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

Question

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?

A.J. Amadi, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

Revision Surgery

Revision eyelid surgery should be done at least 6 months
after the initial surgery to allow time for healing and tissues to soften.  Asymmetries, excess skin, fat rolls,  fat malposition can all be improved.  Other treatments may include laser or
chemical peels to tighten skin and improve texture

Earl Stephenson, Jr., MD, DDS, MBA · Answer

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

Steve Laverson, MD, FACS · Answer

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.

Kenneth D. Steinsapir, MD · Answer

You did not provide us a photograph. There is more than one thing that can go awry with lower eyelid surgery. "Putting a stitch in the eyelid" seldom corrects the problem. It is understandable that the surgeon wants to take care of this issue as rapidly as possible for you. However, it does not benefit you to have a fix that does not really help. I agree that a second opinion is a good idea. If you want to maintain your relationship with your surgeon, consider having them arrange a second opinion with an oculoplastic surgeon they work with. Generally it is best if you allow the eyelid to heal for an extended period of time. This allows for a more precise correction. Also some issue do settle down with a little time. Please consider reposting your questions with photographs.

Todd C. Case, MD · Answer

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.

Sam Goldberger, MD · Answer

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.

Peter A. Aldea, MD · Answer

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.

Barry L. Eppley, MD, DMD · Answer

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.

Chase Lay, MD · Answer

Hi Concerned,

	It's hard to say without photos, but it's still early.  You're doing the right things with taping and massage but the surgeon could inject some steroids as well to help to accelerate the softening/maturation of the scar tissue.  At the very least keep you on your surgeon and ensure he/she watches you closely.  Seek another opinion as well. If it did become an issue I'd revise it in 3 to 6 months.  Don't worry too much yet, in a few weeks it make look much improved.  

	If you do need a revision seek the opinion of an experienced facial plastic surgeon or oculoplastic surgeon.

	Best of luck

	Chase Lay, MD

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