How common is entropion after lower blepharoplasty done from outside the eyelid?

The subciliary approach to lower lid surgery can increase the risk of lower lid retraction if too much skin is removed. This pulling down of the eyelid is different than ectropion. Lower lid retraction generally needs surgery to repair it. In my hands, I perform all my surgeries via a transconjunctival approach.

A quick literature search suggests that rates of ectropion after a subciliary lower bleph are somewhere around 20% (+/- maybe 10% depending on what article you are reading). Some surgeons can do it well, others less so. It is important to ask your own surgeon what his/her rate of ectropion is in his/her practice. As for whether it is repairable without surgery, if it is caught early enough, a surgeon can be very aggressive with certain injections afterward, but from my experience, usually it will require surgery. This is why I personally do not do this approach for my lower blephs, although I know that there are some excellent surgeons who do!

It is primary done this way to save the expense of accrediting an office operating room. Without that accreditation, the surgeon can cut many corners on the adequacy safety, cleanliness, and staffing requirement. Doing this surgery under local is rough. Doing this under iv sedation makes the performance of this surgery much more controlled. That control can make the difference between getting sufficient support for the lower eyelid or not. Surgeons offering a skin pinch often fail to understand that they are creating a much more significant lower eyelid injury than they are. Using the nice sounding euphemism of "skin pinch," is a marketing strategy soft selling surgery. You might be fine or you may end up with a lower eyelid retraction. Lower eyelid retraction after these procedures continues to be quite common.

So you are actually giving two conflicting procedures. I suspect that your surgeons intentions are to perform a transconjunctival lower eyelid bleph with a skin pinch at the end. The risks of ectropion in these cases is less than 1% unless there is significant lower eyelid laxity, If the surgeon is cutting through the muscle then they are not performing a skin pinch, but a true lower lid skin muscle flap.

In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there's loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.

Your question is asking about ectropion and entropion. Which condition are you concerned about or are you worried about both?
Subciliary traditional open liwer blepharoplasty increases the risk of developing an ectropion. If a small amount of skin only is removed, the chance of happening is less. Your skin and the muscle is removed and the chance is higher. If it significant amount of skin and muscle is removed, then the chance is high.
Many people, if not most people will develop slight ectropion with age.
For that reason, it’s not so much a matter of if you’re going to get an ectropion but rather, when will you get one.
For that reason, I’ve stopped removing skin and muscle from lower eyelids.
Most people treat, an ectropion with Canthopexy or canthoplasty.
I suggest patients have in person, consultations with multiple plastic surgeons before choosing a provider and scheduling surgery. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar facial characteristics to your own for whatever procedure you’re interested in.
An experienced plastic surgeon that should have no difficulty showing you with the before, and after pictures of at least 50 previous patients. Being shown a handful of pre-selected images, representing only the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they’ve actually performed.
Look very carefully at any evidence of early ectropion in the after pictures on the examples you are shown.
I think it’s safer to leave the skin and muscle alone (use trans-conjunctival lower blepharoplasty )because it potentially creates future problems and isn’t great aesthetic benefit.
My opinion is only my opinion and plenty of plastic surgeons will have their own opinion, which will inevitably differ with mine.
Best,
Mats Hagstrom, MD

Entropion, a condition where the eyelid turns inward, is a potential complication of lower blepharoplasty, particularly when the procedure is performed from outside the eyelid (transcutaneous approach). However, the incidence of entropion after lower blepharoplasty varies depending on various factors such as the plastic surgeon's technique, patient's anatomy, and pre-existing conditions.When lower blepharoplasty is performed through a transcutaneous approach, the plastic surgeon typically removes excess skin and fat from the lower eyelid to improve the appearance of bags or puffiness. However, this approach can sometimes disrupt the normal anatomy and tension of the eyelid, potentially leading to complications like entropion.The reported incidence of entropion after lower blepharoplasty varies in the literature but is generally considered to be relatively low, especially when the procedure is performed by experienced plastic surgeons who take appropriate measures to preserve eyelid integrity and function. However, it's essential for patients to be aware of the potential risks and discuss them with their plastic surgeon before undergoing surgery.To minimize the risk of entropion and other complications after lower blepharoplasty, it's crucial to choose a skilled and experienced plastic surgeon and follow their pre-operative and post-operative instructions carefully. Additionally, patients should communicate any concerns or unusual symptoms to their plastic surgeon promptly to ensure timely management and optimal outcomes.