My husband had a secondary lower blepharoplasty to repair slight ectropian nearly 4 weeks ago and is very concerned about the outcome. He has been performing the required exercises, yet his lower lids are now very slack and red. He is 75. He has been prescribed cortisone drops which help temporarily. Is this any cause for concern and if so, what is the treatment and how soon should it be addressed?
1 Month Post Lower Blepharoplasty: Concerns
Doctor Answers 12
Ectropion following eyelid surgery
Your husband still has ectropion of both lower eyelids. Although 4 weeks postoperatively is not a sufficient length of time to judge the results, I am concerned that with the amount of ectropion evident on the photo and his symptoms the problem may not resolve by itself. Blepharoplasty is not a procedure to treat the ectropion, unless you are mistaking it for ectropion repair. In any case, I would suggest a consultation with an occuloplastic surgeon sooner rather than later. In many instances, it is better to perform a revision procedure sooner, before more scarring and eyelid pulling took place.
First, an ectropian is not easy to fix. You will need a Board Certified Plastic Surgeon who specializes in eyes, and ectropians. An Oculoplastic can also assist in this provided they are familiar with ectropian repairs and blepharoplasty issues.
There are many factors at play here: scarring from the initial surgery [blepharoplasty??], inflammation/scarring from the most current surgery, and pre-existing sun-damaged skin.
Often, an exuberant scarring response can be mitigated by steroid injections. In addition, massage can be used to help soften scar.
I would highly warn against repeat surgery too soon. Waiting at least 3 months and often longer will allow scar to soften and the situation to improve spontaneously. Your husband will likely need additional surgery [possible skin grafting], but being impatient and operating too soon will be counterproductive.
Excellent oculoplastic surgeons in Australia include Drs Sullivan, Dinesh, Gabriel, among others.
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The photos do show that the lower eyelid is rolled away from the eye (ectropion), but the photo also shows the lower lids to be quite swollen.
The urgent consideration is protection of the eye, preventing corneal dryness and ulceration:
- frequent use of artificial tears
- use a humidifier
- moist compresses can be soothing
- night time eye drops
- taping of the lower eyelid
- evaluation and monitoring by your ophthalmologist
Massage (lymphatic drainage) techniques can be very helpful.
Taping can help by supporting the lid for better protection of the eye and even to reduce the swelling in the eyelid.
If the eye has adequate protection, it would be wise to postpone any further surgical intervention until swelling decreases.
1 Month Post Lower Blepharoplasty: Concerns
Unfortunately there is still ectropion issue bilaterally. Allow 3 months for healing than seek a revision including lateral canthal fixation and possible skin grafting.
Cause for concern?
I agree with Dr. Bray; 4 weeks post op is too soon to tell, especially when there is as much inflammatory response as there is in the eyelid skin- time will allow healing and softening of the tissues and you will have a better idea whether or not a revision surgery will be necessary. I also agree that you should be evaluated for corneal dry eye now. You may ultimately need correction, but I would not recommend surgery until your tissues have fully healed. Good luck!
Post op 1 month with recurrent ectropion
to echo some of the comments made. lower lid blepharoplasty does not correct ectropion, it makes it worse. at this point there is moderate to severe bilateral cicatricial ectropion with evidence of conjunctival injection (redness), horizontal laxity and possible corneal dryness. First, stop steroid drops until an opthomologist can confirm you are not creating corneal problems, then help protect the corneas with lubricating drops, ointments and apply a moisture tent (plastic wrap over the eyes) at night. second continue massage to keep tissue as supple as possible, consider temporary tarsorraphy suture to support lower lid (only if lid can be easily placed into good position with a finger, otherwise it will only make things worse) and ultimately I fear skin grafts will be required. Flaps are possible but the surrounding tissue appears thin, damaged and in short supply. good luck, remember everything can be fixed but it won't matter if you can't see. protect the cornea from exposure.
Various causes for ectropion
Your husband appears from the picture to have a true ectropion. If this occurred after his first blepharoplasty, it is possible that too much skin was removed. If that were the case, he might have needed a skin graft at the second operation. Given his age, he may also have a degree of senile ectropion, which would require an additional procedure to correct the horizontal laxity of the eyelid. We don't know exactly what was done at the second operation, so it is difficult to say what is needed. A plastic surgeon with an interest in and experience treating these problems should be able to help out; as would an oculoplastic surgeon.
Ectroprion after eyelid surgery
IMHO, the photos show continued ectropion after the lower eyelid surgery and you might consider a second opinion with an occuloplastic surgeon near you. Good luck and hope this helps.
Yes, he has bilateral ectropion.
Lower blepharoplasty is not a fix for lower ectropion. No lid exercises will fix this. Repairing this can be quite complicated. Skin grafts can be used but the result is not cosmetically ideal. I recommend that he first see his ophthalmologist to determine if the lower eyelid position is causing drying of the corneal surface. The ophthalmologist will be able to refer him to the appropriate oculoplastic surgeon. Fortunately, Australia has a number of excellent oculoplastic surgeons.
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