Eyelids Won't Shut After Blepharoplasty

There are two different questions open right now... the first from aching eyes who has had a bleph approximately six weeks ago. The important issue for you at this point is your ability to protect your cornea.
A small amount of lagopthalmos (inability to fully close your lids over the globe) is not unusual immediately after a blepharoplasty. This typically resolves within the first few days and can be related to the local numbing medication and swelling. Lagopthalmos that lasts beyond that can be a concern in terms of full resolution.
Certainly most of these issues should resolve at six weeks. The critical issue if you can't close your lids is are you providing adequate lubrication and protection to your cornea. If the white parts of your eyes are not red and injected and you are not having pain this may indicate that you have adequate protection.
You should, however, have a conversation with your plastic surgeon.
To the second question posted in the comments section, 4 years is a long time to be unable to fully close your lids and you may need some form of intervention to correct this. A complete evaluation by a board certified plastic surgeon or occuloplastic surgeon is indicated. There can be many issues including that your upper lids are don't have enough skin or laxity to close or that your lower lid is somewhat loose and needs attention to correct.
I hope this helps.

This is a good question, because many patients are concerned when their eyes do not fully close immediately following blepharoplasty. Fortunately, this is normal for about a week. Beyond that, they need to see their surgeons, because the eyes can dry out and lead to corneal problems. Thank you for the question.

Poor closure of the eyelids
following blepharoplasty surgery is not uncommon and occurs for a variety of
reasons.  In the vast majority of
cases the problem occurs because of swelling and weakness of the orbicularis
muscles.  These issues tend to
resolve with time.  Rarely the
condition is caused by over resection of eyelid skin.  When this occurs secondary surgery is usually necessary and
may require skin grafting.

When eye closure is impaired
following surgery several steps should be taken to avoid damage to the
eyes.  These include lubrication of
the eyes with eye drops during the day and ointment at night, massage of the
eyelid and muscle exercises designed to strengthen the orbicularis muscles.

                  When
these maneuvers are utilized, most patients are eventually able to close their
eyes without difficulty and suffer no permanent damage to
their eyes.  If this complication
occurs it’s important to maintain close contact with your plastic surgeon so
that your situation can be monitored closely.

A small amount of lagophthalmos (inability to close eyelids) is not unusual after eyelid surgery and can persist for days or even weeks afterward.  In your situation, I would use a thicker form of eye drop at night time (Refresh PM). Some degree of a dry eye feeling is normal for a few weeks after the surgery, so make sure you use artificial tears frequently.  Discuss your concerns with your Surgeon so that he/she can keep close tabs on you and appropriately direct your care.

Having this level of incomplete eyelid closure after surgery can occur in some patients. As you are only 6 weeks from having had surgery you still have healing and swelling reduction to occur. As has been mentioned, the key is to keep the eyes lubricated, especially at night. Artificial tears during the day and an ointment (such as lacrilube) at night works best for maintaining a protective coating while you sleep. Additionally, performing exercises to squeeze your eyes close will also help promote normal eye closure.

If you had an upper blepharoplasty (eyelid surgery) about 6 weeks ago, it's normal to still have incomplete eyelid closure(lagopthalmos) due to swelling.  You should be sure to use eye drops and lubricants to ensure that your cornea does not become dry during the night.  Unless your surgeon removed too much skin during the surgery (which is rare) your swelling should resolve over the course of weeks.

Be sure to follow up closely with your surgeon or see an ophthalmologist if you have any visual symptoms such as dry eye, excessive watering of the eye, or any visual change.

Best wishes,

Dr. Bruno

At this stage of your healing slight lagophthalmos is normal.  Make sure that your eyes/cornea are will protected with lubricants or eye patches at night during this healing period.  Your doctor should be able to guide you in this healing process.

On the other hand after a few months the patient's ability to close eyes after eyelid surgery should not be compromised. It can happen if too much skin is removed. In my opinion it is not optimal to remove maximum available skin and fat during eyelid surgery. The hollow and tight look of eyelids after surgery can result if the surgeon removes too much tissue, in mistaken belief that that's how a youthful look is achieved. A talented and experience can create a natural and youthful look of the eyes without removing too much skin.

Eyelid surgery involves handling the muscle that is responsible for eyelid closing.  The combination of direct trauma to the muscle and swelling may disallow normal eyelid function for weeks and even months.  Almost always, the function will return to normal.  In the mean time, patients may be required to use lubricants to protect the eye and remain in close contact with the surgeon.

Do not let anyone reoperate on you now.  That would be a huge mistake.

 

I think your surgeon is being quite honest. It is within normal range of healing that you have to put some effort into closing your upper eyelid completely. This is particularly true within the first two months of healing. With additional time the remaining eyelid skin will likely relax enough to allow complete closure without effort.

As many other surgeons have pointed out, it is important to keep the exposed portion of your eye well lubricated to avoid complications from drying out the outer lining of the eye. This can be done with topical eye ointments and/or taping the eyelid shut while sleeping. Keep close contact with your plastic surgeon as the healing process continues to ensure that no other intervention is necessary. Happy healing.

A mild scleral show (1-2 mm) due to inability to close your eyes is not uncommon during the first few weeks of surgery. Daily exercises to close your eyes will help. During this time, it is very important to keep the eyes lubricated with drops and ointment at night. Incomplete closure will result in some degree of dry eyes, which will also irritate the eyelids to some degree.
Any irritation will cause some degree of eyelid edema or swelling, which further delays healing. Thus, keep your eyes lubricated, continue eye exercises, and you should recover fine.

It can take several months for all of the changes to occur after a Blepharoplasty. In the meantime, keep your eyes protected and lubricated, especially at night. Follow up regularly with your doctor. I suspect you will continue to see improvement over the next 2-3 months.