Stitch Eyelids to Eyebrow to Fix Ectropion After Eyelid Surgery?

Question

I need to have a second surgery because my first eyelid surgery did not go well. I  have ectropion in one eye. My doctor wants to perform a procedure that he invented. He wants to stitch my eye to my eyebrow shut for over a week. If this works it will be great, but won't this make it worse and create many new scars? Has anyone heard of this procedure? What other options are there for me?

Kenneth D. Steinsapir, MD · Answer

Hi Eric
This is now the third email of yours I've answered. You should know that in addressing vertically compromised lower eyelids, it is approriate to use a variety of techniques to improve the lower eyelid position. This includes removal of lower eyelid scar tissue, placement of hard palate graft, orbital rim implants, etc. 
Suturing the eyelid in place is like casting the eyelids so they don't move while the tissue heals. However, you indicated that surgery was only 4 months ago. It is entirely appropriate to wait until you are 6 to 12 months out from surgery to permit the wounds to full heal and mature.

William Portuese, MD · Answer

It is best to address the underlying cause of the ectropion and not just hold the eyelid up for a temporary position. This will only create new scarring, and it is best to undergo a routine ectropion repair by releasing the scar tissue that is causing it.

Robert Schwarcz, MD · Answer

Eric,
Ectropion might be a genaralization for what is happening to your lower eyelid.  More than likely, scar will be  released, occasionally the midface is brought up for support, and a spacer graft (like tissue from the roof of your mouth) can be used to provide vertical archtecture to your lower eyelid.  At the end of the case to allow healing in a smooth plane a FROST stitch is placed sewing the lower eyelid to the brow.  That is the last part of the procedure. 
good luck
Dr.schwarcz

J. Timothy Heffernan, MD · Answer

Repair of ectropion after blepharoplasty can be challenging. As with most things preventing the problem in the first place is advantageous over any form of repair. Fortunately, many standard techniques have been developed to repair this problem. This would depend upon the cause of your particular difficulty. The causes include excess skin removal, excess postop swelling and inflammation, inappropriate applying of cold compresses after surgery.
The standard technique is to release the lateral canthus and re-suture it its normal anatomical position. Very seldom are more invasive procedures such as skin grafts needed. Another important point is that early repair is better than late repair. If your physician identifies this problem earlier on, attention to the difficulty in the first few weeks is much easier than later.
I wish you all the luck.

Peter A. Aldea, MD · Answer

Eric,
This is I believe your second posting on this website and like others of my colleagues I think it is safe to say we are getting an uneasy feeling reading your posts.
In your previous post, you were advised to best wait 5-6 months or so until the swelling subsided and the eyelid tissues became supple and handled normally again.
A successful ectropion repair depends on correction of THE CAUSE of the ectropion be it scar, looseness or muscle paralysis. With either removal of too much skin and or scar pulling your lid down and away from the globe, the lower lid scar needs to be interrupted and removed while a SPACER needs to be placed under the lower lid cartilage stiffener to keep it up and against the globe. Such graft spacers can come from multiple sources (including the roof of your mouth) and span the space from the rim of the orbit to the bottom of the lower tarsal plate.
Unless your surgeon's name is Dr. Frost and he is a VERY old man, odds are he is NOT the inventor of the suspensory suture keeping the lower lid lifted while preventing scarring from pulling the lid down again. This has been used in eyelid surgery for MANY years.
your best bet - again - is to wait more than 3.5 months for the eyelid to mature and then be seen by SEVERAL surgeons who specialize in eyelid surgery. Do NOT jump into this.
Good Luck.

Steven Wallach, MD · Answer

Ectropion surgery is performed for a tight lower lid. This usually requires a skin graft and/or space graft as well as either a canthopexy or canthoplasty. Many surgeons either tape the eye or palce a Frost suture that is suspended to the eyebrow for support during the early healing process.

Robin T.W. Yuan, MD · Answer

Treatment of ectropion can be a difficult venture. The ectropion can be a cosmetic issue with asymmetry and lower position of the lower eyelid with resulting excessive showing of the sclera on that side. Or, it can be a medical issue with exposure of the cornea and sclera casuing abrasions, ulcerations, and infections. Some ectropion will improve over time if it is scarring problem and the scarring will soften and loosen with time. Suturing the lower eyelid to the upper eyelid (not usually the brow) can be a temporary measure to reduce the corneal exposure (Frost stitch) . The surgeon can also fuse the corner of the upper eyelid wit the corner of the lower eyelid for more long term treatment but this also may distort the appearance of your eyelids and produce asymmetry.(lateral tarsorrhaphy). Severe ectropion caused be actual shortage of tissue or severe, unrelenting scarring needs more aggressive surgical procedures. You need a good evaluation and analysis of your situation.

Marc Cohen, MD (retired) · Answer

Stitching the lower eyelid to the eyebrow is only part of the operation.  Most likely the surgeon plans on removing scar tissue from your lower eyelids, and possibly placing tissue from elsewhere in your body into your eyelid as a spacer.
The stitches to your brow are used to hold the eyelid in the correct position until some of the healing has occurred.  Think of it like a cast for a broken bone.

Stitch Eyelids to Eyebrow to Fix Ectropion After Eyelid Surgery?

Answers (8)

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