35 and had quad blepharoplasty 6 weeks ago, now my eyes doesn't close and I have lower eyelid retractions. (Photos)

Question

My procedure was bilateral levator advancements, with lateral canthoplasty, quad cosmetic blepharoplasty with fat pad repositioning, periocular CO2 laser, filler redistribution. Two weeks ago I got steroid shots to improve the scar tissues and eyelid retraction. Since the surgery I use eyedrops and I massage eyelids 4-5 min every day. Is there any hope my eyes close completely? How about eyelid retractions? My eyes doesn't look even and I am not happy with the result. I appreciate any advice.

Kenneth D. Steinsapir, MD · Answer

You have had a less than ideal outcome in both the upper eyelid and lower eyelid from your recent surgery. The upper eyelids had upper eyelid ptosis with an anterior levator disinsertion.  It does not appear to that the upper eyelid ptosis was addressed by your upper eyelid surgery. Instead a very high crease incision was made to remove the remnant of your upper eyelid fold.  A much better alternative would have been to make a lower eyelid crease with repair of the upper eyelid ptosis.  Your lower eyelid surgery has compromised the lower eyelids and they are now retracted.  This is not ectropion.  This is vertical inadequacy of the lower eyelid.  The bad news is that this has to be repaired surgically and in stages. The repair is likely much more expensive than the original surgery. You need to heal more before it is reasonable to reconstruct these eyelids.  Unless there is an issue with corneal protection, or extreme social issues, it is best to let the eyelids heal 6 months before reconstructing the eyelids.  I would encourage you to get personally assessed now for a second opinion so the details of your situation can be appropriately managed. The good news is that there is help for this.  Of course you never signed up for all of this. Consider getting emotional support during this process if you need it.  Study my website which has a lot of information about how eyelids are fixed after botched surgery.

Brent Moelleken, MD · Answer

There are conservative methods that may minimize the retraction of your lower eyelids.  However it may be necessary to perform a lower eyelid reconstructive procedure at six months after the  initial surgery.  This should be performed by a surgeon with an interest in the mid face and cheeklifts as these procedures are technically difficult.

Mehryar (Ray) Taban, MD, FACS · Answer

It does appear you have lower eyelid retraction. It can be a complex problem. Revision lower eyelid retraction surgery may be considered after 3 months. Important to communicate with your surgeon.

Thomas A. Mustoe, MD, FACS · Answer

It is likely that you will gain eyelid closure over time and the retraction will improve.  I have seen some improvement over a full year, and would absolutely wait until tissues are completely soft before contemplating revision.  The upper eyelids may benefit fromFat grafting and correction of lower eyelid retraction is more involved often requiring spacer grafts.

Brian K. Machida, MD, FACS · Answer

You need to wait 6 months before considering any surgical revision. I would not advise any further steroid injections. The inability to close the eyelids might improve with time. The lower lid retraction and sclera show might also improve with time but I would advise nothing more than massage. At six months, if you are still not happy, then consider surgical revision. The intervention for the lowers is separate for the uppers, so if at that point, you are satisfied with the uppers but not the lowers, you can just work on the lowers. Follow with your surgeon for the revision and if you have questions, you can consult with another doctor for another opinion but your original doctor knows what was done.

Ahmed Ali-Khan, FRCS (Plast) · Answer

Hi thank you for your question and the photos. I suggest you speak to your surgeon and follow their advice as we all have slightly different protocols for such situations. There is still a chance your eyelid position will improve as the tissues soften. In my experience this scenario rare, and I normally ask my patients to massage the eyelids after surgery to help avoid this situation arising. I would however recommend you speak to your surgeon before undertaking anything like that yourself in case their protocol differs.Best wishes.

Robert H. Hunsaker, MD · Answer

While no one predict the future for you, in my opinion you may well still have improvement though the process can be lengthy. If the lagophthalmos and scleral show don't improve enough to be acceptable, there are procedures that can be that that, if done skillfully, can improve things.

35 and had quad blepharoplasty 6 weeks ago, now my eyes doesn't close and I have lower eyelid retractions. (Photos)

Answers (7)

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