Lower Eyelid Pulling Down After Cheek Lift and Eyelid Surgery

Question

I had Cheek Lift with repositioning of my cheek fat and a Blepharoplasty 3 weeks ago. My right lower eyelid is still pulling down. I'm afraid it won't go back up. What can be done about this?

Kenneth D. Steinsapir, MD · Answer

Dear M
Unfortunately, this combination of procedures humbles many a midface surgeon. Generally the biggest issue is a failure to understand how lack of cheek projection affects lower eyelid support.
Lifting up the cheek fat places a downward pull on the eyelid tissues and this can cause the lid contour to be disturbed after surgery. Unfortunately, there is no simple fix to this problem. I would encourage you to discuss your concerns with your surgeon but you may or may not get a satisfactory response. I would be careful regarding rushing to fix the issue. You are likely to need a definitive reconstructive surgery to address the problem. Having small revisional surgeries that don't full fix the problem are emotionally taxing and create even more scar tissue that can compromise the ultimate outcome.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Paul Vitenas, Jr., MD · Answer

If your eyelid is pulling down after eylid surgery then massage on the lower lid from medial to lateral is indicated. If it persist then consult your surgeon or an oculoplastic surgeon for definitive treatment.

Anil R. Shah, MD · Answer

Keeping the lower eye in position is of critical importance for aesthetic purposes as well as functional purposes.  In an eyelid which is pulled down, the eye can be exposed, leading to dryness of the eye, abrasions, and other issues with the function of the eye.

	Myself and a colleague have written an article on the preservation of eyelid position and its importance, as well as a technique we have found effective for specific situations.

Frank P. Fechner, MD · Answer

Did you have the cheek lift through a lower eyelid incision?
Or did you have a cheek lift using incisions within the temporal hair together with a lower blepharoplasty?
In these two situations, you may have a higher risk with prolonged lower lid retraction. Usually, this will improve (or normalize) spontaneously with time.
If you did not have any of the above procedures or procedure combinations, most likely the problem will limited in time. You should lubricate your eyes and follow the care instructions of your plastic surgeon. Close follow up with your doctor is key!

Toby Mayer, MD · Answer

See your doctor and discuss this with him. Very often after a cheek lift there is swelling of the lining of the eyelid causing it to look pulled down. This will go away after several weeks. If too much pull was exerted on the cheek, that can be another cause: time will tell. Eye drops will help the swelling of the lining.

Eric M. Joseph, MD · Answer

If your lower eyelid is pulled down after surgery, this can be very uncomfortable. It can also lead to dry eye, and chronic irritation.
If you're eye feels dry or uncomfortable then start using lubricating eye drops. You could also consult a board-certified ophthalmologist for specific advice.
If you're not pleased with the response of your surgeon, then consider consulting a board certified oculoplastic surgeon for a second opinion.
I hope this is helpful, and best regards.

Paul S. Howard, MD · Answer

Without any further information I'm going to assume you had a "vertical transblepharoplasty midface lift". This operation, while theoretically a good idea, has shown to be disaster in many cases because the entire success of the procedure depends on a very aggressive tightening and suspension of the lower eyelid. Only a very few surgeons have been able to achieve a good result because of this problem. In fact, at three weeks the lower lid should be over corrected meaning your problem will probably get worse. Your primary concern at this point should be the protection of your eyes from exposure and dryness. You should see your surgeon as he/she probably has experience with these problems if still performing this operation.

Sam Goldberger, MD · Answer

If your right lower eyelid is pulling down after 3 weeks, then it probably won't come back up by itself. You need to see an oculoplastic specialist who can evaluate your problem, and then give you the best approach for repositioning the eyelid. I would make sure that the surgeon who repairs the eyelid has a lot of experience doing this because the more procedures you have done for a pulled down eyelid, the harder it is to get a good final result..

Lower Eyelid Pulling Down After Cheek Lift and Eyelid Surgery

Answers (9)

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