Several Concerns After Transcutaneous Lower Blepharoplasty (One Month Ago)

It amazes me that surgeons have so much trouble learning from the past.  Yes, the paradigm that the majority of transcutaneous lower eyelid surgery is based on is wrong.  It if not per se the fault of your surgeon.  Most likely he or she is a general plastic surgoen who carefully follows the plastic surgery literature which supports this surgical approach.  Denial is not just a river in Africa.  Very important and influential papers encourage surgeon to perform transcutaneous lower blepharoplasty but the anatomic descriptions in these papers are not correct.  A large percentage of patients continue to have complications with this surgical approach.  Your fundemental problem is denervation of the orbicularis oculi muscle at the lower eyelid margin.  Yes you have scaring but the loss of motor function I believe is just as important a factor in the bowing and lateral scleral show exhibited by your eyes.  Over the course of the next 11 months, some of this appearance will often improve and the infracilliary scar will improve.  If the result is not satisfactory, simply performing a "tuck" or putting a stitch in the corner of the eyelid (euphemistic ways surgeons term lateral canthal reconstructions) will not help.  Steroid injections now will only damage the eyelid tissue so don't accept these treatments if offered.  Finger winking can be helpful to put these tissues on slight stretch each day.  More definitive reconstruction methods are generally needed.  I am also impressed with your upper eyelid ptosis.  If you have dry eye symptoms from the lower eyelid compromise, consider working with your ophthalmologist on this issue.

You have lateral scleral show which means there is scar formation in the underlying tissue which is contracting and pulling the outer aspect of the lid downward. This may be temporary as sometimes this will improve as the muscle function recovers.  This retraction of the lid is also less common with transconjunctival but can occur with them as well. Although I now use a new lateral access technique, I still will do the open technique on patients with advanced problems and if this occurs I will inject kenalog diffusely in tiny amounts directly into the area which is contracting and will put the patient on a series of stretching exercises which has worked well. If you get to to three months out and there is no improvement you will require a secondary procedure for correction. Hang in there.