LAM FACIAL PLASTICS

dr. lam,

over a year ago i had surgery done to take off some skin overhang and raise my creases a bit higher. now i am so regretting the surgery as my eyes are much too big for my liking. my ps refuses to touch my eyes now as he feels the the creases are already low and fold will lower with time. but all the same, the cut itself looks so different from before. it flares out on the outside and it doesn't seem possible that it will ever lower to what it was originally. my question is:

1) can this procedure be reversed? meaning, can the incision made be eliminated altogether? i understand there may be some scarring, etc. but all i really want is to just have my eyes narrow again like before.

2) or, can the crease be lowered? i just want a crease that is NOT visible at all... very close to my lashes.

i've emailed a couple surgeons in korea -- one claims it is possible. i am so desperate at this point because i hate this new look... it has stabilized now and i don't see much more change in the near future. i don't know what to do. i just can't go on like this much longer...

thank you for any advice.

hi gina,
this is why i simply do not permit my patients to even choose a medium to high crease since it does not follow my aesthetic principles. i am one of the few plastic surgeons who literally dictate the aesthetic. if you don't fit my aesthetic, you can seek another surgeon.

that being said, i think we need to look at your problem as potentially two fold:
1. too high a crease from removal of a lot of skin and high crease fixation.
2. too high a crease and a partially hollowed eye from fat and skin removal

to fix #1 is very hard. i have rarely seen a surgeon who can do this. it is easier to make it higher than to make it lower. however, if a surgeon can show you a lot of before and afters and offer you names of patients willing to speak about their satisfaction with this reversal, i would be more confident that he or she could do it. otherwise, i would be wary.

as far as point #2, i would say this is something that is oftentimes overlooked by most surgeons. since i have a fat grafting practice, i am very aware of crease position and fullness in all races. i don't even care for a high crease in a Caucasian unless she was born that way. No-incision fat grafting can restore the lost contour (if you have lost that) and also lower the crease in most cases. However, to get it to the point that you don't see your crease anymore may be unrealistic.

In summary, I can help with point#2 (if you require that) but not with point#1.
best,
sml

dr lam,

i have been trying to figure out why i just don't like this bleph. i think the main reason is that the cuts flare outward, thus giving my eyes a wider look when i open then fully. my creases used to lie very close to my lashes, and i had more 'space' between my eyes and eyebrows. this bleph has given me a weird look, very unnatural and different from before. my fold is still thick, making it look fake -- do you think i'm still healing? will it thin out? i'm not sure you understand what i mean..

in addition, one of eyes still does not fold on the incision. it folds a bit higher on the outer edge. how is this possible? was too much skin removed? it makes it look bigger than the other eye.

my question is: do you think there any alternative way to fix this than going under the knife? i'm not sure i want to risk that again. for example, could botox or a filler help to bring down the outer edges? i have heard of botox causing brow or eyelid droop...it would help i think if i had more hooding. or if i stretch out my eyes outward it seems to make the inner area taper more, which i like, and flatten out my fold more. *sigh*...i just can't figure out why my eyes look so much bigger, i mean, they are only about 1 mm higher than before.

i don't know what to do. i miss my old eyes so much now...i would rather have no fold than what i have now.

thank you so much, you've been so helpful, and so much more informative & communicative than my own surgeon. i wish i had known about all these complications before i had the surgery.

hi,
as far as the thickness of the fold, it could be 1 of 3 reasons:
1. there is scarring, that could be helped with 5-FU injections.
2. so much skin was removed that the thicker brow skin is now very near the eye instead of the eyelid skin. that is harder to fix.
3. there is still some swelling left but would be less likely if it is past a year now.

as far as the tail of the incision flaring outward, Botox and fillers both can help. However, Botox is so very temporary that I don't think it would be a reasonable cost effective method unless you were going to have it anyway for wrinkles (if you are old enough). If that is the case, then a little Botox on the outer forehead frontalis can (but may not) drop the tail of the brow down and can increase hooding. That is not always a given. Fillers in that area may be a good way to try on fat grafting to see if that helps restore the lost contour of the eyelid, reduce the flare, and lower the crease sufficiently. The only caution is that fillers are not quite as smooth a result as fat grafting so be aware of that. Plus fillers in the brow are hard to get perfectly right. If you are going to have fillers placed, definitely use Restylane. As a hyaluronic acid, it is 100% reversible in case it looks bad. Plus, if you decide to go with fat grafting given the look of the Restylane as a permanent no-incision correction, your physician or I can dissolve the Restylane and proceed with surgery right a way.
Best,
SML

dr. lam,

could you check your PM, and evaluate my picture?

as you can see, my left eye is bigger because it folds above the incision line. it makes both my eyes look bigger overall. the height of the left eye is ok, but i feel the inner corners are not tapered enough. i like the tapering of some of the examples of your patients.

do you think i'm being too critical? i've had a low fold for so song that i just can't get used to this look. i just want the narrow, tapered eye that i once had. is the fold too low to mess with another revision? have you yourself had experience in lowering creases? or do you think a filler might help in my situation to bring my fold down?

thank you again so so much.

hi gina,
boy, a picture is worth a thousand words. given what i see, your creases are rather low. i was picturing some very high crease disaster but they are low. perhaps not as low as you would like but if i had to classify them given the parameters of a low, medium, and high crease, they appear quite low.

now, i see that they are not exactly symmetrical, but that is very hard to fix. remember none of us are symmetrical. read my blog on our obsession with symmetry.

i would caution you against a lid lowering revision for three reasons: 1) your crease is already low by the photo, 2) your skin is very thin and will most likely lead to an irregularized scar in the lid fold if a revision is attempted, 3) you will most likely not get a lid crease much lower.

that being said, you can try fillers. if that works, we can think about fat grafting but i personally would leave your lids alone. remember these comments should be taken with a grain of salt because i have not seen you in person.
best,
sml

dr lam,

you don't know how much i appreciate all the input you've given me. with your last advice, i don't think i will go ahead with the revision. the risks seem to greatly outweigh the benefits.

this morning it seems to look a tiny bit smaller... but the progress is so slow and minute! the asymmetry doesn't bother me too much, but i am just praying that i develop more hooding over my eyes overall, so they narrow more. if anything i just would like my inner corners taper more... would a filler help, or is that area too risky to mess with? do you think i will develop more hooding in the near future?

i wish you were closer to my area in the east coast, i would come see you right away. if only you had done my bleph!!

i think you could try a filler. if that works, we could look at fat grafting in the future, but i don't think you need it. i'm glad that i could be of assistance.
best,
sml

dr lam,

have you EVER done the procedure for lowering/erasing the crease for a patient? i just can't seem to shake this off...i am so so unhappy and i really don't think a filler or fat graft would help my lids lower to the point i want them to. they just seem too big. i really don't care so much about the scarring as long as they are just smaller. i used to have 2mm crease height and now they are around 4~5mm! it has been such a traumatic experience and i have no idea if it will ever change.

if you would not do this, can you refer me to a dr. who can? i don't want to fly overseas but no one in the states seems to be willing to help me. i just don't feel like myself, and i can't go on much longer like this. it has been 1 year and almost 3 months!

i am in such distress.

yes, without success. i will not do it for you. looking at your photos, i would be very hesitant to do it for you given how thin your skin is and how low your crease is already.
sml