3 Weeks Post Eye Bag Surgery Redo and it's Swollen and Now Dropping Down? (photo)

I did surgery two year ago a mini face lift and my eyelid surgery. One of the eyes was not done so I redid it. The doctor saw me after one week looked at my eye and assured me the swelling was normal and so was dropping. Next week Dr and was surprised to see my eye still swollen and dropping and told me to move my eye upward and put warm compress, because the gravity of the surgery and swelling was pulling my eye down. is this normal?

Doctor Answers 1

Normal? No, this is anything but normal.

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You are experiencing what is probably a paralytic ectropion after lower eyelid surgery.  Intact motor nerves supplying the orbicularis oculi muscle along the lower eyelid margin keeps the lower eyelid against the eye.  This little detail can surprise even experienced eyelid surgeon who persist in using an external transcutaneous lower eyelid incision to perform lower eyelid surgery.  The plastic surgery literature has a few popular articles that seem to support the safety of this surgery.  However, these papers are actually not well supported despite their popularity.  If you make a cut through the lower eyelid skin and muscle, a certain percentage of patients will develop a post-operative lower eyelid ectropion as you are demonstrating in your photos.  The response of the operative surgeon can include telling you to message the eyelid, taping the eyelid, or advising immediate surgical revision to "put a stitch in the corner of the eyelid."  It is my personal opinion, that letting the situation heal with taping if you can tolerate it is appropriate because in some cases, the nerves are more bruised than severed and will recover if one is patient.  Rushing in to "tuck" the lid or place a "stitch" is done with good intention.  However, often the surgeon proposing this options is out of their league and these maneuvers can actually worsen a situation that may get better on its own.  If your relationship with your surgeon is good, it is reasonable to work with them and give this time to heal.  It you are uncertain, a second opinion by an oculoplastic surgeon may be appropriate however, it is important to understand that there is a difference between reconstructive oculoplastic surgeons and aesthetic oculoplastic surgeons.

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