The eyes are “windows” to the soul. They are a key distinguishing feature of anyone’s face. Therefore, any irregularity or distortion will change someone’s appearance and attract unwanted attention. 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 revisional eyelid surgery performed by non-expert surgeons results in an unnatural appearance and/or damage to the skin with significant aesthetic and functional problems (rounding of the eyes, sclera show, unable to close eyes, dry eyes, blurry vision, etc).
These are delicate structures, in close relation to the eyeballs, cheeks, eyebrows, eye sockets (orbits), and temples. Proper understanding of these relationship and anatomy is crucial to achieve the best surgical results.
What Is Revisional Eyelid Surgery?
Revisional eyelid surgery addresses cosmetic or functional concerns of patients who have had unsatisfactory or problematic results from previous facial surgery, including blepharoplasty, canthoplasty, brow lift, ptosis surgery, etc. It is important for revision eye plastic surgery to be performed by surgeons with training and experience with original and revisional surgery and facial surgery.
A major component of Dr. Taban’s practice in Los Angeles is performing cosmetic, reconstructive, and revisional eyelid surgery as he has had extensive training (three years of fellowship) in the field of oculofacial plastic surgery, which deals with structures around the eyes and face. He is member of the American Board of Cosmetic Surgery, the American Society of Ophthalmic Plastic Reconstructive Surgery, and the American Board of Ophthalmology.
Restoration for Various Post-Surgical Problems
One of most common issues for Dr. Taban’s patients in Los Angeles is lower eyelid retraction and rounding of the eye with sclera show, related to previous bad lower blepharoplasty and/or canthoplasty procedures. 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 or damage to the eye closure muscle (orbicularis oculi) or others.
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 secondary to lagophthalmos (eyes not closing or blinking normally). In these cases, the lower eyelid needs to be raised and the canthus surgically repaired. This is usually done through hidden incisions the lower eyelids (conjunctiva) with lifting of the lower eyelids (+/- midface lift and internal space graft, such as Alloderm or hard palate graft) and canthoplasty.
At times, skin grafts are used to replace missing lower eyelid skin, which tends to heal very fast with effective results. It is important to realize that canthoplasty (tightening the outer corner of eye) alone is rarely sufficient to address these issues due to significant scarring of the lower eyelids. To restore the natural almond shape of the eye, Dr. Taban in Los Angeles performs a technique called the Madame Butterfly Procedure. Through hidden incision inside, the scar tissue is released, the midface is lifted (which provides support for the lower eyelid and recruits necessary skin), and the lateral canthus is revised. Dr. Taban in Los Angeles has penned several articles on eyelid restoration surgery, including lower eyelid reconstruction and the use of fat grafts in reconstructive surgeries. Dr. Taban performs revision canthoplasty using minimal invasive approach. Please see following manuscript on aesthetic lateral canthoplasty.
Another potential complication is when too much skin is removed from the upper eyelids during upper blepharoplasty. These patients cannot close their eyes (lagophthalmos) with dry eyes and blurred vision. Dr. Taban replaces the necessary skin by using skin grafts, with effective results.
Scar revision is another procedure that Dr. Taban performs in Los Angeles. Common areas for scarring are the medial canthus and lateral canthus. These often cause the patient significant emotional pain as they do not look like themselves. Dr. Taban uses various minimal invasive techniques, such as a z-plasty, to revise and hide the scars better. Epicanthoplasty with z-plasty is one such procedure.
Revision droopy eyelid surgery (eyelid ptosis surgery) is another common procedure performed by Dr. Taban. Traditionally, ptosis correction is done by tightening the levator muscle responsible for lifting the upper eyelid, thereby raising the upper eyelid. However, previous surgeries cause significant scarring, which make repeat surgery very difficult and unpredictable. Dr. Taban in Los Angeles uses a special technique that uses the existing scar to effectively raise the upper eyelid. Visit Revision Eyelid Ptosis Surgery for more details.
Revision lower blepharoplasty is yet another corrective cosmetic procedure that Dr. Taban performs. These patients could have a myriad of different problems, such as bumps and lumps, too much or too little fat (bags), wrinkled or missing skin, scarring, prolonged chemosis, among others. These are especially delicate to work with and care must be taken to avoid further worsening of the eyelids. Dr. Taban uses minimally invasive techniques to help restore the eyelids and eye shape.
Another important cosmetic complication that needs attention is when too much fat is removed from either upper or lower eyelid during upper or lower blepharoplasty, respectively. These patients are left with hollow, sunken, older appearing eyes. Dr. Taban injects either fat or filler around the eyes, deep to the skin, to give more fullness and bring back a youthFUL eye appearance.
For more information on revisional eyelid surgery, visit Wikipedia.com.
Fat transfer is accomplished by harvesting fat (with stem cells) from the belly or thighs and injecting the fat in hollow area around the eyes and brows. Fat is great since it is natural, has stem cells and the results are long term. However, they are not as predictable as synthetic fillers. Hyaluronic acid gel filler are excellent alternative option to fill the hollow sunken area.
Filler is injected in hollow under eyes or upper eyelids with immediate results, which typically last around 2 years. It is important to know the anatomy of normal eyelids and anatomy of previous surgical eyelids to achieve the best natural results.
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 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.
Next, read more about Midface Lift (Cheek Lift) and Cheek Augmentation.