasty through a tiny laser incision on the inside of the lower eyelid, through the pink conjunctiva, to remove puffy eyes and eye bags and correct dark circles under the eyes. This procedure rejuvenates the eyelid without weakening the lower eyelid.

Since you do have a weakened eyelid following blepharoplasty the only way to correct the weakness and tighten the eyelid and give it a nice natural shape is to do a procedure called a canthoplasty. This procedure is relatively minor and tightens the canthal ligament which supports the eyelid. It does require a plastic surgeon who is very experienced in oculoplastic or eyelid surgery-many plastic surgeons are unfamiliar with the operation so you need to ask the right questions and be certain your doctor knows how to do it.

The hollowed look you describe is also common after a blepharoplasty when too much fat is taken out during the blepharoplasty. This can be corrected by transplanting or replacing the fat into the eye socket and also by a procedure called an arcus marginalis release which helps remove the dark circles under the eyes, which also make the eye look hollow.

These procedures are advanced procedures which require the expertise of a plastic surgeon who is very experienced in eyelid surgery. Be sure to ask questions and find a good doctor. Chapter 10 of my book “Save Your Face” entitled “Don’t Let Just Anyone Touch Your Face” gives good advice on how to find the right doctor.

For more information on dark circles under the eyes, hollow eyes, blepharoplasty and plastic surgery read Save Your Face or contact me.

Thank You,

Dr Seckel

Boston, Massachusetts

Put your finger on the bone of your eye socket above the cheek–above this bone any puffiness is eyelid fat, which is removed or repositioned during a blepharoplasty. Any puffiness below this bone is on the cheek and is called a festoon and is not improved by blepharoplasty. Puffy eyelids are caused by protrusion of the fat beneath the eyeball against the eyelid skin

Skin can be snipped during the plastic surgery operation called a blepharoplasty–but I rarely need to do this. Laser Blepharoplasty, which I do, is through a tiny incision on the inside pink portion of the eyelid called the transconjunctival laser blepharoplasty–thus no scar–produces beautiful results. Today during eyelid rejuvenation procedures, less fat is removed and often fat repositioning is done to fill the dark circles under the eyes. Using this technique, eye bags are removed and removal of eyelid skin is usually unnecessary.

For more information on transconjunctival laser blepharoplasty and plastic surgery read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Yes I do perform the eyelid rejuvenation procedure called the one stitch no incision Asian or Oriental double eyelid upper blepharoplasty. It is a wonderful technique because it creates a very natural Asian Upper Eyelid crease without the need to cut the eyelid skin as is done in western blepharoplasty. Recovery is much quicker and there is minimal scarring. The results are much more natural for the Asian eyelid than when the western or Caucasian eyelid blepharoplasty is done.

Many western or American Plastic Surgeons do not understand how the natural Asian eyelid is supposed to look and make the mistake of assuming that Asians seeking blepharoplasty want a round Caucasian eye. This is a mistake that creates scarring and an unnatural appearance when done on Asian people.

The Asian Eyelid has very different anatomy than the Caucasian eye and in Asian people with a double fold the fold is very subtle and is present in up to 60% of Asian people.

The one stitch no incision eyelid rejuvenation technique is much more appropriate to create a natural appearing fold in the Asian Upper Eyelid. It is very important to ask your surgeon if he/she is experienced in doing eyelid surgery on Asian people. If they are not they may mistakenly create a round or Caucasian looking upper eyelid fold which cannot be reversed.

Thank you for your question. I am also in Boston if you would like to consult with me contact me. For more information on eyelid rejuvenation, plastic surgery and facial rejuvenation read Save Your Face.

Thank you,

Dr Seckel

Boston, Massachusetts

I am sorry to hear of your unhappy experience following eyelid rejuvenation surgery. Eyelid malposition, the sweeping up of the eyelid you have experienced is usually temporary unless a canthoplasty was performed.

This should be relatively easy to correct but will depend on the exact procedure your surgeon used. If a canthoplasty was performed, the suture that holds the canthal tendon can be released allowing the eyelid to drop to a more neutral position.

If a canthoplasty was not done then the surgeon may have done an orbiculopexy–which is a procedure that places a suture in the orbicularis occuli muscle to tighten and pull the lower eyelid up. This can also be released.

It would help me to see a front close up view of your eyes. If you can email me a picture then I can give you a better opinion. Please note, I will not publish or show your photo to anyone and will delete it after viewing.

If the canthoplasty was performed to correct laxity of the eyelid, releasing the canthoplasty would create the riskmof the eyelid pulling down at the corner, a condition called an ectropion.

For further information on eyelid surgery, blepharoplasty and facial rejuvenation read Save Your Face or contact me.

Thank you,
Dr Seckel

Boston, Massachusetts

It is normal following fat transplantation or pearl fat grafts to the eyelids to have some noticeable lumps initially. Some of the fat will dissolve as the fat graft “takes”, only about 35 to 60% of the fat survives to fill out the dark circles under the eyes.

I find that massage is very helpful to smooth the lumpiness and would encourage you to do it but check with your surgeon to see if he/she agrees.

I use a different eyelid rejuvenation technique than the pearl fat grafts to correct dark circles under the eyes. I use a transconjunctival technique-that is through a small laser incision on the inside of the eyelid, I release the arcus marginalis-the tisssue that is tethering the lower eyelid to the bone of the eye socket and causing the dark circles under the eyes. Then I place one uniform fat graft along the entire dark circle to plump the dark circle uniformly. This avoids the individual discrete lumps caused by multiple pearl grafts and works well for me. I call this procedure a transconjunctival laser blepharoplasty with arcus marginalis release and fat grafting or fat repositioning. If possible I leave the blood supply to the eyelid fat intact, which helps survival of the fat-this is called fat repositioning which is different from fat grafting.

For more information on blepharoplasty, dark circles under the eyes and eyelid rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

It sounds as though you did not have skin removal just the 3 stitch Asian blepharoplasty.The stitches can be removed to reverse the asian blepharoplasty if no incision or skin removal was done and the stitches are permanent sutures. If you do not like the result of the asian blepharoplasty consult an experienced plastic surgeon about reversing the 3 stitch asian blepharoplasty. If you like the result and just want the asymmetry corrected that can be done too by an experienced eyelid surgeon. You will have another week of bruising after the revisional blepharoplasty surgery.

Be sure to find an expert board certified plastic surgeon who has experience in eyelid surgery, specifically with the asian blepharoplasty and knows how to correct the asymetry or remove the asian blepharoplasty sutures. Preferably find a Doctor certified by the American Board of Plastic Surgery-there are many in Australia.

For more information on blepharoplasty and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

The sad eyed look, also called an ectropion or hound dog eyes, following the eyelid rejuvenation procedure called a blepharoplasty is common after traditional scalpel blepharoplasty an eyelid surgery during which an external incision is made on the outside skin of the eyelid. The turned down lower eyelid not only looks bad but can cause serious damage to the eye if not corrected.

This look can improve with time, but I am concerned that your plastic surgeon did not notice it or address the issue with you.

For the time being I urge you to be proactive and massage the lower eyelids 3 times a day for 5 minutes. Place a moisturizer or eye cream on the lower lid and with your finger start at the inside corner of the eyelid near the nose and sweep the finger to the outside pulling the lower eyelid up to stretch it out and push the lid against the eyeball.

Massage will help and time will tell.

I usually wait at least three months to correct the sad eyed look or ectropion by doing a corrective secondary blepharoplasty or eyelid surgery usually a canthoplasty or canthopexy. This cantholasty or canthopexy procedure tightens the eyelid and brings the lower eyelid up against the eyeball correcting the sad eyed look or ectropion.

Sometimes if the ectropion is very noticeable and causing discomfort I do a temporary one stitch tightening procedure on the outer corner of the eyelid right away to help pull the lid up called a temporary tarsorraphy but I don’t think you need this.

Please send me a photo of a close up of both eyelids front view and I can give you a better opinion.

For more information on blepharoplasty and eyelid rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

I cannot be certain without examining you but a droopy upper eyelid after blepharoplasty eyelid rejuvenation surgery usually means that a muscle called the levator palpebrae superioris has been injured. This muscle, called the levator, functions to open the upper eyelid, and when injured during a blepharoplasty the eyelid droops, a condition called ptosis.

The levator muscle can be repaired and tightened by an eyelid procedure called a levator advancement, and the droopy eyelid improved.

If your lower eyelid is drooping after a blepharoplasty, the condition is called an ectropion or sad eyed look. This often happens when a blepharoplasty is done on a lax lower eyelid. The ectropion can be repaired by an eyelid surgery called canthoplasty or canthopexy.

These are very delicate complex secondary blepharoplasty techniques which I do with the laser blepharoplasty technique and should only be done by a board certified plastic surgeon who is very experienced in eyelid surgery.

If you would like to send me a picture of your eyelids, a frontal and side view that shows close up and only shows both eyes, your nose and eyebrows I could better understand your problem.

For further information on blepharoplasty, eyelid surgery, or non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you for your question.

Dr Seckel,

Boston, Massachusetts

From your description of the hollow appearance of your eye following your blepharoplasty I suspect your diagnosis is correct and that too much fat was removed during your blepharoplasty giving you hollow eyes. When too much fat is removed during the blepharoplasty on the lower eyelid, the lower eyelid sinks in and the eye looks hollow, but the eyeball protrudes and creates a bulge.

This can be corrected. However, correction of the hollow eyes appearance after blepharoplasty is a very delicate procedure and requires the expertise and skill of a specialist. What is required is a plastic surgery procedure called fat grafting during which a small amount of fat from a different area is transplanted back into the eyelid to plump up the depression.

I feel very strongly that no attempt should be made to do a fat injection with a needle-many plastic surgeons do this operation but my personal opinion is that fat injection with a needle is dangerous, especially since you have had prior surgery on the eyelid.

In my opinion, to correct the hollow eye after blepharoplasty, the fat transplantation needs to be done as a surgical procedure under direct vision. Personally I do this type of surgery through an incision on the inside of the eyelid called a transconjunctival blepharoplasty and I use a laser to make the incision. This is called a laser transconjunctival blepharoplasty with fat grafting.

In my opinion you need to seek consultation with a plastic surgeon who specializes in eyelid surgery. Many board certified plastic surgeons are experienced in this type of surgery and some, called oculoplastic surgeons only do eyelid surgery.

I am experienced in this technique but since you live in Los Angeles you may want to seek consultation with an expert in your area. Dr. Meronk in your area has a very informative website http://www.drmeronk.com/hollowed/hollow-eyelid-lower.html. Dr. Glen Jelks in New York City is another very reputable experienced doctor who specializes in eyelid surgery.

For further information on eyelid rejuvenation and blepharoplasty read Save Your Face or contact me.

Thank you.

Dr. Seckel

Boston, Massachusetts