Revisional Eyelid Surgery

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 surgery to not damage the function of the eyelids. Too many times, cosmetic eyelid surgery performed by non-expert surgeons results in an unnatural appearance and/or damage to the eyelids with significant aesthetic and functional problems (rounding of the eyes, sclera show, unable to close eyes, dry eyes, blurry vision, etc).

Eyelids 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 revisional surgery 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 eyelid and facial surgery, including blepharoplasty, canthoplasty, brow lift, ptosis surgery, etc. It is important for revisional surgery to be performed by surgeons with training and experience with original, facial and revisional eyelid surgery.

A major component of Dr. Taban’s practice in Santa Barbara 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 Eyelid Problems

Lower Eyelid Retraction Surgery after Previous Lower Blepharoplasty (Post-Blepharoplasty Lower Eyelid Retraction Repair)

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 eyelid 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 a 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, a cosmetic eyelid surgeon, has penned several articles on eyelid restoration surgery, including lower eyelid reconstruction and the use of fat grafts in reconstructive surgeries. Dr. Taban in Los Angeles performs revision canthoplasty using minimal invasive approach.

Los Angeles Droopy Lid Surgery

Read Dr. Taban's manuscript about Lower Eyelid Retraction Surgery without Internal Spacer to learn more.

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Los Angeles Droopy Eyes Correction

Read Dr. Taban's manuscript about Lower Eyelid Retraction Surgery with Alloderm vs. Hard Palate.

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Read Dr. Taban's Englove Approach for Eyelid Retraction Surgery.

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Read an Article by Los Angeles' Dr. Taban about his Postoperative Wound Modulation techniques.

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Beverly Hills Eye Scarring Skin Treatment

For more information cosmetic eyelid treatment, visit WebMD.com.

*See disclaimer below

los47-year-old Russian female, with post-blepharoplasty lower eyelid retraction and sclera show and rounded eyes, underwent revision eyelid surgery with lower eyelid retraction surgery (internal eyelid lift, alloderm spacer graft, canthoplasty) to restore almond eye shape. Before and 3 months after lower eyelid retraction repair photos are shown.

Beverly Hills Lower Eyelid Revisional SurgeryBefore (left) and after (right) 44-year-old female, with post-blepharoplasty lower eyelid retraction with sclera show and loss of natural eye shape, underwent corrective revision lower eyelid surgery, namely lower eyelid retraction repair, using internal eyelid approach with soof lift and alloderm spacer graft and canthoplasty.

droopy eyelid surgery los angelesBefore (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.

brow lift procedure beverly hillsBefore (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).

38 year old male, with lower eyelid retraction due to previous lower blepharoplasty (by another surgeon), underwent lower eyelid retraction surgery (with alloderm spacer graft), canthoplasty, and tear trough (orbital rim) implant placement. Before and 6 months after surgery results are shown. You can see his written testimonial on realself https://www.realself.com/review/beverly-hills-ca-eyelid-retraction-repair-eyelid-retraction-surgery

revision eyelid surgery46 year old Asian female, with lower eyelid retraction after previous transcutaneous lower blepharoplasty, underwent revision eyelid surgery to raise the lower eyelids (lower eyelid retraction surgery) using internal eyelid approach with soof lift and internal alloderm graft and canthoplasty. Before and 5 months after oculoplastic surgery photos are shown.

Upper Eyelid Skin Graft

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 in Los Angeles replaces the necessary skin by using skin grafts, with effective results.

*See disclaimer below

excess eye skin los angelesBefore (left) and 2 months after (right) revisional eyelid surgery. The patient was unable to close eyes due to too much skin being removed from prior surgery.

Eyelid Scar Revision

Eyelid scar revision is another procedure that Dr. Taban in Los Angeles performs. 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, a cosmetic eyelid surgeon in Santa Barbara uses various minimally invasive techniques, such as a z-plasty, to revise and hide the scars better. Epicanthoplasty with z-plasty is one such procedure.

*See disclaimer below

upper eyelids creases surgery LABefore (left) and after (right) revisional eyelid surgery. Note the severe hollow upper eyelids with deep scars (creases) from prior surgery.

web scar surgery los angelesBefore (left) 29-year-old female with left medial canthal web or scar. After (right) 3 months after left medial canthal web-scar surgery, epicanthoplasty.

tear trough procedure los angelesThis patient suffered from severe eyelid scarring in the medial canthus from previous blepharoplasty with canthal web. She underwent revision eyelid scar surgery with epicanthoplasty. Preoperative and 3 months postoperative photos are shown.

Los Angeles Revision Eye Scar Surgery Before (left) and after (right) 86-year-old female, with significant eye irritation from previous canthoplasty, underwent revision right canthoplasty.

Revision Droopy Eyelid (Ptosis) Surgery

Revision droopy eyelid surgery (eyelid ptosis surgery) is another common procedure performed by Dr. Taban in Beverly Hills.  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 makes 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.

*See disclaimer below

Failed Ptosis Operation Los Angeles
Before (left) and 3 months after (right photo) of revisional left upper eyelid ptosis surgery (after two previous failed operations).


 Before (left) 21 year old female, with history of 2 previous failed right upper eyelid ptosis operations. After (right) 3 months after revisional right upper eyelid ptosis surgery (using full-thickness method).
Before (left) 21 year old female, with history of 2 previous failed right upper eyelid ptosis operations. After (right) 3 months after revisional right upper eyelid ptosis surgery (using full-thickness method).

droopy eyelid canthoplasty los angeles
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.

upper left eyelid operation Los Angeles
Before (left) 87 year old female, with persistent left upper eyelid ptosis after previous droopy eyelid surgery. After (right) 3 months after revision left upper eyelid ptosis surgery.

Revision Lower Blepharoplasty

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 eyelids 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.

*See disclaimer below

tear trough procedure los angeles
49-year-old female, who had a 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 hyaluronidase 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 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.

blepharoplasty revision operation santa barbaraBefore (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).

Fat Transfer to Correct Hollow Eyes after Blepharoplasty

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 in Los Angeles injects either fat or filler around the eyes, deep to the eyelids, to give more fullness and bring back a youthFUL eye appearance.

Eyelid fat transfer is accomplished by harvesting fat (with stem cells) from the belly or thighs and injecting the fat in the 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 is excellent alternative option to fill the hollow sunken area.

Eyelid Filler Injection to Correct Hollow Eyes after Blepharoplasty

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.

Read Dr. Taban's abstract about Lower Blepharoplasty with Previous HA Fillers.

Click to Read

*See disclaimer below

filler injection blepharoplasty los angelesBefore, prior aggressive upper blepharoplasty resulting in hollow upper eyelids, and 2 months after filler injection in upper eyelid-brow area.

belotero filler injection beverly hillsBefore 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.

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Next, read about Revisional Droopy Eyelid Ptosis.

*Disclaimer: Results vary from patient to patient. Results are not guaranteed.

The doctor I went to see for my eyes surgery did a terrible job, he took too much skin on upper and lower eyes lid, … I went to see dr Taban, He was my last chance, looking at my eyes he knew right away what I need it. I had 2 surgeries with him and I am so happy, …

matest

matest November 2, 2016

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