Problems Post-Blepharoplasty and CO2 Laser

Blepharoplasty is a fairly traumatic procedure for a small, delicate area. On top of that, the CO2 laser is very very traumatic to the skin. As you know by now, it will cause redness, swelling (including upper eye), drainage, scabbing, etc.

Either procedure alone may cause the lower lid to droop or lag so that it does not function properly. As a result, the eye can dry, turn red, get ulcerations.

This does not mean that you ruined your eyes. Steroid treatments (oral, iv) may help bring down the swelling. If the skin is no longer oozing, I recommend that you ask your surgeon about using steri strips to suspend the lid into position until the muscles start to work and the swelling resolves.

It is also very important to protect the eye from dessication. This may mean patching at night and ointments/eye drops at other times. It is best to coordinate with the surgeon.

Some types of lower lid blepharoplasty will slow the drainage of blood and fluid from the upper eyelid, and this causes the lid to swell. As the swelling in the lower lid improves, so will the swelling in the upper lid.

It’s important to work closely with your doctor to prevent the lower eyelids from pulling downwards. The CO2 laser is effective in reducing wrinkles (I routinely use a MixtoSX Microfractional CO2 laser in my practice) however the heat from the laser can cause the skin to contract significantly. It’s difficult to provide a complete diagnosis without an examination,

Recovery after eyelid surgery varies from patient to patient. While most lower eyelid surgery is healed within two weeks, some patients take longer for various reasons. I would definitely talk with your surgeon about what is happening as this may represent normal healing or can represent infection or some other complication.

What you are experiencing is not atypical after CO2 laser resurfacing.  After all, you have received a second degree burn of the skin.  It takes time to heal and 2 weeks may not be enough for you.

I would be concerned about the lower lid position.  I would recommend that you discuss with your surgeon some repositioning therapy to keep this from becoming a problem that demands and operation for correction. 

The redness and swelling will assuredly resolve, later than you would like, but still will.  In the mean time, protect the lower lid position.

Web reference: http://www.zubowicz.com/subpag,22-atlanta-eyelid.htm

However, the lid retraction and dry eyes are a concern. Sometimes the lid is pulled down excessively by the combined procedure and you need to see your doctor to make certain your eye has adequate protection.

In some cases when CO2 resurfacing has pulled the lid down a very simple procedure called a temporary tarsorraphy is required to pull the lid up and protect the eye during healing. The earlier this is done the better.

Follow up woith your doctor and be sure to muse the moisturizing ointment to keep your eyes from becoming dry.

Web reference: http://drseckel.com/dark-circles-under-the-eyes/puffy-eyes-surgery/

C02 laser is a thermal burn to the skin and takes months to recover. Your surgeon should have notified you of this extended healing time. As soon as the scab is healed (approximately two weeks) makeup can be applied. If your eyes are dry, the use of Lacri-Lube opthalmic ointment at night, and Natural Tears during the daytime will help. Patients who undergo blepharoplasty alone, have two weeks of swelling and bruising before returning to work or social activities without visual detectability. The laser extends this healing period longer, but one can use makeup over the lasered areas.

Without knowing exactly what surgery was performed it is hard to say what the best course of actionis. We are assuming that uyou have used a board certified plastic surgeon. The tightness is from the laser and the lid drooping is fromtension on the lid which should resolve . It is really too early to tell what will happen. The combination of surgery and laser treatment is a longer healing period. All the best.

The combination of laser and lower lid blepharoplasty is not uncommon one in our Santa Rosa plastic surgery practice. The laser is usually what delays your postoperative healing. However, your symptoms appear much more severe than the majority of patients I see. It is not uncommon to have some stiffness of the lower lids and even some retraction so you see some white below the iris of the eye.

Keeping your eyes lubricated at all times is imperative to prevent dryness and potential corneal injury. I would discuss with your surgeon a referral to an ophthalmolosgist who can examine the present state of your cornea and ensure that no other untoward process is delaying your healing. We work closely with one or two ophthalmologists and they are an invaluable source of help and knowledege for the rare patient that needs to see them.

In addition, make sure that you have also discussed with your surgeon what the care of your lower lid skin should be at this stage. The laser is akin to a burn so you need to moisturize it and keep it from any sun exposure right now. Eventually, your surgeon may recommend massage in an upward direction to soften that stiff lower lid. In general, the droop you refer to resolves with time and massage, but in rare cases an operation may be needed for correction.

Hang in there during this dificult time and communicate with your surgeon frequently since this is a time when conditions can still be modified in a positive direction with good postop care. Good luck in your recovery.

First, swelling in the upper eyelids is very common after ANY surgery around the eyes. This should improve. The description of your lower lids concerns me. If they are very tight and you are seeing the conjunctiva and your eye are irritated then I suggest you quickly go back to your doctor to be checked out. You don't want to get into a vicious cycle of dry eyes, possible ectropion and chemosis.

Steven Wallach, MD