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Mark Johnson, MD, PhD
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Mark Johnson, MD, PhD
Cosmetic surgeon | Views: 43325


Friendname: DrMarkEJohnson
Business Name: Nouveau Jeunesse Rejuvenative Medicine
Website: findnewyouth.com
 
Location: 7131 W Deschutes Ave, Ste 101
Kennewick, WA 99336
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Telephone: 509-736-9989
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Ask An Expert > Mark Johnson Message Board > what can I do for loose excess skin under my eyes after lower eyelid surgery a year ago
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odonnellsmod
,
what can I do for loose excess skin under my eyes after lower eyelid surgery a year ago
I had consulted with a surgeon regarding loose sagging skin under my eyes which was not corrected after a procedure 5 years ago. He ended up doing pretty much the same procedure. I still have these loose skin pouches under my eyes. I read about a skin pinch and am very interested


richardgalitz
Facial plastic surgeon
Miami, FL
United States
View My Professional Profile
Loose skin under eye  May 10, 2011 10:45 AM

A terrific way to solve the problem of loose skin under the eye, especially after previous surgery is the CO2 Fraxel laser. You can tighten the skin alot or a little without any significant anesthesia or surgial risk and recovery.


pearsonfaces.com
Facial plastic surgeon
Fleming Island, FL
United States
View My Professional Profile
Skin pinch versus resurfacing, etc.  May 10, 2011 12:11 PM

A skin pinch for the lower eyelids is useful if there truly is redundant lower eyelid skin. It's a relatively low-risk procedure that we do in the office with only local anesthesia (numbing medicine). However, if the problem is one of loss of elasticity--rather than excess skin--resurfacing procedures with laser or medium-to-deep chemical peeling can be more appropriate. All of this depends on the patient's specific anatomy, of course.

All the best,

--DCP


docpichler
Plastic surgeon
sacramento, CA
United States
View My Professional Profile
loose lower lid skin after surgery  May 10, 2011 1:23 PM

I want to make sure that you do not have malar pouches (!)(a photo would help), puffiness over the tip of the cheekbone. That's difficult to deal with. But, for the "normal" residual excess skin you have several options, each useful: laser resurfacing, "pinch" excision, skin flap excision or chemical peel. Your surgeon can explain the pros and cons of each, but none are very invasive. My first choice might be laser , if the excess skin is not a lot.


drgrossman
Plastic surgeon
New York, NY
United States
View My Professional Profile
  May 10, 2011 5:27 PM

People don't grow extra skin, not unless they have gained weight and stretched the skin.
There may be many reasons for your concerns.
Please provide photos so that all of us stop guessing.
Thanks.


docblinski
Plastic surgeon
Miami, FL
United States
View My Professional Profile
  May 11, 2011 3:25 AM

Your question is so specific that I can not advise without a posted photo. The skin pinch lower lid techniques is an option but I doubt in your case.


odonnellsmod
  May 11, 2011 7:32 AM

Here is a picture. Thank you for your responses

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Photo:

picture



docblinski
Plastic surgeon
Miami, FL
United States
View My Professional Profile
  May 11, 2011 7:47 AM

Wow thanks for posting the photo so quickly. Unfortunately you will need a revision of a few issues. You have lateral canthal webbing, laxity of the canthus, excess skin. I would recommend a open canthal plasty and repositioning of the lower lid tissues. Seek in person opinions. Best of luck.


drgrossman
Plastic surgeon
New York, NY
United States
View My Professional Profile
  May 11, 2011 7:48 AM

You don't need any skin tightening procedures. What you need is fat transfer or a filler in the hollow area under the eye and cheek. This will definitely solve you problem. Good luck


pearsonfaces.com
Facial plastic surgeon
Fleming Island, FL
United States
View My Professional Profile
Fillers for tear troughs.  May 11, 2011 9:30 AM

The picture helps a lot! I certainly don't see any excess or loose eyelid skin in the photos. Neither skin pinches nor resurfacing would be helpful. Rather, I agree with Dr. Grossman that fillers along the tear troughs (orbital rim hollowing) would be more appropriate. I'm not a big fan of fat grafts in this area, though, since they can often create lumps and irregularities that are very hard to correct.

All the best,

--DCP


richardgalitz
Facial plastic surgeon
Miami, FL
United States
View My Professional Profile
lower eyelid problems  May 11, 2011 10:16 AM

You may still benefit from some gentle CO2 laser work however I agree that Juvederm filler work will be most beneficial to the tear trough area and other selected spots.


richardgalitz
Facial plastic surgeon
Miami, FL
United States
View My Professional Profile
eye problems  May 11, 2011 10:20 AM

As I just replied I would use Juvederm as a filler in the appropriate ares as needed. I find injected fat a poor choice (even though natural tissue ) it tends to go in lumpy and ball up over time. It also has an unpredictable duration period different in every patient.


samir
Plastic surgeon
Baltimore, MD
United States
View My Professional Profile
Eye lid surgery  May 11, 2011 12:51 PM

Lower lid blepheroplasty is NOT a simple surgery. One has to examine the eye and the periorbital region completely including the skin, amount of excess skin, position of the lid, the upper lid, and it's position the brow, the boney component and the fat as well as the position of fat.The presence of droopy lid. The position of the globe in relation to the bone. Then a plan of action can be presented. Remember taking too much skin in the lower lid can lead to diasterous situations. Consult a BOARD CERRTIFIED PLASTIC SURGEON, OR BOARD CERTIFIED OPHTHALMIC PLASTIC SURGEON.
AS FOR THE PIVH LOWER LID SKIN EXCISION IS A CONSERVATIVE METHOD OF REMOVING WHAT YOU CAN GENTLY PINCH OF SKIN AND KEEP THE EYELID IN GOOD POSITION.


AlexanderRivkinM.D.
Plastic surgeon
los angeles, CA
United States
View My Professional Profile
Radiesse and Juvederm would be a better option  May 12, 2011 11:07 AM

Looking at your picture, I would say that your primary issue at this point is volume loss, not loose skin. The volume loss goes from the tear trough area under the eye and extends into the anterior cheek in a typical diagonal pattern. I see patients with this issue on a daily basis. Injecting Radiesse in the cheek area and Juvederm or Restylane in the tear trough corrects the volume loss and looks smooth and natural. The procedure is essentially painless (after numbing cream), takes 10 minutes and lasts for a year in the cheeks and 2 to 3 years in the tear troughs. Risks are limited to bruising and a bit of swelling. The nice thing about using hyaluronic acid (Juvederm or Restylane) is that these fillers are dissolvable at any time with a quick injection of an enzyme. So, even if there is some persistent swelling afterwards, it is entirely correctable.

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Photo:

Radiesse and Juvederm would be a better option



odonnellsmod
  May 12, 2011 12:03 PM

Thank you all so much for the responses.


samir
Blepheroplasty  May 12, 2011 7:24 PM

Based on the pictures
You do not need another blepheroplasty, infact you can not have another blepheroplasty because you are starting to have scleral show.
you have major problem with tear trough and major mid face descent.
to correct appropriately, you need to discuss with your plastic surgeon at least mid face lift, and fat trasposition to the tear trough and possibly fat graft to the tear trough.
LOTS OF SURGERY
If you do not like that DO NOT DO ANY THING OTHERWISE YOU WILL HAVE MAJOR PROBLEMS..


MissJ521@aol.com
'If I were in your johnny'  May 12, 2011 9:08 PM

The skin pouches to your lower lids look to be fat pockets that are extending past your orbital rim . Your bone structure is retrusive. The lid/cheek complex which should be a 'smooth transition' is disjointed. If I were in your johnny, I would narrow my consults with PSs to those conversant in orbital rim implants and subperiosteal midface lifts so that the deficient bone structure can be corrected and the midface be hoisted higher for a smoother lid/cheek complex. Once you get to that stage, you can then think about filling in any residual tear trough areas with filler. But filler alone wont substitute for the type of structure you are lacking which is contributing to your problem. Nor will any skin pinches. You also have a litany of cosmetic issues that could be corrected. But I will withhold commentary in that regard.

I am not a plastic surgeon performing the procedures suggested and have no vested interest in suggesting them. However, I have good reason to believe that the procedures I'm suggesting you narrow your consults to are very much on target with your problem.


DrMarkEJohnson
Cosmetic surgeon
Kennewick, WA
United States
View My Professional Profile
  May 17, 2011 7:37 PM

I agree that volume loss is the issue. Fillers would certainly be an appropriate solution, but for a more long-lasting result I would recommend stem cell augmented fat transplantation. The results cant be beat! Usually there will be mild to moderate swelling that lasts about 2 weeks, and occasionally some bruising occurs. The results last years.


DrAmiyaPrasad
Facial plastic surgeon
New York, NY
United States
View My Professional Profile
Treatments for Excess Skin Under Eye Area  July 25, 2011 9:27 AM

A: I?m a Cosmetic Oculofacial (Specializing in Eyelid and Facelift Surgery) Plastic Surgeon practicing for 15 years with offices in New York City?s Upper Eastside. The ?skin pinch? procedure is effective in treating excess or redundant skin. Many time, skin which is elastic is perceived as excessive and too much skin is removed. For skin tightening without the skin pinch, I routinely use the MixtoSx Micro Fractional CO2 laser or Pelleve? (in darker skin patients). My cosmetic surgery guide ?The Fine Art of Looking Younger? (available on Amazon and as an ebook in all formats) might be a helpful book if you are considering cosmetic surgery of the eyes or face.


DrAmiyaPrasad
Facial plastic surgeon
New York, NY
United States
View My Professional Profile
Treatments for Excess Skin Under Eye Area  July 25, 2011 9:28 AM

A: I?m a Cosmetic Oculofacial (Specializing in Eyelid and Facelift Surgery) Plastic Surgeon practicing for 15 years with offices in New York City?s Upper Eastside. The ?skin pinch? procedure is effective in treating excess or redundant skin. Many time, skin which is elastic is perceived as excessive and too much skin is removed. For skin tightening without the skin pinch, I routinely use the MixtoSx Micro Fractional CO2 laser or Pelleve? (in darker skin patients). If you are considering cosmetic surgery for the eyes, my book ?The Fine Art of Looking Younger? might be helpful (available on Amazon, iTunes or Barnes & Noble).




 



 

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