How to Fix Bad Results from Blepharoplasty?

Question

I had my lower eye lids done. They are so bad, they hang out and too much skin was taken out. You can see the inside of my eye ball and I have to keep putting drops on them. I still have bags.

	They look so bad, I can't go out. What can be done to fix them? It looks like the surgeon just cut all my skin off. I can't stand it! They hurt and my eyes want close all the way. The bottom lids go over the top and stick. I'm very worried.

David Shafer, MD, FACS · Answer

You unfortunately have issues which cannot be ignored and likely will not resolve with conservative (watchful waiting) measures. You should see an expert evaluation with a plastic or oculoplastic surgeon very soon. In the mean time, be sure the keep your eyes moist with drops or ointment to help prevent any damage. Good luck.

Kenneth D. Steinsapir, MD · Answer

Dear Mollie
Just about any surgeon who performs facial cosmetic surgery offers routine cosmetic eyelid surgery.  However, fixing routine cosmetic eyelid surgery after it goes bad is a whole other matter.  Aesthetically fixing your lower eyelids so that they sit against the eyes, function properly, and look right involves significant reconstructive surgery.  I am not aware of any general plastic or facial plastic surgeons who can perform this type of work.  Finding an oculoplastic surgeon who performs this type of work is also challenging due to the exotic nature of the reconstruction you require.  Therefore, it is likely that you will need to travel to find a surgeon who can provide a satisfactory reconstruction for your eyes.  
I encourage you to look at my website: lidlift.com.  I have specific pages discussing this type of eyelid reconstructive surgery.  Look at www.lidlift.com/fixing/  and also www.lidlift.com/midface/ .  There pages have detailed descriptions of how these repairs are approached together with before and after photographs.
There is no substitute for a personal consultation.  In brief, I believe that you need a lower eyelid reconstruction that also included a vertical advancement of the midface over a hand carved ePTFE orbital rim implant.  This will recruit cheek skin into the lower eyelid.  This replaces the skin that was over resected by your prior eyelid surgery.  The rim implant serves as a felting material to hold the cheek in place.  The lower eyelid needs to be vertically and horizontally lengthened.  Tissue from the roof of the mouth is used for this purpose.  This is called a hard palate graft.  This is sewn behind the lower eyelid to avoid placement of an unsightly skin graft.  The reconstructed lower eyelid is then sewn closed for about a week.  The surgery is done in stages for this reason with each lower eyelid reconstructed about one week apart.  You can see for yourself from my website that these methods can reconstruct very significant post belpharoplasty abnormalities.

William Portuese, MD · Answer

It is important to wait several months to ensure that the swelling has indeed subsided after the upper and lower blepharoplasty has been performed. Continue to use drops during the daytime and Lacri-Lube ointment at night to prevent a drying of the cornea. Follow up with your surgeon or an oculoplastic surgeon can address these issues for you.

Hisham Seify, MD, PhD, FACS · Answer

It can be fixed, as previously expressed in this forum. You have lower lid malposition following lower blepharoplasty. This is not an uncommon condition, but the full blown ectropion is rare. You will need an examination by a plastic surgeon with occuloplastic training or an occuloplastic surgeon.Repair of your lower lids wih canthal support and possibly reconstruction. I would not worry; just have a good advice and a good surgical plan. It could be fixed.

Christopher L. Hess, MD · Answer

Unfortunately, in an effort to make a "home run" result many surgeons take too much skin which leads to ectropion.  However, mild ectropion can occur after surgery even when the correct amount of skin is removed.
Not knowing how long ago surgery was makes this somewhat difficult but I'll give it a shot.  First you're doing everything right by using the drops.  Next you should be taping the eyes closed at night and using an ointment to keep them moist.  Third you should be massaging the lids in a superior direction.
Now the hard part.  If you're several months out the only thing that's going to help is surgical correction.  I would recommend a mid-face lift with lower lid canthopexy after release of the scar tissue.  If this doesn't work than unfortunately the only answer is to add skin bad by grafting it.  Usually the skin is taken from the upper lids.
You need to see a surgeon who understands this problem.

Scott E. Kasden, MD, FACS · Answer

You not only have a cosmetic situation, your eyes are at risk.
 
To start with, you need to keep them moist with ointmant and drops.  Taping may help too.  I am not sure if too much skin was removed or other structures were injured, or you have residual swelling- much depends on the time from surgery.  
You need to discuss your concerns and exam with your doctor.  Depending on timing from surgery, you may need to discuss surgical options.  If further surgery is needed, I recommend that you ensure that you are in the hands of an eyelid specialist who feels comfortable with this problem.  
It can be improved, but proceed with caution, and don't rush into surgery.

Stella Desyatnikova, MD · Answer

Unfortunately, it looks like you got a big problem. It will not get better by itself,and it will not be easy to fix, but it should be possible. You need to see an oculoplastic surgeon, well versed and experienced in lower lid repair techniques. You might want to see more than one surgeon for a consultation to discuss your options. You will get much more information than any of us can give you over the internet.

Mark Berkowitz, MD · Answer

I am sorry to learn of the difficult y you are having after eyelid surgery. First and foremost, speak with your surgeon about alleviating the problem.
Until it is corrected, it is important that you lubricate your eyes with artificial tear drops and lubricants. Depending upon the timing since surgery this may improve with conservative measures like massage. If massage does not help improvement you may need further corrective surgery to allow the lids to go back to their normal position.  This may be a combination of skin and eyelid grafts, lower eyelid tightening and mid face cheek lifting.
Your eyes need to be evaluated by an ophthalmologist to make sure that the cornea is not affected. An ocular plastic surgeon, who specializes in the eye and eyelid area will be your best resource at this time after you speak with your own physician.

Robin T.W. Yuan, MD · Answer

It seems your diagnosis is fairly accurate although sometimes healing is abnormal despite good surgery. Depending on when you had your surgery, you need to see an experienced and reputable plastic or oculoplastic surgeon sooner than later. If the surgery is recent, temporary measures may be advisable to prevent further distortion of the lid due to scarring and contracture. Sometimes a stitch or a surgery needs to be performed at t he corner of the eyelids to temporarily close the eyelids to prevent drying out and injury to the cornea. If the surgery was a while ago and you have been living with this ectropion, or turning out of the lower eyelids, it might be time to commit to a reconstructive procedure. This is dependent on a careful examination to determine the nature of your anatomical problem. Sometimes it will require a skin graft when the skin is too tight. Sometime it will require a cartilage graft to prop up the eyelid. Sometimes it is a problem with lack of hard structure support under the eyelid that requires a special cheek implant. Or, it can be a complex combination of all of these remedies. You should not have to suffer with this result and need to seek experienced surgical help. Go seek a second or third opinion.

Brooke R. Seckel, MD, FACS (retired) · Answer

The picture shows that your lids are pulled down and away from your lower eyelids which is what we call an ectropion. Although this condition may improve with time if you are in your first month of recovery, it is a serious condition because of the risk of dryness to the eye.
It is essential that you be closely followed by the doctor who did your surgery. Keeping the eyes moist with eye ointment and drops is essential.
If you are early in your recovery-3-4 weeks your doctor may decide to place a small stitch in the corner of your eyelids to help pull the lower lids up and closer to the eye.
This is called a temporary tarsorraphy and can be very important to protect the eye and help stretch the lower eyelid as it heals.
If the ectropion persists after 6 weeks or if the eye moisture cannot be adequately maintained and the eye protected you may need a permanent reconstructive procedure.
Hopefully as the swelling goes down your lower lids will recover and the ectropion which is visible now, and exaggerated by the upward gaze in your photo will have greatly improved

How to Fix Bad Results from Blepharoplasty?

Answers (10)

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