How to get my lower lids to cover more of the white of my eyes ? Want them to look like my eyes before surgery. (photo)

Lower lids too low and too much white showing. Surgery was 4 weeks ago. What can I do ? Any ideas. Thank you

Doctor Answers 11

Post Blepharoplasty Healing

Hello,Four weeks post blepharoplasty is too early to asses final results.  I recommend waiting for the resolution of post surgical swelling as well as the full return of muscle function/tone around the eye.  It's difficult to predict how much spontaneous improvement you will have with waiting alone but you will have some.  There are correction procedures available for the problem if it is persistent. Regards,

Jacksonville Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

Patience after Eyelid Surgery

Your photos do suggest lower eyelid retraction following blepharoplasty.  But you must be patient! Your condition may improve significantly with massage, lubrication, and time.  Please discuss at length with your surgeon or seek a second opinion from a board certified, fellowship trained Oculoplastic surgeon (just like your initial surgeon?).  I would anticipate you need to wait a minimum of 6 months before considering any revisions --- but this decision can only be made in person with an eyelid surgical expert.  Massage, taping and other non-surgical interventions may be helpful for now.  Best of luck in your recovery.

Damon B. Chandler, MD
Moorestown Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Lower lid ectropion

It looks like you developed an ectropion. Often massage and taping can help. Best to discuss this with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Scleral show

Ms. McElheny,I'm sorry this happened to you!  It can be fixed.  This usually happens when you have skin removed from the lower lids and the lower lids don't have enough support or tone to remain in position against the eye.  You get what is called ectropion - where the lower lids are actually pulling down and away from the surface of your eye.  You should go back to see your plastic surgeon (the one who did the procedure) if you can.  He or She should help you get back to a normal lower lid position.  Things he or she will do will likely include:

1. massage.  with some cream on your fingers (or ointment - whatever you're not allergic to) sweep your fingers firmly across your lower lids a few millimeters below your lashes from your nose toward your temples.  This actually helps a lot in supporting the lower lids and lengthening the scar tissue that is forming.  Over several weeks you will see a change in your lower lid position with this move.  It may not be enough to totally correct your issue, but it will certainly help.

2. Canthopexy:  This actually tightens the lower lid using a stitch at the temple end of the lid.  It will elongate your eye sideways a little, but it will help your lower lid stay in position against your eye.  Think of a clothesline that is drooping in the middle.  If you tighten the end, the middle will come up.  

3. Lid tightening surgery:  This is the third option, where your surgeon can actually shorten your lower lid to tighten it and bring it back to where it belongs.  It is a longer surgery, but if you need it to correct your problem, it will be worth it.  

If you can't go back to your plastic surgeon, find someone you trust.  Make sure they are board certified in plastic surgery or oculoplastic surgery.  And best of luck.
Dr. Jespersen

M. Renee Jespersen, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 5 reviews

Post-blepharoplasty lower eyelid retraction with scleral show

See an oculoplastic surgeon. You have lower eyelid retraction and ectropion after previous blepharoplasty, from tight skin. Lower eyelid retraction surgery is needed and it may require skin graft. See link below.

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

Lower Lid Retraction

The photos demonstrate a significant degree of lower lid retraction.  This may improve over time, but may require a revision procedure in order to improve the lower lid position.  This may be related to scar tissue tethering your lower lids, excessive skin removal, injury to the branches of the facial nerve which control lid closure, or a combination of the above.  Only time will tell.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

This is a post surgical ectropion and vertical insufficiency of the lower eyelids.

It may improve with more time but unlikely to completely resolve.  Lateral canthoplasty, usually described as a "stitch" or a "tuck" also will not correct the problem. Your problems are a combination of motor nerve injury to the orbicularis oculi muscle and tethering of the lower eyelid.  Reconstructive surgery is available to repair these situations but it is complex.  Generally it is best to heal for several months to see if your issues settle down sufficiently to avoid the necessity of revisional surgery which is complex and expensive.  See your general ophthalmologist for dry eye care while you are healing from this and try to avoid letting your surgeon "tuck" the eyelid because this uses up tissue that will be needed for definitive repair.

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

Lid retraction post blepharoplasty

You have significant lid retraction at 4 weeks post op.  The main thing now is to keep the eye well lubricated as it can get very dry when the lids are so low.  You can use warm compresses and massage the lids upward.  Always hard to tell from just a picture, but it looks like you don't have much excess skin here.  So a canthoplasty may not be enough to get the lids up.  You may also need some sort of graft - either skin, or on the inside of the lid.  But need to let everything heal for several months before doing a revision.     

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 28 reviews

How to get my lower lids to cover more of the white of my eyes ? Want them to look like my eyes before surgery

After at least 3 to 6 months healing if still with partial ectropion than consider lower lid canthopexy/plasty..

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Scleral show following surgery

You have significant scleral show 4 weeks following lower eyelid surgery.  While you may need further surgery such as a canthoplasty or canthopexy it is probably too early to say that definitely. Massage and stretching in an upward direction would be helpful. Taping at night to support you lower eyelids would certainly protect your eyes along with coverage such as a sleep mask. If after 6 to 12 weeks of conservative care is no improvement then you should consider surgery.

Richard O. Gregory, MD
Orlando Plastic Surgeon
4.6 out of 5 stars 12 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.