I Have Dry Eye After Lower Blepharoplasty, is Laser Resurfacing for Wrinkles Too Risky?

If your dry eyes after blepharoplasty are caused by the eyelid not hugging the eye and allowing tears to not bathe the surface of the eye's cornea, then any treatment to the skin of the eyelid, laser or chemical peel,  to improve the wrinkles could worsen this problem.  Sometimes oculoplastic or plastic surgeons will do a tightening procedure, such as a canthopexy, to lift and anchor the lower eyelid up against the eye. Then after this heals and proves to be successful, laser resurfacing can be done. It would be wise to seek consultation with an ophthalmologist or better yet, an oculoplastic surgeon, before considering the resurfacing.

It might be well worth your time to have your lower eyelids and ocular surfaces evaluated by an oculoplastic surgeon prior to undergoing any additional eyelid treatments.  Alternatively,  almost all ophthalmologist are well versed in evaluating and treating patients with dry eyes.

Once a patient's dry eyes are optimized, consideration can be given for laser resurfacing of the lower eyelids.  In patients who have significant dry eye symptoms,  I would favor a fractional treatment rather than a fully ablative one.  Fractional treatments  (CO2 or Erbium) are usually done as a series with incremental improvement over time.  With this approach, there is the opportunity to experience one treatment and wait 6 weeks to several months before going forward with additional treatments.

Best wishes,

Mark Lucarelli, MD, FACS

Madison, WI

 

 

A full examination by a highly specialized surgeon who performs these procedures all the time is first and most important step.  The CO2 laser can be performed to improve the skin under the eyes without worsening the dryness but it has to be done carefully.  The exam may reveal that the eyelid needs to be tightened or lifted to improve dryness, and this could be done in combination with some laser. 

If you have dry eye after a lower eyelid procedure, you should have that evaluated by an oculplastic surgeon, facial plastic surgeon, or plastic surgeon that specializes in this.  Drooping of the lower lid is called "ectropion" and this is often treatable to improve your dry eye condition  You should only consider laser under the eyes after your dry eye condition is optimized or improved.

Laser treatment can cause the lower eyelids to draw down even further as the skin tightens, so you would want to make sure any drooping of the lower lid is corrected first.

I would recommend changing your priorities - treat the dry eye (or ectropion) first, then consider laser for additional treatment only if recommended by a specialist that feels comfortable the laser treatment won't make the dry eye worse.

Best of luck, please let me know if you have any additional questions!

Lower lid blepharoplasty if done properly including canthoplasty (tightening the lid) may actually improve pre existing dry eyes. However, in a few cases the surgery itself can interfere with tear flow and actually cause dry eyes when one did not exist before. Unfortunately this is not alwasy predictable. Once you have developed dry eyes doing laser resurfacing poses a new risk: if not done very carefully it could tighten the lower lid skin to the point to cause a downword shift of the lid margin thus exposing more of your eye and making the dryness potenitally worse. As always go to experienced surgeons/cosmetic dermatologists.