I had an upper Blepharoplasty 6 weeks ago. My eyelids still do not shut all the way. I can make my eyelids shut if I "muscle" them down, but if I shut them gently then about 2 mm of sclera shows, particularly from the center of the eyes to the inner corner. My eyes also open now when I sleep. My plastic surgeon said that the amount of sclera showing is mild and will correct itself over time. Is this normal, and is he being honest? I really worry that I'll need to have skin grafts or some sort of corrective surgery.
Eyelids Won't Shut After Blepharoplasty
Doctor Answers 28
Upper Lid Blepharoplasty
There are two different questions open right now... the first from aching eyes who has had a bleph approximately six weeks ago. The important issue for you at this point is your ability to protect your cornea.
A small amount of lagopthalmos (inability to fully close your lids over the globe) is not unusual immediately after a blepharoplasty. This typically resolves within the first few days and can be related to the local numbing medication and swelling. Lagopthalmos that lasts beyond that can be a concern in terms of full resolution.
Certainly most of these issues should resolve at six weeks. The critical issue if you can't close your lids is are you providing adequate lubrication and protection to your cornea. If the white parts of your eyes are not red and injected and you are not having pain this may indicate that you have adequate protection.
You should, however, have a conversation with your plastic surgeon.
To the second question posted in the comments section, 4 years is a long time to be unable to fully close your lids and you may need some form of intervention to correct this. A complete evaluation by a board certified plastic surgeon or occuloplastic surgeon is indicated. There can be many issues including that your upper lids are don't have enough skin or laxity to close or that your lower lid is somewhat loose and needs attention to correct.
I hope this helps.
Eye Lids Not Shutting 6 Weeks After Blepharoplasty
Hi Aching Eyes,
The most important aspect of your recovery at this time is to protect your corneas both when sleeping and awake. Consult with your surgeon, and even your ophthalmologist regarding the best method of cornea protection. Moisturizing eye drops during the daytime, and taping the eyes shut when sleeping is recommended.
In my 23 years of performing upper blepharoplasty, after every case I have kept the excised skin for the first few days until I see that the lids are shutting completely. The lids are always open a bit following upper blepharoplasty if enough skin has been taken to achieve an excellent cosmetic result. Fortunately we have not had to use the skin for grafting. Rarely, it may take weeks or a few months until the lids completely close.
As time goes by, the 2 mm show should resolve, but remain in close touch with your surgeon, and protect your eyes. Good luck and be well.
Protection is better part of valor
If you know your eyelids do not shut completely while you sleep, you should use some eye ointment at night to protect the cornea. Usually, the Bell's phenomenon causes the eyeball to rotate upwards when you close the eye and this protecs the cornea but this may or may not be sufficient in individual patients. Often, surgeons will leave a little "scleral show" at the conclusion of the upper blepharoplasty because tissues do relax. You might ask your surgeon if the failure to close completely is due to tightness of the soft tisse or muscle weakness as surgeons will often excise varying amounts of the orbicularis oculi muscle, the muscle that makes the eyelids actively shut. Both the tightness and the weakness should improve over time.
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Incomplete eyelid closure after blepharoplasty
If you had an upper blepharoplasty (eyelid surgery) about 6 weeks ago, it's normal to still have incomplete eyelid closure(lagopthalmos) due to swelling. You should be sure to use eye drops and lubricants to ensure that your cornea does not become dry during the night. Unless your surgeon removed too much skin during the surgery (which is rare) your swelling should resolve over the course of weeks.
Be sure to follow up closely with your surgeon or see an ophthalmologist if you have any visual symptoms such as dry eye, excessive watering of the eye, or any visual change.
Eyelid lag correction after upper Blepharoplasty
As mentioned above, a small amount of scleral show is normal after upper eyelid blepharoplasty. However, this should get better within several weeks. You may be able to help this along by massaging the lid in a downward direction to help prevent scar tissue from keep the lids from closing. The main issue is while this slowly works out is to make sure your eye is protected by applying lubricant at nights and during the day. From the sound of it, you are doing a good job with this so far. I think it is too early to consider surgical revision at this stage. Good luck.
Some things you can do right now
It is very, very rare to need skin grafts after an upper blepharoplasty. So, eventually, you should be fine.
In the mean time, there are three things you can do to help:
1) Massage. If you massage your lids downward for 5 minutes twice a day, this can stretch the lids just enough to get closure. Ask your doctor to show you how to do this.
2) Exercises. Close your eyes very, very tight and hold them like this for 10 seconds. Repeat 10 times. Do this series 3 or 4 times a day. This exercises the orbicularis muscle which is the sphincter that closes your eyes.
3) Use moisturizing eye ointment at night. If you get pain, excessive tearing, or blurry vision, see your ophthalmologist right away.
Keep a Lid On It - Vision Before Vanity
A mild degree of tightness and temporary inability to shut the eyes completely is within the normal realm of post-operative healing in the first few weeks after Upper Blepharoplasty. However, it is unusual to have "scleral show" after an upper blepharoplasty, since this generally describes the exposure of the white of the eye (sclera) above the lower eyelid, most commonly occurring after Lower Blepharoplasty, and noticeable when the eyes are open.
There is a protective reflex rotation of the eye upwards under the upper eyelid, which may also result in the appearance of scleral show, after either an upper or lower blepharoplasty, or a brow lift. This reflex is helpful to protect the cornea from drying and exposure during sleep. Under this circimstance, scleral show is seen when the eyes are "closed".
The risk of prolonged scleral show or "lagophthalmos" (inability to completely close the eyelids) is corneal irritation due to exposure of the cornea and drying. If severe, this can lead to permanent corneal damage. You should see your plastic surgeon or ophthalmologist to evaluate the quality of your tear film, and to check whether there is any evidence of damage to the cornea. Protective measures can include the use of lubricating eye drops during the daytime, eye ointment at night, protective contact lenses, or temporary plugs in the tear ducts to allow your natural tears to accumulate, or a combination of the above.
Mild tightness or lagophthalmos of 2mm should subside with time and conservative measures, but be careful to keep the eyes moist at all times during this healing process.
Poor Closure of Eyelids Following Blepharoplasty is Not Uncommon
Poor closure of the eyelids following blepharoplasty surgery is not uncommon and occurs for a variety of reasons. In the vast majority of cases the problem occurs because of swelling and weakness of the orbicularis muscles. These issues tend to resolve with time. Rarely the condition is caused by over resection of eyelid skin. When this occurs secondary surgery is usually necessary and may require skin grafting.
When eye closure is impaired following surgery several steps should be taken to avoid damage to the eyes. These include lubrication of the eyes with eye drops during the day and ointment at night, massage of the eyelid and muscle exercises designed to strengthen the orbicularis muscles.
When these maneuvers are utilized, most patients are eventually able to close their eyes without difficulty and suffer no permanent damage to their eyes. If this complication occurs it’s important to maintain close contact with your plastic surgeon so that your situation can be monitored closely.
Eyelids won't shut
Mild lagophthalmos is normal in the short term after upper blepharoplasty. The key is to keep your eyes protected during this period with artificial tears and ointment at night. I am sure tour plastic surgeon has gone over this with you. If you cannot close your eyes 3-6 months after surgery, you may have to have a correction. This problem, if it does not resolve on its own, is fixable.
Upper Blepharoplasty and Eyelid Closure
A small amount of lagophthalmos (inability to close eyelids) is not unusual after eyelid surgery and can persist for days or even weeks afterward. In your situation, I would use a thicker form of eye drop at night time (Refresh PM). Some degree of a dry eye feeling is normal for a few weeks after the surgery, so make sure you use artificial tears frequently. Discuss your concerns with your Surgeon so that he/she can keep close tabs on you and appropriately direct your care.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.