Internal Eyelid Scarring After Lower Bleph-options?

Had transconjunctival lower bleph 4 months ago, no skin pinch. Prominent eyes. Severe internal scarring (can feel along lid). I now have lid retraction, scleral show, bulgy lids and roundness verses their original long, almond shape. I have been massaging, squinting, pushing upwards and given a steroid injection 1 month ago-no change. Doctor wants more injections but I'm afraid of side effects. He says can surgically "just release scar tissue." Is it that simple? Steroids ok? Revision imminent?

Doctor Answers 5

Unusual to have lower eyelid retraction due to a transconjunctival lower eyelids blepharoplasty with no skin excision

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Seems very unusual that you would get lower eyelid retraction from a transconjunctival lower eyelid blepharoplasty.  The whole purpose of the transconjunctival approach is to avoid injury to the middle lamella of the lower eyelid.  When eyelid retraction occurs due to scarring it usually in this layer.  Photos would be helpful to understand your condition.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Eyelid retraction after eyelid surgery

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Your concerns are valid regarding your condition and the effects of repeated steroid injections. The problem is that when you catch this early you can disrupt the scar by massage or pulling the lid up with a suture or surgical instrument if the problem is due to scarring. When the scar matures these methods do not work and you have to divide the scar. If the scar has held the eyelid in a contracted position for months the lining on the inside of the eyelid shrinks and you cannot get it out to length if you just divide the scar late in the game. That is when the solution to the problem becomes more difficult and less reliable.

Before you proceed with a revision you need to make sure sufficient time has elapsed from the initial surgery and that your surgeon can do more than just divide the scar if more work is needed. You will unfortunately need to get the opinion from more than one surgeon before proceeding.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Aaron Stone, MD
Los Angeles Plastic Surgeon

The steroids will not resolve the lower eyelid retraction.

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However, they can atrophy the fat and skin where they are injected.  One does not just "release the scar" or "tuck" the eyelid.  Fixing these issues is anything but simple.  Performing an aesthetic reconstruction involves some of the most complex surgical work performed on the eyelids.  Generally there are several problems that need to be addressed at once including issue with the lower eyelid that existed before surgery that contributed to why you got in trouble with the surgery in the first place.  Typically the cheek needs to be vertically lifted to recruit skin into the shortened lower eyelid.  To control the shape of the lower eyelid margin, a hard palate graft is use.   My approach also involves placing a hand carved ePFTE orbital rim implant to improve the projection of the cheek bone at the orbital rim.  This material serves as a place to support the vertically lift cheek.  These surgeries are highly specialized.  I advice is to be very cautious about allowing a surgeon to "release scar" even if they are offering this surgery for free.  The risk is that the surgeon lacks the specialized knowledge, skill, and experience to repair the issue and will only use up resources that are need to make a definitive repair.  This is help, you just need to look for this type of care.

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

Problem after lower blepharoplasty

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This sounds like a complicated unusual problem after transconjunctival blepharoplasty. See an oculoplastic specialist for evaluation and treatment.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 88 reviews

Lower eyelid scar

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Hi, can you post some before and after pictures? Steroid injections and scar release are viable options for scars in general. For a specific answer, pictures are helpful. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 102 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.