Getting Worse 14 Months After Blepharoplasty, Is Revision an Option? (photo)

Went to an occuoplastic surgeon after 14 months of misery - he told me that my lower lids were loose and though my tear ducts were producing tears, only 1/2 of my eye was getting the benefit of them. He said my eyes were being pulled down at the outer corners, He told me to try and stretch the skin and loosen the ends. I'm in a nightmare. I tape my eyes shut at night, and wear sunglasses during the day. My life is forever changed. Help?

Doctor Answers 9

Revision is definitely an option

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From photos alone, it is difficult to assess your problem. The movement of the eyelids is quite important as well, both passive [manipulation by the examiner] as well as active [blinking].

From the photo alone, the only thing that can be seen here is that your righ tlower eyelid is slightly drooping laterally [outside corner], and the left upper eyelid is slightly droopy [ptosis].

An examination by an experience ASOPRS trained Oculoplastics surgeon is your best bet. If you're not happy with your original surgeon, find another one on ASOPRS dot org.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Getting Worse 14 Months After Blepharoplasty, Is Revision an Option?

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 It appears and sounds like you have dry eye syndrome and should follow the instructions of the occuloplastic surgeon that eveluated you in person.  Lower Eyelid Surgery should be performed using the transconjunctival method without external skin removal when patients have weak lower eyelids.  Otherwise lower lid malposition can occur, tear ducts are displaced and the eyes dry out.  

Can a revision correct my eyes 14 months post blepharoplasty?

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Your situation needs a careful evaluation which starts with an examination. It is difficult to know what your problem is from a single photo. If your problem is related to dryness.  There are many procedures that could correct the lower eyelid position and improve your symptoms. These include canthoplasty, tarsal strip, or horizontal lid shortening depending on the clinical findings. Find a plastic surgeon with an interest in eyelid surgery.

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Getting Worse 14 Months After Blepharoplasty, Is Revision an Option?

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It sounds like you could benefit from treatment.  What that treatment is will depend on your examination.  You should seek furhter consultations from Oculoplastic surgeons to see what could be done. will help you locate Oculoplastic surgeons near you.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Dry eye after blepharoplasty surgery

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Your situation is complex and you cannot be fully assessed by just looking at your one frontal photo. I assume your complaints are sun sensitivity and inability to fully close your eyes at night while sleeping. The question then is is the problem due only to the upper eyelids, only the lower eyelids or both. From the photos it is unclear that too much eyelid skin was removed. You may have had a pre-surgical condition (such as lack of lower eyelid support) that contributed to this as it was not accounted for in planning the surgery. The outer corners of your eyes are lower than the inner corners. On the right side this is even greater and consequently the lower eyelid edge lies lower on that side. You may have horizontal lower eyelid laxity. No amount of eyelid massage will change that architecture without surgery.

Taping alone may be insufficient and you may need to add a long lasting lubricant such as lacrilube at night in order to alleviate some of the symptoms. It is possible that most of your problems are due to corneal exposure while sleeping.

You will need to see a few surgeons in order to decide how to proceed. You should get copies of your medical records including before surgery photos, before surgery physical examination and operative report to bring to your consultations so the surgeon can fully assess your situation. There is even the possibility that you had a canthal procedure that is the root cause of the current situation.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Problems following blepharoplasty

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i agree the additional surgery may be of benefit.   if the skin is loose enough.. a canthoplasty can lift and tighten the corner of the eye.

a cheek lift may be of benefit to take the weight of the cheek off of the lower lid.

if the skin is tight or the lid tight inside   then a spacer can be used to release the tissue..  there are still many options

Lower eyelid revision can help a lot

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Jill: Your photo shows us several interesting post surgery features. The sun bothers you and that may be hard to correct. Sun glasses and face foundation that absorbs rather than reflects light might help.The dry eyes may persist but I see enough down pull of the lower eyelids that should be able to be corrected with surgery that may very well correct the dryness. A procedure called a "canthoplasty" is straight forward enough to do if you have the right surgeon and this will lift up and tighten the lower eye lids and give more eye ball coverage and protection. If the dryness is due to under production of tears then you may still need artificial tears but you would probably have noticed dry eyes before your surgery in this case. I think the canthoplasty surgery is indicated and you should talk with someone who is competent in doing that operation. For some reason your upper lids still look swollen or edematous. That usually just goes away with in 3-6 months after surgery. You have some droop (ptosis) to your left (not your right) upper eye lid.........forget it as it is a non player in your symptoms and hardly of any importance in your facial esthetics. I must say that I would strongly avoid having any Botox or fillers as there is no reason for them and they may make things worse.

Harlow Hollis, MD
Victoria Plastic Surgeon

Getting worse 14 months after blepharoplasty

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  It is always good to get additional opinions.  For example, I am a fully trained, oculo-facial plastic surgeon and member of ASOPRS, and I have almost 30 years of clinical experience, and yet I disagree with a lot of what Dr. Steinsapir wrote.  I certainly do believe that there is help available to you and that eyelid revision may provide you with significant symptom relief.  Please let me know if I can be of further assistance.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 138 reviews

These are very complex situations.

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You have the right idea on seeking second opinions.  What you have is a very typical eyelid result.  Too much skin appears to have been removed from the upper eyelids and the right upper eyelid is ptotic.  The lower eyelids are pulled down as a consequence of the transcutaneous lower blepharoplasty.  The orbicularis muscle that should function as a sling to hold up the lower eyelid has had its motor nerves injured when the lower eyelid incision cut these nerves.  This caused the actual lower eyelid edge to roll out which helps to give the lower eyelid an abnormal appearance.  Stretch back from the lower eyelid incision has pulled the outer corner of the eyelids in shortening the horizontal width of the eyelid aperture.  Unrelated to your surgery, the right eye sits lower in your facial skeleton but this asymmetry contributes to you post surgical appearance.  Further, your eyebrows have relaxed down as a result of the upper eyelid surgery.  The lower eyelids are irregular with under eye hollowness and the is a small bit of fullness under the left lower eyelid that is consistent with a small knuckle of fat.

I have not had the opportunity to examine you.  However, I don't think the recommended eyelid message will accomplish much.  Please be careful if surgeons propose tightening the lower eyelids.  This will not necessarily correct the changes you are seeing.  I think a lot could be done for you with BOTOX and carefully done fillers.  The key is finding the right eyelid surgeon.  Unfortunately, this type of corrective work can be expensive.  The first goal should be to determine what is going on with the tearing and if you have chronic corneal exposure as a result of the eyelid surgery.  Consider getting more than one opinion from fellowship trained oculoplastic surgeons.  The American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a website with a geographic directory of surgeons ( asoprs dot org).

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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.