Should I ask for revision? (Photo)

Question

6 months out from bilateral lower Bleph. I have graves eye disease. Cut was on the outside and extended past the corners of my eyes. I fsoon and he is open to revisions if I like - I just am not sure what to ask for? Things seem “off” - but I’m not sure how to pinpoint it. Surgery was complicated by ocular rosacea afterwards that I’m still treating.

Gary M. Horndeski, MD · Answer

You may benefit from a bilateral canthopexy to correct the lateral position of the lower eyelids.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

It is too early for any surgical revision. In the meantime stretching of the eyelids in upward direction over the globes and over-night taping in stretched position may help. I would suggest waiting at least 1 year before considering surgical revision, if needed. Good luck.

Ryan Endress, MD · Answer

It would be helpful, of course, to see preoperative photos for comparison, but it does appear that you have a rounding of the lateral part of your lower lids, which generally means you would benefit from a canthoplasty to reshape and tighten the lid. This will give you a much more natural and youthful appearance.

Kenneth D. Steinsapir, MD · Answer

When did your Grave's develop? What did you look like before you had surgery. In this photo, you are looking down so it is challenging to know precisely what your concerns are. You looking like you have upper eyelid retraction in this photo but that may be related to your looking down in this photo. Upper eyelid retraction would have nothing to do with a lower blepharoplasty. I recommend being more specific about your concerns and post a photograph that shows you looking straight ahead. If your new concerns are related to the Graves' disease, you should see an oculoplastic surgeon who manages thyroid eye disease. There is no substitute for a detailed in person assessment.

Mats Hagstrom, MD (license on probation) · Answer

To make a good assessment we need to see before and after pictures. 
Ask your provider to forward the pictures they took. 
It looks like your surgeon removed skin and possibly some of the orbiculsris muscle. Doing this can pull the eyelid down and or cause it to turn outwards. This is typically called an ectropion. The condition is difficult to correct. It’s usually done with a canthoplasty or canthopexy. 
If your surgeon created the problem then they are unlikely the person to correct it. In other words if they did not have the skill to do the lower bleph without causing an exctropion then they probably don’t have the skill to correct the complication considering the revision procedure is substantially more complex and difficult. 
I suggest you have a few consultations with senior oculoplastic surgeons in your area. Bring your before and after picture to the consultation. You should also ask your current provider to forward a copy of your operative report. This just like all pictures taken are part of your medical record which you have a right to get a copy of. Bring a copy of your operative report to the consults as well so the next surgeon will understand what was done during your first surgery. 
During your second opinion consultation ask each provider to show you their entire collection of before and after pictures of previous patients who are the same lower eyelid condition.
This is why you need pictures of yourself to use as reference.
Highly experienced oculoplastic surgeon should have access to 100s before and after pictures of the previous patients who had ectropion correction surgery. 
You should ask them to show you examples of previous patients who had the same outcome from previous lower eyelid blepharoplasty surgery, not done correctly.
I’m making some assumptions here because you did not include proper before and after pictures which is necessary in order for us to make quality assessment.
You definitely don’t want somebody to remove more skin or do surgery that’s not going to correct the problem.
Any attempt at correcting your outcome can make things worse.
Finding the right provider is now absolutely critical.
To do that you may have to have several consultations to find the most talented and experienced oculoplastic surgeon.
Best,
Mats Hagström MD

Should I ask for revision? (Photo)

Answers (5)

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