I’m 30 days post op from a Endoscopic brow lift and lower Blepharoplasty. My lower lids seem to be drooping down on the outer edges; my right eye more prominent that the left. Dr. has me doing rolling massage three times a day. I’m devastated by the outcome but I haven’t expressed concern about this with my Dr. yet. I meet him again in two weeks. What is this and should I call him sooner? Also, is it normal not to have feeling from the top of my head to my brow? I’m 50 and a nonsmoker.
Is This Lower Lid Retraction After Lower Blepharoplasty? (photo)
Doctor Answers 2
Lid retraction might be temporarily caused by swelling that follows surgery. If it lasts you may need a specialist's revision
Having continued communication with your surgeon is critically important. Your doctor obviously set out the procedure the best way they know how and is following up with you in 2 weeks. You are getting the appropriate attention that you need for your concerns. The question of numbness after an endoscopic brow lift is a reasonable, and it is not at all unusual to have numbness. There are nerves in the forehead skin that provide specific innervations for sensation, and swelling affect them.
As a cosmetic oculofacial plastic surgeon who specializes in eyelid complications and revision surgery, I have lot of experience with lower eyelid retraction. When people come to me, I would generally do conservative management, including massage, as the first line of treatment if there is no clear medical indication for a revisional procedure. Sometimes the eyelid can look relatively retracted but not because of healing complications, but because of swelling that causes the muscles of the lower eyelid, called the orbicularis muscle, to have less tone causing sag.
I have had many patients who come to me whose eyelids where so pulled down from another surgeon's work that their eyes are exposed, or the outer corner of the eyelid was not connected. They were not only having overriding of the eyelid but also causing a lot of ophthalmic issues that are a potential threat to the vision and health of the eyes.
When things settle, and your eyelid is retracted more than you want, then a revisional procedure may be pursued. It is very important that you continue to communicate with your surgeon as they know the anatomy of your eyelid better than anyone. Understanding that even in the even in the best in hands, there are definitely times procedures may need some kind of revision procedure. Your surgeon will work with you and do whatever enhancement is necessary. I hope that was helpful, and thank you for your question.
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Assessing for Lower Eyelid Retraction following Blepharoplasty
When assessing lower eyelid positioning before and after surgery, it's absolutely critical to have photos of the entire face, to ensure that expressions are the same both before and after. This is because even the slightest expression can significantly change the position of the lower lid line, and we can't tell if the expressions are the same if we don't see the entire face. The head needs to be positioned in the same plane as well (neither tilted forward or back), as the lower lid can seem significantly lower if the head is tilted even slightly more forward in the after photo. Make sure you express any concerns to your surgeon and follow his/her directions for any eyelid "exercises", as 30 days is still relatively early in your healing.