Why are my lower eyes drooping after a Phenol peel? (photo)

Question

hello, I had a Phenol peel six weeks ago and my lower eyes are now drooping severely, especially at the outer corners. I highlighted my concern to my doctor after two weeks and he said the skin had retracted as a result of the peel and would move back into the original position in a few weeks. However, it's now been six weeks and there is no improvement. If anything, the problem is worse. Thank you in advance for any advice you can give.

Larry S. Nichter, MD, MS, FACS · Answer

I predict that intruding into the corners of her lower eyelids will improve with time. This is most likely caused by both edema which can take some weeks to resolve as well as skin contraction during the inflammatory phase of normal healing.

Parker A. Velargo, MD, FACS · Answer

It looks like your skin responded nicely to the peel.  I would stay in close contact with the physician that peeled you.  The skin of the lower lid tightens and contracts as part of the healing process following deep peels (this also gets rid of the wrinkles).  The contraction resulted in a mild extropion (drooping of your lower eyelids), which can take several weeks to months to resolve on its own, but it usually does.  In the interim, ask your physician about taping the corners of your eyes upwards for support, massaging of the lower eyelids regularly, and steroid injections to help speed the recovery process.  I know that this is distressing, but chances are that it will eventually correct itself.

Brian M. Harmych, MD, FACS · Answer

Some degree of lower lid retraction is normal following a chemical peel and usually resolves over time- which may take several weeks to months. Close follow up with your surgeon is important during the healing period to observe closely for complications such as dry eye and corneal abrasion. Lubricating drops may help the symptoms of dry eye. Gentle massage of the lower eyelid may also help. However, I suspect this will resolve over time. If your surgeon is concerned about it, consultation with an ophthalmologist or oculoplastic surgeon may be indicated.

Luis A. Cenedese, MD, FACS · Answer

This condition exemplifies  the strength of the Phenol peel and why a conservative approach is warranted when treating the eyelids.  Stretching or taping of the lower eyelids in an upward direction may assist in stretching the skin back to its normal position.If not a lateral canthal tightening procedure can restore the natural postion of the eyelid.

George Commons, MD (retired) · Answer

It appears that you had  a complete peel of your lower eyelids and that is fine.   Sometimes this droop occurs as skin of your lower eyelids retracts.   This is frightening but I agree that this will likely resolve on its own.  This may take another 6 to 12 weeks.  It is worth waiting for self correction at this point.   Surgery is not indicated now but if this persists or gets worse that is a possibility.   You best bet is to wait this out.  The retraction will dissipate with time I believe.   Massage with excellent eye cream may help.   Tiny injections of the lower lids with triamcinolone  steroid (1 mg per cc in lidocaine 1%) may help.  Keep your eyes taped up with steristrips to train the regression of retraction may help.   Keep a cool mist vaporizer in you sleeping area.  Use frequent artificial tears   (Refresh tears).   See your doctor for weekly photos so you can see the progress.  This always is comforting.   This will pass naturally  more likely than not.   It is disconcerting but you likely will be fine without surgery. Keep irritation away from your eyes.  Any irritation increases the swelling  and this increases the pull down.   It is a  swelling cycle that must be broken to enhance recovery.   My Best,  Dr C

Why are my lower eyes drooping after a Phenol peel? (photo)

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