Lower Eyelid Drooping After Blepharoplasty

Question

I had upper and lower eyelid surgery. My lower lid on one eye is drooping. The doctor tightened it, but it's still away from the eye and causing extreme dryness. My vision is also horrible. Should I go back for corrective surgery? I am afraid he will not fix it but make it worse.

Brent Moelleken, MD · Answer

Revision lower eyelid surgery is complex.  It involves midface techniques (i.e. cheeklift), possibly grafts into the lower eyes, and complex canthal surgery.  The skillset and paradigm required for the revision surgery of the lower eyelid is entirely different than for the primary surgery.
Surgeons undertaking this surgery should have an interest in these areas before attempting a third time redo lower eyelid surgery.
There was no time limit specified in your post.  Shortly after surgery, the lid can pull down and this can often be treated with conservative means.
With any problem with vision, it is a good idea to see an ophthalmologist.  He or she will also check for excessive dryness of the cornea, the lining of the eye.

Jed H. Horowitz, MD, FACS · Answer

Healing after #lowerEyelidsurgeryectropion is not uncommon in the first 6 weeks after lower lid surgery.this can improve with taping, massage, injection with 5fu.the eye must be protected from drying while this heals

James R. Gordon, MD, FACS, FAAO · Answer

Usually ectropion following lower eyelid blepharoplasty is due to excessive skin removal. It can also be the result of unusual scarring or hematoma formation. There are several techniques to treat this common problem. See an oculoplastic surgeon who is comfortable in the management of your condition.

Richard J. Bruneteau, MD · Answer

In
the immediate post-operative period, lower eyelid drooping is not an uncommon
finding in blepharoplasty patients. In the vast majority of patients, lower
eyelid drooping resolves with conservative management. In a small percentage of
patients, this problem persists and surgical intervention becomes necessary.

It’s
difficult to make a treatment recommendation without knowing the surgical time
line of your procedure. In addition, it’s difficult to know what option is best
for you without performing a physical examination.

In
general terms, the vast majority of patients can be managed conservatively.
This usually involves massage and suspending the lower eyelid with steristrips.
In most cases the lower eyelids will snap back and patients will have total resolution
of their problem. When lower lid drooping persist after a suitable period of
time has elapsed, surgical correction may be necessary.

This
problem requires close monitoring by your surgeon. In some cases consultation
with an expert in eyelid reconstruction may be necessary.

Paul Vitenas, Jr., MD · Answer

This is not an uncommon problem can present in a variety of ways. If surgery was recent then massage from inner to outer areas of the lower eyelid and the use of steristrips will sometimes completely correct the problem. Other times there may be more precise surgical repair to be done. I would see my surgeon and see what he recommends.

Anil R. Shah, MD · Answer

Eyelid surgery, and surgery on the face is some of the most delicate surgery in all of plastic surgery. Correction of the drooping after blepharoplasty mandates advice from an expert in facial or eyelid plastic surgery. Myself and a colleague have recently written an academic paper (see below link) on avoiding this complication after blepharoplasty.

Boris M. Ackerman, MD · Answer

Mild lower eyelid droop after eyelid surgery can occur on occasion.  Typically it is expected to resolve in a few weeks.  Prevention of this complication should start during preoperative visit with your surgeon.  It is paramount for a surgeon to examine the lids in a thorough fashion to determine the optimum surgical approach to avoid any so called "retraction" complications of the lower eyelid.  This way a proper procedure is planned and executed, as one can not apply the same cookie cutter approach to all the eyelid surgeries.

	Revision lower eyelid surgery is not an area for a surgeon with only limited expertise and experience.  There are a number of issues to discuss, such as timing, specific surgical approach, expectant recovery, etc.  There are a number of conservative measures your surgeon can attempt while you are waiting for resolution or appropriate timing for revision.  Find a surgeon you can trust and follow his advice.

Vincent N. Zubowicz, MD · Answer

Temporary drooping of the lower lid after eyelid surgeon is not uncommon.  The vast majority of patients will have this resolved assisted perhaps by taping and massaging the lid towards the proper position.  Reoperation too soon can create a disaster.

	Should a reoperation be necessary, it should be done by someone who specializes in solving these types of problems.  In any event, you owe it to yourself to get another opinion.

Farbod Esmailian, MD · Answer

I am not sure how far out from surgery you are, but the non surgical methods are to massage the lower eyelid in an upward direction and tape up the lower eyelid. This usually works in the early postoperative cases. Keeping the eye moist during the day with drops and placing ointment in the eye at bedtime is a must.

	If, at around 6 months, this still persists, then surgery is warranted. At that point there are different procedures (lateral tarsal strip, cantoplasty, cantopexy, etc...) that can address the issue.

	But I generally would exhaust the non surgical approach as long as the eye itself is well lubricated and protected before going down the surgical way, as surgery for correcting ectropian is usually not satisfying for the patient and surgeon.

	Hope that helps.

Lane Smith, MD · Answer

This is not an uncommon problem and there are many ways to fix this problem. To answer if you must go back to the surgeon, that depends on many factors:

your relationship with him or her;
his or her skill level;
and the degree of the problem, etc.

Generally, it is best to return to the original surgeon and express your concerns. Be honest with your doctor and tell him or her that you are worried that he or she may not be able to correct the problem. Do it in a kind and polite way because all surgeons, myself included, have delicate egos.
If  your doctor feels confident that he or she can fix the problem, you might want to give him or her another chance. Usually if there is a problem, the original surgeon will attempt to correct the problem for free or at a greatly reduced price.
If your doctor is hesistant, ask your doctor for a referral to another physician who may be able to correct the problem. It is usually best to try to work with your doctor even if there is some conflict or disagreement. Most definitely, your original doctor wants you to have a good final result and will do his or her best to help you.