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Secondary blepharoplasties prove challenging

Key iconKey Points

  • Removal of too much upper-eyelid skin can cause significant functional, reconstructive problems
  • Fat-grafting technique can improve defect from too much fat removal
  • It is important that surgeons not reoperate too soon after primary procedure

Dr. Popp
Complications can occur following both a primary and secondary blepharoplasty, and potential postoperative problems can include aesthetic and/or functional issues. Surgeons must proceed with caution and establish clear and realistic cosmetic expectations and surgical goals with the patient prior to surgery.

"In general and as with most revision surgeries, secondary blepharoplasties can be more difficult than primary blepharoplasties, because the second time around, there will likely be a distorted local anatomy and scar-tissue formation in varying degrees, which may make the revision surgery more challenging," says Jeffrey C. Popp, M.D., F.A.C.S., director, Popp Cosmetic Surgery P.C., Omaha, Neb.

Patients desiring a revision blepharoplasty will typically complain of a suboptimal aesthetic outcome and/or have functional complaints that impact vision and are the result of the primary procedure.

UPPER EYELID In the upper lid, the most common complication is caused by the removal of too much fat — resulting in a hollowing of the superior sulcus — or the removal of too much skin, which can result in an overly taut upper eyelid and lead to a lagophthalmus and dry eye. Patients can also have too much residual skin following the primary blepharoplasty, which may not necessarily be due to an inadequate removal of upper eyelid skin during the primary procedure, but instead may be due to a brow ptosis.

A 39-year-old female patient who was seen after four-lid blepharoplasty with overly sculpted fat and a sunken superior and inferior sulcus. (Photos credit: John B. Holds, M.D., F.A.C.S.)
"In the case of excess upper eyelid skin, the surgeon must first determine whether there is a true dermatochalasis of the upper eyelid or if there is a brow ptosis inducing the appearance of excess skin. A browlift will improve the dermatochalasis and provide a balanced correction," says John B. Holds, M.D., F.A.C.S., Ophthalmic Plastic and Cosmetic Surgery, St. Louis.

Improvement six months after upper and lower eyelid revision with dermis-fat graft placement into the upper and lower eyelids. The supratarsal sulcus and lower-lid contour are much more regular, according to Dr. Holds.
Though the removal of too much upper-eyelid skin should be a rare complication, it can cause significant functional and reconstructive problems that must be addressed. Usually, only a skin graft can improve the situation. Although not aesthetically pleasing, this approach may remedy the functional disturbances that the patient may have.

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