Lower eyelid droop 3 weeks post quad blepharoplasty (Photos)

At this point, it is best to 1) do squinting exercises; 2) massage your lower eyelids upwards; 3) use lubricating eye drops, for about 3 months after surgery to allow healing. If there is still lower eyelid ectropion/retraction at that time, see an oculoplastic surgeon for possible revision surgery.

While it is not uncommon after a quad blepharoplasty to have some mild degree of lower lid retraction, you definitely need to have your surgeon follow this to make sure that it improves over the next few weeks.  We ask our patients to begin light lymphatic massage by applying a single finger with pressure to the lower lid and massaging the lower eyelid skin laterally and upwards to help milk out some of the swelling.  When performed for a few minutes 4-5 times per day, this can often be extremely helpful in speeding up recovery of the lower lid and effectively allowing this lid to "stick down" as it did before surgery.  I hope that helps and wish you the very best.  

Hello not30anymore - Thanks for your question. I'm sorry for your troubles. Unfortunately what you are experiencing occurs on a regular basis. It could be due to swelling, poor lid support, and/or too much skin removal. I'm not sure what was done during your surgery but I see the properly performed sub ciliary incision. You have some mild lid lag at this point. It might benefit you to perform night time vertical taping to taking gravitational tension off the outer part of each lid. If this doesn't fix the problem, you will need a lid suspension procedure. Time and patience are necessary at this point.  Good luck, Dr. Shah

I do not think for a minute that your issues will resolve with more time.  However, it is too early for surgical intervention and you may or may not ultimately choose to have the complex surgery needed to revise this type of an eyelid.  You started out with a negative vector eyelid and a downward tilt of the lower eyelids.  Surgery has foreseeable cause an issue with these.  However, time can soften some of these changes.  If you are having eye irritation and discomfort, get help from your ophthalmologist.  It is reasonable to get a second opinion if you feel your relationship with your surgeon has broken down.  Generally these types of issues are not surgically managed for at least 6 months.  However, you could get a second opinion consultation at anytime.

3 weeks after surgery, your eyelids likely still have healing to do. Eyelid retraction usually resolves with time. At this point, we recommend to our patients gentle upward cheek massage, eye lubrication with ointment at night and drops during the day and the tincture of time. If you would like a second opinion, I recommend an oculoplastic surgeon who specializes in eyelid surgery. Hope this helps.

 I think the best advice you've been given so far was from Dr. Taban.   It's never a bad idea to get a second opinion especially if you're worried. I would get a second opinion from an oculoplastic surgeon or facial plastic surgeon.    Lower eyelid retraction can occur after lower eyelid blepharoplasty and it can be a permanent issue in some cases. Follow the directions  Dr Taban  and I would also consider injections with Kenalog mixed with 5-FU  if you don't see signs of improvement over the next week or two. Follow up closely with your surgeon. There's a very good chance you're just fine but make sure you are monitored. Chase Lay MD

It appears from the photos that you had skin incisions on the lower eyelids.  This can weaken them for a while such that they don't stay firmly up against the globe (eye) surface.  With time and the orbicularis muscle strength coming back, the lower eyelids can sometimes raise back up on their own.  Weakening of the orbicularis is higher when both the upper and lower eyelids were operated upon with external skin excisions.  I would suggest warm compresses and following your surgeon's recommendations.  Massage to the area I think also promotes healing and can help the incisions not become too hard (hypertrophic).  Topical or injection steroids and/or a substance called 5 FU can help the incisions not harden, which can worsen the situation.  If the eyelids fail to come back up as you wish they can be raised sometimes just with a lateral canthal (eyelid outer corner) resuspension.  Other times a cheek lift is also needed to help maintain support, and very rarely skin grafting.  Don't give up, and remain in touch with your surgeon, who knows your situation best.  When needed, I have many times helped other surgeons and patients when the unfortunate situation of long-term ectropion/retraction ("Drooping") of the lower eyelids becomes permanent with revision surgery.  Best regards.

With  current modern lower eyelid techniques, especially with someone your age, it would be very unlikely to ever have this issue be permanent. We sometimes see this from postop swelling that may take several weeks, even a couple of months, to resolve, when the transconjunctival technique was used and should resolve completely. If you still have this problem two or three months from now, you need to see someone, and probably a different    Dr. than the one who did the surgery. 

Sorry to hear that you are having some post-op issues. In your photos, it appears that you do have some gapping and lower position of the lower eyelids. You are right to be concerned about the position of your lower eyelids. However, you do still have quite a bit of swelling in your lids.Discuss with your surgeon taping of your lower eyelids to provide better support and position until the swelling subsides.Also ask your surgeon about lymphatic drainage massage to help reduce swelling in the lids.A second opinion is certainly an option, but maintain good communication with your primary surgeon.