The eyes are “windows” to the soul. They are the most distinguishing feature of anyone’s face and are the first feature that attracts someone else’s attention. Hence, any irregularity will get noticed by others. It is crucial for any cosmetic eyelid surgery to be natural and not result in an “operated” appearance. It is equally important for any cosmetic eyelid surgery to not damage the function of the eyelids. Too many times, cosmetic eyelid surgery performed by non-expert surgeons results in unnatural appearance of the eyelids and/or damage to the eyelids with significant visual problems (unable to close eyes, dry eyes, blurry vision, etc).
What Is Revisional Eyelid Surgery?
Revisional surgery addresses cosmetic or functional concerns of patients who have had unsatisfactory or problematic results from previous eyelid and facial surgery, including blepharoplasty, canthoplasty, browlift, ptosis surgery, etc. It is important for revisional surgery to be performed by surgeons with training and experience with original and revisional eyelid and facial surgery.
A major component of Dr Taban’s practice is performing revisional surgery and canthoplasty as he has had extensive training (three years of fellowship) in the field of oculofacial surgery, which deals structures around they eyes and face. He is member of the American Society of OculoFacial Plastic Reconstructive Surgery, American Academy of Cosmetic Surgery, and American Board of Ophthalmology.
One of most common eyelid issues that patients visit Dr. Taban regarding is lower eyelid retraction and rounding of eye, related to previous lower blepharoplasty and canthoplasty. The formation of scar tissue in different layers of the lower eyelid can cause tethering or contraction of the lower eyelid, developing retraction (pulling down) of the lower eyelid. There might have been too much skin removed from the lower eyelid. In additional to rounding and surgical appearance of the eye, it can cause significant ocular/visual discomfort with tearing, redness, dry eyes, and blurry vision. In these cases, the lower eyelid needs to be raised and the canthus revised. Some surgeons use skin grafts to raise the eyelid; however, this is aesthetically not pleasing since they are almost never matched to surrounding skin.
Other surgeons tighten the outer corner of the eyelid; however, this is rarely successful since there too much scarring in the lower eyelid and tightening the outer corner alone won’t accomplish anything. To restore the natural almond shape of the eye, Dr Taban performs a technique called Madame Butterfly Procedure. Through hidden incision inside the eyelid, the scar tissue is released, the midface is lifted (which provides support for the lower eyelid and recruits necessary skin), and lateral canthus revised. Dr. Taban has penned several articles on eyelid restoration surgery, including lower eyelid reconstruction and the use of fat grafts in reconstructive surgeries.
Before (left) and rafter (right) revisional eyelid surgery. Note the severe hollow upper eyelids with deep scars (creases) from prior surgery.
Before (left) and 2 months after (right) revisional eyelid surgery. Patient was unable to close eyes due to too much skin being removed from prior surgery.
Before (left) and 3 months after (right) right lower eyelid retraction surgery and midface lift.
Before, prior aggressive upper blepharoplasty resulting in hollow upper eyelids, and 2 months after filler injection in upper eyelid-brow area.
Before and immediately after FILLER (Belotero) injection in both upper eyelids to correct significant upper eyelid hollowness after prior upper blepharoplasty in a 59 year old female.
Before (left) Middle age female, with under area eye contour irregularities after previous lower blepharoplasty and multiple filler injections. After (right) 2 months after revisional lower blepharoplasty with fat repositioning (and dissolving of fillers).
Before (left) 29 year old female with left medial canthal web or scar. After (right) 3 months after left medial canthal web-scar surgery, epicanthoplasty.
Before (left) Middle age woman with multiple prior eyelid surgeries and blepharoplasty, resulting in right lateral canthal angle distortion and lowering, unnatural right lower eyelid contour, and droopy upper eyelid. After (right) 2 months after revisional eyelid surgery, right canthoplasty, right lower eyelid retraction surgery (internal, with midface lift, without graft) and lower eyelid contour surgery. Fat injection in upper eyelids.
Before (left) Middle age woman with right lower eyelid retraction after previous lower blepharoplasty, now needing revision cosmetic surgery. After (right) 4 months after right lower eyelid retraction surgery with internal alloderm graft, midface lift, canthoplasty, giving more natural almond shape eye appearance. (later she would also benefit from ptosis surgery and brow lift).
49 year old female, who had history of 3 previous cycles of under eye hyaluronic acid gel (Juvederm and Restylane) injections to fill “hollow” under eye area (tear trough), followed by hyaluronidaze injection to get rid of “excess filler”, resulting in puffy, unnatural under eyes area. After examination, it was determined she had more under eye fat prolapse with some residual filler. She underwent transconjunctival lower blepharoplasty (scar-less, stitch-less incision inside the lower eyelid) with fat repositioning. This revision cosmetic eyelid procedure was done under local anesthesia in our Beverly Hills office. Note the improved, smoother under eye (lower eyelid) appearance after surgery. Preop and 3 months postoperative photographs are shown.