Problems Post-Blepharoplasty and CO2 Laser

Two weeks ago, I had CO2 laser combined with a lower lid Blepharoplasty. Eyes are very dry, drooping, and stiff. Recovery has been much worse than I anticipated. My eyes developed a few ugly scabs which, finally, seem to be flaking off. But my eyes are still so sore from the tightness. One of my lids is drooping, red, very stiff and doesn't move naturally.

It's pretty bad, although I'm really more concerned about my upper lids. They are so swollen! My surgeon didn't touch them so I can't understand why I would be swollen there. I look in the mirror and think I have destroyed my eyes. I read other people who were back to work in a week. I wonder what on earth happened to me? Many thanks for any insight.

Doctor Answers 11

Follow-up after Blepharoplasty and Micro Fractional CO2 Laser Resurfacing

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,

New York Oculoplastic Surgeon
4.5 out of 5 stars 40 reviews

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You are healing

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.

Upper lids are OK

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.

Robert M. Freund, MD
New York Plastic Surgeon
5.0 out of 5 stars 22 reviews

Recovery After Eyelid Surgery

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.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 13 reviews

CO2 laser prolongs blepharoplasty healing but keep eyes moist

CO2 laser resurfacing significantly prolongs blepharoplasty healing by 3-4 additional weeks.

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.

CO2 laser takes longer to heal

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.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Patience and continued care are your best option

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.

Talmage J. Raine, MD
Champaign Plastic Surgeon
4.5 out of 5 stars 8 reviews

Keep eyes lubricated and see an ophthalmologist

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.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 16 reviews

CO2 and Lower eye lid surgery

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

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

CO2 is a burn

CO2 laser resurfacing of the lower eyelid skin causes a burn.  Burns take a few weeks to heal.  Your peers that returned to work after a week probably didn't have the laser resurfacing done.  Follow your surgeon's instructions and hang in there.  They will get better.  Good luck!

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.