Lower Eyelid Drooping After Blepharoplasty, How Long Should I Wait to Fix it?

I got a blepharoplasty three weeks ago and one of my lower eyelids is drooping. I am 58 yrs old and in good health. I am putting ointment in my eye and taping it into place every night and massaging it several times per day. After the first week, the eyelid came up a bit but no progress has been made in the last two weeks. My surgeon says she can put a stitch in the corner of my eye to pull the lid up if it does not improve. Is this the best way to fix it? How long should i wait?

Doctor Answers 14

Droopy eyelid after surgery

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In many cases the nerves that go to the muscles of the lower lid are stretched during the surgery and can take time to get better. I do agree with the taping , especially at night and it might take 6 weeks for the nerve to start working again. Whether or not it will take a simple stitch in the corner is too early to tell.

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Please please wait

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Please wait at least 3 months...preferably even longer. I sometimes recommend waiting up to a year after the initial surgery. Now if it is a severe problem, and it has obviously stopped improving, then 3 months would be the minimum amount of time.

In addition,  there are other treatment options while the scar is softening:  steroid or 5FU injections to help soften scar, or injection of hyaluronic fillers to help stretch tissue and temporarily improve eyelid position.

See your Doctor again and inquire about these options.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Droopy eyed after blepharoplasties

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You may have swelling that has pulled the eyelid away from the globe (eye ball). Usually this resolves with time and conservative measures (like you are doing) over a few weeks, but can take a few months. Placement of a tarsorrhaphy stitch to help close the lateral part of the eyelid opening will help for the short term. If this persists more than 3 months or begins to cause symptoms with the affected eye, then surgical intervention may be indicated sooner. You should discuss this with your surgeon.

Todd C. Case, MD
Tucson Plastic Surgeon

Droopy Eyelid After Surgery

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It sounds like you have what is called ectropion ("ek tro pea yon").  This is an abnormal position of the lower lid where the lid is furrowed outwardly.  This can be due to scarring and/or swelling.  Certain patient can be identified prior to surgery by testing how lax the lower lid is by pulling on it.  In your case I would wait to see if the position improves as the swelling subsides over a three month period.  If present after that time then some surgeons would use a steroid injection to try to soften scar tissue in hopes the eyelid would return to its normal position.  If that does not correct the issue then a surgery to tighten the lower eyelid may be necessary (canthoplasty).

Dr. ES

Lower Eyelid Drooping After Blepharoplasty, How Long Should I Wait to Fix it?

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 It's best that you have this discussion with the plastic and cosmetic surgeon that did your lower eyelid surgery.  If he/she's not able to treat you, assuming your diagnosis is correct regarding the lower eyelid malposition, perhaps he can refer you to a local eye surgeon for treatment.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Lateral canthus

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The first step is massage and patience. If it does not go back into position you should have an evaluation by some one experienced in fixing this not uncommon problem following lower lid cosmetic blepharoplasty. Depending on the reason for the malposition, and where the lid may be contracted can determine the type of repair that would be necessary. Sometimes just stitching it up is not enough.

Perry F. Garber, MD
Long Island Oculoplastic Surgeon

Lower Eyelid Drooping After Blepharoplasty, How Long Should I Wait to Fix it?

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A lot will depend on the examination.  It certainly wouldn't hurt to get a second opinion from an Oculoplastic surgeon with a lot of experience in fixing these type of problems. 

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Lower Eyelid being pulled Down after Lower Lid Blepharoplasty

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There are many potential reasons why a lower lid would be pulled down in the immediate (as opposed to weeks after) postsurgical period. The exposure of the white of the eye (ECTROPION) and the inability to completely close the eye (LAGOPTHALMOS) are known surgical complication. A lot has to do with unrecognized laxity and looseness of the lower lid commonly seen in people over 50. As everything in life prevention is better than the cure. In such cases, a simple tightening of the lid (canthopexy) could prevent many such cases.

In the presence of a loose lower lid, swelling, inflammation, temporary nerve damage conspire to allow downward migration of the lid. The problem is that as the scar tissue is setting and splinting the operative site it risks keeping the lid in a permanently lower position. Placing a temporary side (Frost) stitch is better than taping because it works 24/7. However, if the pulling down is caused by the removal of too much skin you will require a corrective operation.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Timing Of Lower Eyelid Ectropion Repair

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In the management of lower eyelid ectropion after blepharoplasty, three weeks is still early. Taping and massage are good early measures and often can be enough for a few millimeters of lower lid sag. Even if not, they buy time for inflammation to settle down and healing to occur. If it fails to correct itself on its own after three months, then surgical correction will be needed. This can be done by tightening the corner of the eye as your surgein has suggested.

How to fix droopy eyelid?

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This problem must be approached individually.  Treatment depends on the degree of eyelid malposition, whether or not there is lagophthalmos, what symptoms you are having, what the trend is over time, how bad it looks, and how you feel about it.  Tarsorrhaphy, suggested as a possibility by your surgeon, is a good temporary solution.  Corticosteroid injections, massage, and surgical revision (usually a minor office procedure) are other treatments.  Sometimes, spontaneously resolves as orbicularis tone recovers and edema (swelling) resolve.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 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.