Upper eyelid blepharoplasty and mid face lift via lower lid blepharoplasty to eliminate drawn look. (photos)

I am just over 2 weeks post op and have concerns over my left eye. Do I have lower eyelid retraction? If so can this be treated without further surgery? Lastly my right eye skin bulges over incision scars is this due to swelling being present? Will this improve with time ? I am scheduled to meet my surgeon this week to discuss my concerns. Many thanks.

Doctor Answers 5

Lower eyelid retraction

Another very common scenario unfortunately. the photos do seem to show the you are developing lower lid retraction. The reasons for this are complex, but with the degree of retraction present it is likely to have been due to excess skin removal. If a mid face lift was conducted at the same time, the surgeon may not have planned for the inevitable mid face descent in the weeks after surgery. Unfortunately, this is unlikely to improve significantly but I would be hopeful on some improvement, so don't get too depressed about this. At this point, it is essential to be patient. Do not under any circumstances have any procedures done before 6 months at least, just persevere with patience and massage. Many surgeons will offer a 'canthopexy' procedure which would not be appropriate in this case. After a few months I would discuss any residual problems with your surgeon and make sure that you get a second opinion from an experienced oculoplastics surgeon. 
I would not be too concerned about the swelling around the scars. this will settle well.

London Oculoplastic Surgeon
5.0 out of 5 stars 1 review


We need better photos to be able to give you answers.... however, it seems like not enough skin was removed from the upper lids and even after the swelling subsides you most likely will need more skin removal.  Can't comment on the lower lid as the photos are not showing the entire face; however, it seems like the lower lid is retracted but this could also be due to swelling.  At this time your only and best option is to wait at least 6 month to get a better idea of what is due to swelling and what is due to surgical tech.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 60 reviews

Revision lower eyelid retraction surgery

It is early to tell as you are still healing but usually you want the lower eyelid to be over-corrected early on since it comes down over few months. It is probably best to let things heal for 3 months and re-evaluate.  Discuss with you surgeon. See link below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

First, I am so sorry you are having an issue after cosmetic eyelid surgery.

While you are only two weeks out from surgery, the problem of lower eyelid malposition after transcutaneous lower blepharoplasty is well known and foreseeable.  I suspect that your surgeon reinforced the lateral canthus at the time of the surgery to precisely prevent this sort of problem.  That is pretty standard fair these days.  Unfortunately, it does not work in many cases.  The lower eye is very dependent on the integrity of the muscle or Riolan and the tarsal orbicularis muscle to keep the lower eyelid positioned on the eye surface.  The transcutaneous incision, cuts the motor nerves that supply these critical muscles.  This causes a permanent weakness in the hammock function of the lower eyelid.  Tightening the lower eyelid with canthal support can actually make the problem worse not better.  The lower eyelid, when shortened by canthal tightening, will find the shortest path on the curved surface of the eye.  This will generally be lower than before and that is what you are experiencing.  The left lower eyelid is more bowed than the right lower eyelid but then left lower eyelid started out with a worse position than the right side.  Will massage correct this?  It is unlikely to fix the eyelid position.  Overtime the lower eyelid incision will soften and be less conspicuous. If your surgeons offers to fix the problem by putting a stitch in the corner, this will not be effective and it will use up the limited resources needed for a definitive repair.  I recommend conservative measures for the next 6 to 12 months.  It you still feel something needs to be done to address your concerns, that would be the time.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid retraction

Thank you for sharing your concerns. At 2 weeks post op, you certainly are still swollen. The lower eyelid is retracted. You should massage it upwards through the day and tape it upwards when you go to sleep. Make sure to see your doctor this week.  Good luck,

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 145 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.