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

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 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

 

 

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.

I have performed Co2 fractional laser resurfacing on several patients who started with complaint of dry eyes and have also had tear duct plugs placed for treatment of dry eye. It is hard to tell with out a photograph what procedure would be best for your situation. You mention the dry eye occured post blepharoplasty and without a photograph it is difficult to determine if this is from lack of your eyes having full closure,or if too much skin was removed and you have scleral show, or if something else is the cause of the dry eye. If you have proper closure the laser should be fine to remove the wrinkles around the eyes and not further aggravate the situation. Post laser you would be advised to use a good lubricating ointment and drops during the recovery phase. My wife suffers from dry eye on her left side and I performed a full face CO2 resurfacing on her four days ago and she has had no agitation or complication from the laser. A thorough evaluation during your consultation and a understanding of your history and post surgeries will allow a surgeon to advise you of your options. A few opinions would not be a bad idea! Best regards!

Ablative lasers may make the eyes more dry, and it may not improve the wrinkles if you have excess skin.  In fact, a lower lid blepharoplasty may, on occasion, improve the dryness and wrinkles, if it is accompanied by a canthopexy  (an internal stitch that brings the lower lid closer to the eye, allowing the tear duct to work more effectively).  A lower lid blepharoplasty may be better for you than laser resurfacing of the lower lid.