Fourteen months ago I had a brow lift (endotine implants). I now have lagothalmos in both eyes, (left eye 2mm short). I have mild upper lid asym. The "lago" caused chronic dry eye and I need ongoing treatment. My surgeon recommends lowering brows some to recover eye lid coverage. The more affected eye has slightly lower brow, not a correlation. My Opthamologist says surgery could make it worse. He recommends plugs or gold implants for affected eye. I have cosmetic and health concerns. Help!
Surgical Correction or Not to Correct Lagophthalmos from Brow Lift?
Doctor Answers (7)
Correction of lagopthalmos
If there is enough skin to allow the eye to close at this time, then reversing the forehead lift will likely not help. If that is the case a gold weight to help the lid drop might be a better choice. If the eye that is dry is the one with the higher eyebrow, you can try Botox or Xeomin ton that side only to see if weakening the muscle will allow the lid to close.
Lagopthalmus Following Brow Lift
Pictures would be helpful, but I have reversed the brow lift in some patients to correct the lagopthalmos which is the inability to close the eye. Most of these patients also had an upper eyelid blepharoplasty by their surgeon at the same time. As mentioned by others Botox is an easier solution that may improve the dry eyes.
Dry Eyes after Brow Lift
Dry eyes are very common, with or without plastic surgery. Lagophtalmos, a condition where the upper eyelid has difficulty closing, has several potential treatments. A implant in the upper eyelid (gold, platinum, etc) can allow gravity to push the eyelid down a bit. Tear duct plugs also keep the eyes moist. For some patients, Botox may possibly be used to help lower the eyebrow and upper eyelid. Lastly, reversing a brow lift with further plastic surgery may help. However, only after a comprehensive evaluation can a plastic surgeon or eyelid specialist help determine appropriate options for you. Best of luck.
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Correction of lagopthalmos
There are several ways to go about trying to correct this problem, altho I have never seen a case where an endo brow was able to left the lids that much without an aggressive upper lid blepharoplasty. In plastic surgery we like to take a ladder approach. Try the simple things first, you don't need an atom bomb to kill an ant. I would try botox in the forhead to relax the brow. If this works then you will need to go every 3-4 months for botox. The next styep would probably be releasing the brows and endotines endoscopically and letting the brow go back to its original height. This would also be good to do while there is a botox effect to let the brow drop as needed. I would probably save the gold weight procedure as a last resort. Make sure the problem is the brow and not over resection of eyelid skin. Good luck, Dr. Schuster in Boca Raton
Lag after brow lift
This is a difficult problem and I suggest you consult with an eye plastic surgeon. A few solutions are:
- Botox to forehead to lower brows
- Correction of any existing lower eyelid retraction or lower lid laxity
- Punctal plugs as suggested by your eye MD