I had a lower bleph done 4yrs ago and now my lower left lid is dropping. I am looking for a surgeon that has a high degree of skill set in this field and has alot of experience with this type of surgery. I would also like input on what type of procedure is recommended and which will provide the best results with as few complications as possible. I have had 2 injections of prp with minimal improvement.
Lower Lid is Dropping 4 Years After Lower Bleph? (photo)
Doctor Answers (7)
Causes of lid retraction and lower eyelid malposition
Lid retraction and malposition of the lower eyelid has several causes. These can include over resection of the skin, scarring in the internal lid, pull down of the lateral cheek and weak support of the lower canthal tendon. There are many options for correction all of which require accurate diagnosis.
Eyelid revision surgery
I am not sure a canthopexy (tightening of the ligament in the outer corner) will help and it could make things worse. The lid has 3 layers to it. If there is scarring in the middle layer sometimes releasing that scar lets the lid come up. After 4 years though the constant lower position of the lid creates contraction of the inner mucosal layer. You would not be able to correct it then without adding tissue to the inner layer. There is no way to know what is best just from a photo and you are doing the right thing in being very careful in choosing your surgeon. I doubt injections will help in such cases as I gather you have found out.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
Lower Lid is Dropping 4 Years After Lower Bleph?
Yes photo shows "lower lid drooping" or scleral show laterally. WHY did you wait 4 years??? Only solutions is a cantopexy/arraphy surgery.
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Lower lid scleral show
It appears that you have some ectropion of the lower lid. There are several causes and thus several different solutions based upon the cause and problems appreciated. This can include a lateral canthal suspension procedure, sometimes midlamellar release and graft, sometimes a lower lid skin graft, and sometimes even a midface lift. It really depends upon the exam. Good luck.
Please be very careful out there.
You are correct regarding your concerns. The problem is that fixing this issue is very specialized. I have patients from all over the US and the world who come to surgery for this type of issue. It is not something that the plastic surgery, facial plastic surgeon or oculoplastic surgeon down the street will be able to help your with.
Lower Eyelid Drooping after surgery
From the photo, it appears that you may have some shortening in the lower lid that may be accentuated from loss of volume. There are a number of options, including both surgical and non-surgical. The muscles that pull back the lower lid can be weakened with botulinum toxin and the loss of volume can be improved with filler to the area. Surgically, the shortening might be improved with a mid-face lift, tightening the lower lid, or sometimes putting in a spacer graft. The choices will depend on the way the eyelid feels on examination as well.
Lower eyelid retraction
You have lower eyelid retraction which can happen as an aging process, or sometimes after lower eyelid procedures.
You need lower lid retraction repair, probably with a graft on the inside of the eyelids.
If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.
I have attached a photo of lower lid retraction repair can achieve.
Best of luck
p.s PRP will not do anything for your lower lid retraction