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.
Blepharoplasty cost varies considerably across geographical location, although most Beverly Hills plastic surgeons charge $2,000-$3,000 in “isolated” upper eyelid surgery under local anesthesia. But if the lower eyelid or under eye-bags is addressed at the same time, most patients can expect to pay twice the amount.
Clinics in posh districts and surgeons who specifically cater to high-profile individuals also charge higher than the average. While a premium price does not always equate to good value, it generally provides high value on privacy—i.e., private first floor entrance and exit.
Aside from “exclusivity,” patients who need a more extensive amount of work will also have to pay more because they will require general anesthesia.
To achieve maximum longevity and/or a more rejuvenated appearance, some patients will also need their upper blepharoplasty to be performed in conjunction with a brow lift. As of this writing this “combo” procedure, which is almost always performed under general anesthesia, costs around $5,000-$6,000.
Another common adjunct procedure of blepharoplasty is dermal filler injection, which is often used to correct the deep tear trough and “skeletonized” eye socket. It costs around $600-$700 and is typically repeated annually to maintain the “plump up” look of the skin.
Most US doctors who treat the areas around the eyes with fillers often choose Juvederm and Restylane, two brands that consist of hyaluronic acid gel that is naturally found in the skin, so the risk of allergic reaction is very unlikely.
Aside from its compatibility with the human body, hyaluronic acid can be easily dissolved or reversed by an injectable enzyme if the patient is not happy with the results.
Botox injection is also a common complementary procedure of blepharoplasty. When used to treat the appearance of crow’s feet, it costs around $250-$400.
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, warns that prudent patients should not only focus on the price, nor skimp on their surgery, but rather choose doctors with great qualifications, resulting in more natural results and lower risk of complications.
Dr. Dhir says that board certifications and plastic surgery affiliations must be factored in when looking for a reputable blepharoplasty doctor. A good rule of thumb, he further explains, is to choose a board-certified facial plastic surgeon (ENT), board-certified plastic surgeon (member of the American Board of Plastic Surgery), and/or board-certified ophthalmologist.
Aside from “proper” board certifications, Dr. Dhir highlights the importance of choosing a surgeon who performs blepharoplasty and its adjunct procedures on a regular basis, and has impressive before-and-after photos of his actual patients.
Surveys have shown that a good number of male patients cited stiff job competition as their main reason for getting a plastic surgery procedure. For the past several years, men accounted for 8-9 percent of all surgical enhancements performed in the US.
Los Angeles plastic surgeon Dr. Tarick Smaili explains the most commonly requested plastic surgery for men and the corresponding techniques to preserve their masculine appearance.
- Male breast reduction. This corrects a condition called gynecomastia in which the excess skin, tissue, and fat lead to the appearance of woman-like breasts.
Aside from removing the excess soft tissue, typically the procedure also involves reducing the nipple size to further achieve a more masculine contour. Meanwhile, failure to address an overlarge areola can lead to a disproportionate or “effeminate” appearance.
- Rhinoplasty. More commonly referred to as nose job, it should be able to produce results that respect the patient’s ethnicity, the rest of the facial features, and most importantly, his gender.
According to studies, the ideal angle between the upper lip and nasal tip for men is around 90 degrees, thus creating a straighter profile. For this reason, male rhinoplasty must avoid any procedure that may cause the tip to become more upturned, leading to a feminine look.
Nevertheless, some male rhinoplastic patients can tolerate a minimal droop and still look attractive and “manly” with such feature.
- Facelift. Compared to women, most male patients require less contouring in their jaw line since they tend to ask for subtle improvements.
Male facelifts and forehead lifts also tend to be more conservative because it is crucial to preserve the “heavy” brow look and the strong jaw. An overly tight appearance, meanwhile, can lead to feminine-looking brow, flat cheeks, “distorted” smile, and other telltale signs of surgery.
- Liposuction. In general, men have more fibrous fats and have bigger body-frame than women, so their surgery is more time-consuming, more challenging, and more expensive.
Liposuction only removes the excess “superficial” fat beneath the skin, and not the deeper visceral types that lead to obesity-related health condition. For this reason, men who are complaining about their “beer belly” are rarely considered as good candidates for the procedure.
- Eyelid surgery. There are some subtle nuances involved in male eyelid surgery. For instance, men tend to have thicker and more vascularized skin (increasing the risk of bleeding and more postop bruising), and shorter upper lid platform than women.
Facial plastic surgery such as facelift, rhinoplasty (nose job), fat grafting, brow lift, and eyelid lift involves postop bruising and swelling that may prevent anyone to join social activities for a couple of weeks.
Take note that healing from such procedures takes many forms—e.g., social recovery, physical recuperation, and return of normal sensation.
For many patients, the hardest part of the recovery is not really the postop discomfort, which can be easily controlled by painkillers, but the interruption in their social activities.
The list below explains the length of social recovery after a specific type of facial plastic surgery and what kind of postop symptoms one should expect during the initial healing phase:
- Facelift. Five to seven days after surgery, the swelling and bruising will rapidly improve that most patients can return to their social activities by eight day, although usually with the “assistance” of camouflage make-up and/or fashion accessories such as sunglasses and scarves.
- Rhinoplasty. The postop bruises are the most apparent around the eyes and will take a week to subside to a significant degree. However, social recovery greatly varies from patient to patient, with some people able to look “more acceptable” within a week, while others have to wait for two to three weeks especially if they have a thick nasal skin.
- Fat grafting. This involves injecting a small amount of fat into the area that needs more volume, leading to mild swelling and bruising that can last for seven days, although some patients may have to wait for another week to appear “socially presentable.”
- Eyelid surgery. This involves a rather straightforward recovery with the use of very fine incisions made within the natural upper eyelid crease and close to the lower lash margin. For this reason, most patients can have “dinner with friends” after about five days, although big sunglasses remain helpful to hide any residual swelling and bruising, and to protect the scars from harsh elements.
- Brow lift. With endoscope or small camera probe, the procedure will only need several small incisions that can lead to about a week of social recovery; however, the initial healing phase could take longer with the standard technique in which one continuous incision from ear to ear, behind the hairline, is used.
The “core value” of eyelid surgery, or blepharoplasty, is to deliver a more youthful, well-rested eye; this is achieved by removing some of the loose skin and/or excess fat in the lower and upper eyelid. For some patients, they might need adjunct procedures such as Botox and dermal fillers to further rejuvenate their eyes.
The first step to deliver natural results from eyelid surgery, as suggested by celebrity Beverly Hills plastic surgeon Dr. Karan Dhir, is to remove just the right amount of excess skin and fat. The whole idea is to preserve the intrinsic preoperative shape of the eye, he adds.
Over-correction, or removal of too much skin, leads not just to “fish eye” or expression-free eye, but also to dry eye syndrome and lid traction in which the entire iris becomes visible. While revisions could improve these botched results, these are typically expensive and have increased risk of scarring.
Because botched results are difficult to address, the key is to get it right the first time. For this reason, a prudent patient must choose a surgeon based on his qualifications and certifications, ideally from The American Board of Plastic Surgery and The American Society of Plastic Surgeons.
Preserving some fat layer is also crucial to achieve natural-looking results. While the excess fat contributes to the under-eye bag appearance, removing it altogether could lead to a skeletonized appearance.
Aggressive fat removal was a common practice in the 70s, although most surgeons these days avoid this technique because it could lead to a more aged appearance. In fact, some even reject the procedure when performing an upper eyelid surgery.
The excess fat is more problematic in the lower eyelid, leading to a puffy appearance. But instead of removing it altogether, Dr. Dhir says that most patients will benefit more if the fatty tissue is redistributed to achieve a smoother, but still somewhat plump result.
While some patients’ problem is the excess fat, others complain about the lack of volume around their eye socket that leads to a tired, almost skeletonized appearance. For these people, volumizers in the form of dermal fillers (e.g., Restylane and Juvederm) could help them achieve a more youthful visage.
But Dr. Dhir warns that the tear trough is a very sensitive area—i.e., its skin is markedly thin—that dermal fillers must be injected at the proper depths to avoid excessive bruising and lumping, and to achieve natural results as well.