What to do when eyelid surgery goes awry?

Although there are typically very low risks to having eyelid surgery with an eyelid specialist, there are some cases in which results are not ideal. The factors that contribute to a botched eyelid surgery can include, but are not limited to, a surgeon’s experience, complicated cases, patient not following directions, healing disorders, and other underlying conditions. At Lewen Cosmetic Center, we approach eyelid surgeries with a goal of getting it right the first time. We want patients to have the best result possible without putting them through additional, unnecessary procedures. With that being said, we will also inform you if it isn’t in your best interest to proceed with a surgery if it is believed you won’t heal properly or encounter complications. However, even with all necessary precautions and planning, sometimes results can be less than ideal or require extra attention. For this reason, Dr. Lewen prefers to keep a close eye on all of his surgical patients with extra hand holding and attention than that of most general plastic surgeons.

How do I know if I need a revision eyelid surgery?

If you find yourself asking this question, it may be best to seek medial advice from an oculoplastic surgeon. Common issues to look for when questioning the need for a revision eyelid surgery are:

  • Lid retraction This happens when the eyelid pulls away from the eye itself leaving the lids unable to completely close, and essentially, putting the health and safety of the eye at risk.
  • Unsightly scars Thicker scars tend to form during the first few weeks following surgery, which is why all post-operative patients should be closely monitored and follow strict direction of limiting strenuous activity until cleared by their surgeon. Hypertrophic scarring following surgery can usually be softened and resolved easily with injections of steroids.
  • Uneven lid appearance Many factors can contribute to the uneven appearance of eyelid height following surgery. Dependent on the specific eyelid surgery performed, there may be different approaches taken to resolve the issue. In most cases, evenness can be achieved with a simple in office procedure such as one of Dr. Lewen’s specialty facial filler injections.
  • Hollow or sunken eyelids following a blepharoplasty Having hollow or sunken eyelids as a result from an upper or lower blepharoplasty procedure is likely due to having too much fat or volume removed. With these cases, for the most part, volume can be restored with a non-surgical in office procedure known as the cannula eyelid lift or subbrow specialty filler.
  • Round eye shape Rounding of the eyes following an eyelid procedure can be a result from multiple eyelid surgeries and scar tissue causing an irregular shape. These types of cases typically require a revision canthoplasty to restore the almond eye shape, and sometimes are done with a graft to lift the eyelid back to its normal position.

What are the risks to having a revision eyelid surgery?

As with any eyelid surgery, the most common risks following an eye procedure is bruising, swelling, and dry eyes. With multiple eyelid surgeries, the dry eye issues can worsen significantly. We generally won’t proceed with additional eye surgeries until a patient has their dry eyes under control. This approach is solely for the comfort and safety of the patient, and one of the many reasons you should have an oculoplastic surgeon perform your blepharoplasty, ptosis repair, canthoplasty, reconstruction, and/ or revision eyelid surgery as they are fully equipped and trained to address any concerns or complications should they arise following your procedure.

Will my eyes be comfortable following surgery?

The most discomfort a patient has following droopy eyelid surgery is dry eyes. Dry eyes can be managed and should be checked regularly by your surgeon. Most commonly, patients will be instructed to use regular artificial tears leading up to and following surgery, along with use of a thicker eye ointment for added dry eye relief. For specific dry eye relief instructions following your surgery, you should consult your chosen oculoplastic surgeon.

Can my eyes go back to the shape they used to be before eyelid surgery?

We are regularly asked what can be done to give patients back their natural eye shape. This can be an emotional time for patients, and generally requires a more in-depth consultation dependent on the amount of previous eyelid surgeries a patient has had. While keeping the health of the eye as a priority, there are procedures that can either fully restore the natural eye shape or at least give the illusion as such. The best way to determine if you are a candidate for a revision eyelid surgery or to see what surgical or non-surgical route is best for you, is to come in for a consultation with Dr. Lewen who is a double-board certified Oculoplastic Facial and Reconstructive Surgeon.




Miami Residents Ask: Is Facial Fat Grafting Permanent?

Fat grafting is a technique that has been used in cosmetic applications to add volume to the skin. Although the technique is more intensive than dermal fillers, it does offer unique benefits for men and women who want to reduce wrinkles or enhance facial features, such as a greater longevity.

The Fat Grafting Procedure

The fat grafting procedure is a three-step process.

  1. Fat is removed from an area of the body, such as the thighs, abdomen flank, or buttocks, using a limited liposuction technique.
  2. The fat is processed to remove any impurities and isolate the fat cells.
  3. The fat cells are loaded into a syringe and injected into the treatment area of the face, such as nasolabial folds, cheeks, under the eyes, forehead and other areas.

With fat grafting, you do have some downtime, typically one to two days.

How Fat Grafting Works to Reduce Wrinkles and Add Volume

The transferred fat cells absorb nutrients and oxygen from surrounding tissues until a process known as “neovascularization” occurs by which the body develops new blood vessels to deliver nutrients and oxygen to the fat cells directly. Neovascularization is the most important facet of fat grafting. Once the blood vessels are developed by the body, the fat grafts become an integrated part of the subcutaneous tissues and work much like the native fat cells. Recent studies have also revealed that the fat cells contain growth factors that help the body heal naturally. This mechanism enhances the anti-aging benefits of fat grafts.

How Long Do Fat Grafts Last?

The key distinction between dermal fillers and fat grafts is that transplanted fat cells are integrated into the tissues, whereas dermal fillers contribute to the presence of certain proteins, such as collagen and hyaluronic acid. While every fat cell may not survive the grafting procedure, for all practical purposes, fat grafting is considered a permanent solution. We do advise our patients that some fat cells may not survive the harvesting, purification and implantation, so a follow-up fat grafting procedure may be required to achieve the desired results.

Can You Extend the Results of Your Fat Grafting?

Because fat grafts become part of your subcutaneous tissues and are subject to changes that affect native fat cells, many people want to know how they can extend the longevity of their fat grafts. The surgical technique that is used and the experience of the surgeon is of utmost importance. Dr. Lewen specializes in facial fat grafting, and his skills provides his patients with the best possible outcomes for the procedure.

Learn More About Facial Fat Grafting at Lewen Cosmetic Surgery

Dr. Lewen can discuss fat grafting and the results that he achieves with his patients during a consultation. To learn more about fat grafting at Lewen Cosmetic Surgery, contact us to schedule your personal consultation.

Miami Residents Ask: Is Mohs Surgery Covered by Insurance?

Skin cancer is the most common type of cancer, and it affects millions of people in the United States. The Miami area sees a high number of skin cancer cases due to the outdoor lifestyle that makes Florida a popular place to live. If you are diagnosed with skin cancer, Dr. Lewen may recommend Mohs surgery.

What is Mohs Surgery and When Is It Recommended?

Although Dr. Lewen does not perform Mohs surgery himself, he is able to provide patients with highly recommended colleagues who are able to perform the surgery instead. Skin cancer that has not spread to surrounding tissues can be treated through a surgical incision of the abnormal tissues or Mohs surgery. Mohs surgery is highly recommended in most cases because it ensures that only the cancerous cells are removed. Often, this minimizes scarring and ensures patients of positive prognosis in the cancer treatments. The technique that is used for Mohs surgery is referred to as micrographic surgery. The surgeon removes thin layers of tissues from the lesion and studies it under a microscope. If the surgeon detects cancer cells in the tissues, another layer is removed and evaluated for the presence of cancer cells. This process continues until the surgeon removes a thin layer of tissue that is free of any cancerous cells. The wound that is left on the skin is treated with techniques that minimize scarring and preserve the aesthetics as much as possible.

Once this is done, Dr. Lewen will perform any reconstruction procedures that are necessary to areas of the eyes or face that have been affected by Mohs surgery. Dr. Lewen and his staff will continue to closely monitor your healing progress following the Mohs surgery and skin reconstruction.

Considerations for Insurance Coverage of Mohs Surgery

The cost of Mohs surgery can be expensive, so insurance coverage is an important consideration. Fortunately, Mohs surgery is a medical procedure, and it is not considered an elective even though it does provide some cosmetic benefits. Micrographic surgery has become a standard procedure under insurance policies, so it is covered in most cases. We do advise our patients that they should check with their insurance carriers directly, and we are happy to provide any details that will help you explain the medical necessity of the procedure. Even if your Mohs surgery is covered, you may have some out-of-pocket expenses to consider before having the procedure.

What If Insurance Doesn’t Cover Mohs Surgery?

If your insurance does cover any or all the cost for your Mohs surgery, we may have some options to help you afford the cost. We work with CareCredit® to offer our patient’s financing options that fit their budgets.

Learn More About Mohs Surgery at Lewen Cosmetic Surgery

If you have been diagnosed with skin cancer or have an unusual lesion that you need to have evaluated for skin cancer, contact Lewen Cosmetic Surgery to schedule a consultation. Dr. Lewen will determine if your skin cancer can be treated with Mohs surgery, and we can assist you with finding out if the procedure is covered by insurance.

Why Mohs Surgery is Ideal for Treating Facial Skin Cancers in Ft. Lauderdale, FL

Skin cancer is a common problem among Miami residents because the Florida lifestyle means spending a lot of time outdoors. Sometimes, despite your best efforts, skin cancer develops in areas that are most often exposed to sunlight, such as the face. There are several options for treating skin cancer, yet Mohs surgery is considered the gold standard for treating skin cancer on the face. Although Dr. Lewen does not perform Mohs surgery himself, he does Mohs reconstruction surgery if necessary after a dermatologist has removed the skin cancer with Mohs surgery.

What is Skin Cancer?

Skin cancer describes a condition in which abnormal cells develop in multiple organs of the body, such as the skin. There are several types of skin cancer, including:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

Of these, melanoma presents the most serious type of skin cancer because it can infiltrate the surrounding tissues and organs. Most cases of skin cancer involve basal cell carcinoma.

Skin Cancer Treatment Options

Treatment for skin cancer does vary slightly based on the type of cancer, but treatments may include:

  • Excising the cancerous cells to include a margin of healthy tissue
  • Radiation therapy
  • Topical immunotherapy and radiation
  • Cryosurgery
  • Curettage and electrodesiccation
  • Mohs micrographic surgery

While each of these options may successfully remove or destroy the cancerous cells, there are disadvantages to most, such as scarring and side effects. Mohs micrographic surgery produces no side effects, and the technique involves removing the smallest amount of tissue necessary to remove the cancerous cells.

Mohs Surgery for Facial Skin Cancer

Dr. Lewen does not perform Mohs surgery, but he is happy to provide recommendations for patients and to perform any facial reconstruction surgery once the skin cancer has been removed. Mohs surgery offers exceptional precision when removing cancerous cells from the face. Rather than removing a large section of tissue with traditional excision, the doctor removes very thin layers of skin cells. Each layer is studied under a microscope to detect the presence of cancerous cells. If cancer is detected, the surgeon removes another thin layer of skin from the lesion and studies it under the microscope. This process is repeated until no cancer cells are detected. Depending on the size of the resultant wound, the surgeon may:

  • Allow the wound to heal naturally
  • Suture the wound closed
  • Use skin grafts or flaps to cover the wound

Following the removal of any facial skin cancer, Dr. Lewen may perform facial reconstruction surgery afterward. He will choose a technique to help minimize scarring as well as preserve your vision and the delicate tissues around the eyes and cheeks. He may even recommend scar revision surgery at a future date to further camouflage the scar with the surrounding skin.

Interested in Mohs Surgery for Facial Skin Cancer? Contact Lewen Cosmetic Surgery.

If you have been diagnosed with or suspect that you have skin cancer on your face, contact Lewen Cosmetic Surgery to schedule a consultation. Dr. Lewen will determine if Mohs surgery and facial reconstruction is your best option, or recommend alternative treatments for the lesion.

Procedures Ectropion Repair Can Be Combined with in Miami, FL

There are many signs that indicate to others how long we’ve been around on this earth. While some are positive such as, accumulated wisdom or wealth, other, more physical signs like failing joints and wrinkles are the less desired side effects of aging. Since our face is the first thing people notice about us, one of the biggest indicators that we are getting old is the condition of the skin and underlying structures of the face, specifically in the eye area. Ectropion repair surgery is a popular procedure performed on older adults that corrects a common aging issue of the eyelids. Those desiring a more rejuvenated and alert appearance of their eyes may be interested to know that this procedure can be performed alone, or in conjunction with other cosmetic eye procedures to turn back some of the most obvious effects of aging.

What is Ectropion Repair?

Ectropion is a condition that causes the orientation of the eyelids to roll outward. The eyelid droopiness is typically attributed to cancers and abnormalities from previous plastic surgeries, but can also be congenital, trauma-related, or age-related. Ectropion repair surgery is usually recommended to patients afflicted with the condition as it can improve any irritation, dryness, or watery eyes the patient is experiencing. Another benefit of ectropion repair surgery is that it can be combined with other surgical eye procedures to produce the best results.


Many patients that choose to undergo ectropion repair surgery do so because they desire a more alert and rested appearance. Blepharoplasty is another surgical eyelid procedure that accomplishes this same goal and can be combined with ectropion repair for a fresher, more dramatic result. Patients that suffer from puffiness in the upper eyelid, lower eyelid or both can benefit from blepharoplasty. During the procedure, Dr. Lewen will make small incisions in the natural contours around the eye, minimizing any visible scarring. He will then remove fatty tissue and excess skin while tightening any loose muscle in the eyelid to produce a smoother appearance.

Droopy Eyelid Surgery

Some patients that suffer from ectropion also struggle with ptosis, a term that describes a sagging or droopy eyelid. Those with this condition typically complain that the condition makes their eyes look small, tired, or heavy and can even affect vision. Fortunately, droopy eyelid surgery coupled with ectropion repair surgery can correct these concerns for a more rejuvenated and alert end result.

Take the Next Step

Dr. Gregory D. Lewen and his staff provide these eyelid procedures and more at locations in Miami, Aventura, and surrounding areas of Florida. For more information or to schedule a consultation, contact Lewen Cosmetic Surgery today.