9yrs ago,had quadblepharoplasty n canthopexy. rt. lower lid have mild ectropion due to surgeon being overly agressive. Dr tried 2 fix it twice by resecting skin, improved a little but, not enough. Was quite afraid 2 undergo another procedure. Now I feel is x for another attempt to fix this sclera show, is there a possibility another surgeon can fix this ectropion by another canthopexy?
I Have Mild Ectropion on my Rt Lower Lid Due to a Blepharoplasty Yrs Ago, Can It B Fixed?
Doctor Answers (5)
This is not ectropion.
This is vertical inadequacy of the lower eyelid. Lack of support at the orbital rim also contributes to this issue. It appears that your prior surgeon attempted to correct the situation by tightening the lower eyelid. This simply forces the lower eyelid under the curvature of the eye making the situation worse. I have developed a surgery to repair these situations using a hand carved orbital rim implant made of ePTFE. The cheek is vertically lifted onto the rim implant and the lower eyelid itself if vertically and horizontally lengthened with a hard palate graft borrowed from the roof of the mouth. Look on my website to see examples of these types of surgeries. Unfortunately, you will need to travel from Des Moines to have this surgically addressed. Messaging the lower eyelid at this point will do nothing.
Lower lid retraction after blepharoplasty
The picture you've posted demonstrates moderate lower lid retraction with scleral show due to over resection of lower lid skin and subsequent wound contraction. I'm sure you've been instructed to perform twice daily cheeck massages up until now. If not, they do help. Due to lack of adequate skin and moderate contraction, I believe the best approach would be a mid-face lift that would give you some upper check and lower lid skin laxity and soft tissue support which should improve the ectropion. Other options involve skin and conjuctival grafting or another canthoplasty with canthopexy.
Ectropion or scleral show after blepharoplasty.
Ectropion or scleral show after blepharoplasty especially after attempted repair is a difficult procedure. This is especially truee when the eyeballs "stick out". See an ophthalmic plastic surgeon with a great deal of experience.
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Lower eyelid lag or malposition after surgery
Even though the problem may have started with removing too much eyelid skin and may have been treatable by just adding skin in the past I doubt that will work now. After so many years in a lower than normal position the inner most layer of the eyelid will have shrunk as well. You will most likely therefore need a spacer of mucosa or dermal matrix on the inner most layer in addition to skin elevation techniques (midface lift, canthopexy...) and/or skin grafting.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
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.
Repair of lower lid retraction after blepharoplasty
You appear to have lower lid retraction. Skin resection is not the treatment for this condition. Possible treatments may include lateral canthal tightening, mid face lifting, skin grafting, and grafting to the inside portion of the eyelid. You need to be evaluated by an oculoplastic surgeon (a specialist in eyelid surgery). The best way to find one in your area is to look on the website for the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS): www(dot)ASOPRS.org
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.