I hate a lower bleph 3 years ago. I ended up with a scar contracture in my right lid (no skin was taken). Lid needs to come up about 1 mm. Original general plastic surgeon went back in and tried to find scar tissue, but failed to find and release it. He did two canthopexies to try and get the lid up (dissolvable suture) Both have pulled down. Would a drill hole canthoplasty work better? I saw an oculoplastic and he recommended canthplasty, but not what type. Droopy eyelid
Lower Eyelid Droop. Second Opinion?
Doctor Answers 4
More than likely, you will need a graft to the inside of the eyelid to help keep the eyelids up. An in-person consult is ideal as your surgeon can feel for the scar/tightness and give you a more adequate recommendation.
The lateral tarsal strip canthoplasty procedure including periorbital cicatrix (scar) lysis and regional skin/fat grafting including follow-up triamcinolone/5-FU injections with post-operative external support tape may be a helpful scenario for your situation!
Revisional lower eyelid surgery
Lower eyelid retraction can happen after lower blepharoplasty, and it is usually due to tightness of the lower eyelid/cheek area, pulling the eyelid down. It can be worsened by weak orbicularis muscle, which is responsible for closing the eye and blinking. Canthoplasty alone won't address the underlying problem and that's why it failed in your case; it doesn't matter if is absorbable suture or permanent drill hole. The tightness needs to be released and likely an eyelid graft (placed inside the eyelid) is needed to elevate the lower eyelid. Consult an oculoplastic surgeon with experience in revisional lower eyelid surgery.
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Lower lid scarring following blepharoplasty
If you truly have scarring pulling the lids down, those scars need to be released and the lid placed on upward traction during the first week postop to have any chance of a normal position. Even then you may need steroid injections to at the first sign of recurrence. A canthoplasty alone is just not going to cut it.