Blepharoplasty a second time (or revision eyelid surgery) generally requires a different approach than the initial procedure to achieve natural-looking results and avoid complications, as suggested by experts at the California Surgical Institute.
There are two reasons why a complete redo is warranted: 1.) Botched results due to aggressive scarring or eyelid retraction must be addressed. 2.) Further aging sometimes results in reappearance of redundant skin around the eyes, although this is quite uncommon.
In most patients the results of upper blepharoplasty are near permanent that in the event of sagging recurrence, they will most likely benefit from a brow lift—which can eliminate the fullness in their eyelid platform—instead of a repeat surgery.
In the event that more than one blepharoplasty is needed due to progressive aging, it is rare for patients to require skin excision or removal because it has already been done in the initial surgery. Oftentimes, the goal is just to address eyelid ptosis or drooping due to muscle weakness.
The levator muscle, which is responsible for raising the upper eyelid, needs to be tightened to correct the drooping appearance. Just like in standard upper blepharoplasty, the technique uses a small incision within the eye crease to hide any telltale sign of the surgery.
But tightening the levator muscle sometimes results in dryness of the eyes, as the patients may not be able to blink normally. But over time, they should be able to close their eyes without any problem.
In the meantime, patients who are experiencing dryness will have to frequently use ointment and/or drops to keep their eyes lubricated.
But should blepharoplasty a second time is needed due to botched results, it involves a more complicated approach especially if too much skin has been removed during the initial surgery, leading to eyelid retraction and incomplete blink.
The general rule of thumb is to wait a minimum of six months before a revision surgery is attempted. The idea is that allowing the scar to mature and all the residual swelling to dissipate will make the corrective procedure easier, safer, and more predictable.
However, it might be better to intervene sooner in situations where the eyelid is severely retracted or deformed, or the patient is experiencing severe medical and visual issues.
Due to the complexity of revision blepharoplasty, a prudent patient must only consult a board-certified plastic surgeon who performs primary and corrective eyelid surgeries on a regular basis.