Eyelid Revision (Revision Blepharoplasty)

The eyes are often considered the most prominent facial feature and are frequently a primary area of concern during the aging process. An eyelid lift, also known as blepharoplasty, is a surgical procedure designed to rejuvenate the appearance and functionality of the eyelids by addressing common issues such as loose and hooded upper eyelid skin, as well as bags underneath the eyes.

An eyelid revision, or revision blepharoplasty, is typically performed to repeat these effects, for someone who has experienced natural aging since their first procedure, or to correct issues that arose from a previous surgery. This includes functional issues and aesthetic results that did not meet expectations.

An eyelid revision is one of the most intricate and challenging procedures that plastic surgeons undertake, requiring meticulous planning and execution tailored to address the specific issue or issues at hand. The procedure might involve removing or repositioning excess tissue to refine the eyelid’s contour, correcting asymmetry, or improving poor eyelid position. Given the complexity of eyelid revision surgery, it is crucial to select a surgeon who possesses extensive expertise and experience in performing these types of procedures to ensure the best possible outcome.

The key is customization. The procedure must be adapted to your unique eyelid structure and specific concerns. Ancillary procedures such as brow lifts, fat transfer, laser resurfacing, deep plane facelifts, or tissue grafting may also be required to obtain effective results.

If you are seeking eyelid revision due to unsatisfactory results or complications related to previous surgery, you may be experiencing various concerns that can impact both the appearance and function of your eyelids.

Common issues include over-removal of skin or fat, leading to a hollowed or gaunt appearance; asymmetry between the two eyelids; eyelid malposition, such as ectropion or entropion, which can cause discomfort and irritation; and incomplete correction of the initial concerns, such as persistent hooding or bags under the eyes.

The surgical approach for eyelid revisions that address complications from prior surgeries may involve a combination of techniques. These can include fat grafting to restore volume, repositioning the cheeks with a midface lift or deep plane facelift to support the lower eyelids, and adjusting the skin and muscles to improve symmetry. Procedures such as canthoplasty, which tightens and reshapes the outer corners of the eyes to address ectropion, may also be necessary. In severe cases, a graft from the roof of the mouth (hard palate) may be required to support and correct the eyelid.

Complications and unsatisfactory results are not, however, the most common reason for undergoing an eyelid revision. Most people seeking this surgery have previously undergone a successful procedure, and, years later, wish to enhance their eyelids’ appearance again due to the natural aging process.

Eyelid revision surgery in these cases has a high success rate when performed by an experienced and skilled plastic surgeon. During the procedure, your surgeon will make precise incisions along the natural creases of the eyelids to address skin laxity and fat compartments while minimizing visible scarring. For the lower eyelids, hidden internal incisions may be used to address protruding “fat bags.” Brow lifts, fat grafting, and laser resurfacing may also be incorporated. Often, deep plane facelifts and other procedures on the lower face and neck are necessary to achieve a natural and cohesive appearance.

The ultimate goal of eyelid revision surgery is to restore a more youthful, natural, and functionally sound eyelid appearance while minimizing the visibility of scars and ensuring a harmonious and balanced outcome.

Before you go

If you’re considering a revision blepharoplasty, have a candid conversation with your surgeon about your motivations and expectations. This procedure can be as much about your emotional and psychological well-being as it is about physical changes to the body. Openly discuss what you hope to achieve and what concerns, if any, you have from your previous surgery. A thorough understanding of your goals and apprehensions helps your surgeon tailor the procedure to your specific needs.

If you are undergoing complex revision eyelid surgery, be aware that outcomes may be limited. It’s important to be comfortable with the risks and have realistic expectations. Sometimes, it is better to postpone surgery if you are not comfortable with the risks or not emotionally ready.

During the procedure

Revision blepharoplasty procedures are performed under local or general anesthesia, so you will be pain-free during the surgery. You will be able to go home the same day, but someone else will need to drive you. Since eyelid revision surgery may include additional procedures to address a variety of issues, it is best to have a conversation with your physician about the exact process and time involved; it can vary depending on the specific techniques.

Eyelid Revision Aftercare 

After your eyelid revision, anticipate a post-operative care regimen similar to your initial eyelid surgery. This includes diligent eye care with prescribed medications and drops, as well as plenty of rest with your head elevated. It is crucial to follow your surgeon’s instructions on caring for stitches, which typically involves gentle cleansing and applying prescribed ointments to avoid infection.

Expect to dedicate about seven to ten days to your initial recovery. Avoid strenuous activities, eye strain, and exposure to irritants like smoke. Regular cold compresses can also help manage swelling and discomfort. Many surgeons will recommend also using warm compresses after three days in the areas with persistent bruising. You can expect to return to everyday activities after one to two weeks and exercise after three to four weeks.