Droopy Eyes After Lower Blepharoplasty

Question

I had a lower Blepharoplasty two weeks ago, and both of my eyes look a little droopy, especially the left one, giving me a tired look. Is it possible to correct it? How and when? I had a previous blapharoplasty four years ago.

David Shafer, MD, FACS · Answer

If you post a picture, we may be able to give you more specific advice. However, this early after surgery, it is best for conservative treatment (massage and taping). You should discuss this with your surgeon. Good luck.

Trevor M. Born, MD · Answer

Dear Scared Florida
Your concerns are reasonable and should be addressed by your surgeon.  There are many steps at this time which will help keep the lower eyeid from pulling down more-
massaging the lid in an upward direction several times a day
temporary partial closure of the lower eyelid to the upper eyelid
steroid injection into the healing tissue(if needed)
Theratears - eye lubrication if you have dryness and/or patching the eyes at night or goggles for dryness
taping of the lower eyelid for support
Please follow up with your surgeon so that your progress can be monitored and i am sure that things will be fine.
With Warm Regards,
Trevor M Born MD

Kenneth D. Steinsapir, MD · Answer

Dear Scared
Gladwell got the concept of thin slicing on the money in his book Blink.  Your impressions are probably correct.  
However, it is not clear to me if you are referring to your lower eyelids or your upper eyelids.  You state you had lower eyelid surgery and now your eyes look droopy.  You could be referring to a sag in the lower eyelid position or a heaviness in the upper eyelids.  When the upper eyelids swelling which can occur with lower eyelid surgery, they will look heavy.  This type of situation generally improves with time.  When the lower eyelids look droopy after surgery, this type of problem gets worse as it heals more.  However, in either case, you need time to let the dust to settle.
It is generally a mistake to assume that a problem this early will need surgical repair or revision.  Focus on healing.  If you become depressed thinking about your surgery, consider seeing a psychotherapist or neuropsychiatrist.  Occasionally, antidepressants are needed.  The reason for this is that healing from surgery and dealing with uncertainty can be stressful.  How we cope with that stress is different for everyone.  Try to be aware of these feelings and take care of your emotional well being while you heal from surgery.  Being patient and letting yourself heal can be very difficult under these circumstances.

Frank P. Fechner, MD · Answer

After 2 weeks, remaining swelling and muscle weekness can all contribute to a droopy looking lower lid. I general, any blepharoplasty will disturb the lower eyelid support. Having had a blepharoplasty in the past, I would be not surprised that your support is borderline. Many blepharoplasty surgeons may add support with virtually any secondary lower blepharoplasty prophylactically.
You will see improvements over the next weeks (and even few months). If the lid is still droopy after 4 months, that is the time to start worrying...  Stay in close touch with your surgeon as there are little things to do to "nurse" the lids along.

Edward Buckingham, MD · Answer

Only two weeks after a blepharoplasty is too soon to be worried about the outcome. Give it more time. However, it sounds like what you are describing is that the lower eyelid margin is pulled down a little bit called scleral (the white part) show or lower eyelid retraction. It is a risk especially in revision blepharoplasty. Right now the most important consideration is that the eye is well moisturized. If the eyelid is pulled down and exposing too much of the globe (eyeball) you may experience dry eye symptoms which can be dangerous. If your eye feels gritty or sandy make sure you let your doctor know and get on some eye lubrication. Then give it 3 months at least to heal. Worst case scenario is that corrective surgery can be done although you need to find someone who does it well. It can be tricky.

William Portuese, MD · Answer

Since it has only been approximately two weeks since the surgery, your eyes can still be a little droopy from the edema and swelling. Give it a couple of months to settle down and have your surgeon re-evaluate your eyelids.

Christopher L. Hess, MD · Answer

Lower lid blepharoplasty, depending on how much work was done, can cause significant swelling and hence drooping of the eyelids for quite some time.  This is especially true is the periosteum or layer of tissue over the bone was elevated for fat redraping. 
The best thing you can do is continue to massage the lower lids in a upper and out direction to both help the swelling the direct the tissues to their correct position.  If you still have issues after 12 weeks then it's worth discussing with your surgeon.  In the mean time continue to see your surgeon frequently.

Joseph M. Perlman, MD · Answer

Lower lid surgery can have a longer recovery time and more complications than upper lid surgery.  Surgeons nowadays tend to remove minimal lower eyelid skin in order to prevent the lower eyelid from retracting the patient developing what's called ectropion, which is where lower eyelid everts.  I have my patients start performing upward massage along the lower eyelid bone as well as doing a squinting exercises where they squint real hard and hold it for three seconds.  I'll have them do this four or five times and repeat this process three times a day.
At two weeks you are still early in the recovery process so be patient keep your regular postoperative visits.  Let your physician know your concerns.

Amir Moradi, MD · Answer

One of the most significant risks associated with lower eyelid surgery is ectropion.  This is when the lower eye lids are pulled down. (could be everted in more sever cases)
The reason is that the lower eye lid supporting ligaments can not handle the down ward pull of the skin of lower eyelid or the cheeks. 
Most of the time this is due to swelling and is temporary.  But it could also be the result of scar retraction or excessive skin removal.
Your surgeon needs to know about this.

Hisham Seify, MD, PhD, FACS · Answer

Lower lid malposition is onr of the most common sequela following lower blepharoplasty. Most cases will not require any further managment. Massage and taping will help in the early stages. If you develop any signs of corneal irritation, please seek the advice of your surgeon and start using eye drops during the day and ointment at night.

Droopy Eyes After Lower Blepharoplasty

Answers (13)

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