Will this lower lid retraction get better? (Photo)

Question

I'm only on week post op but one eye is drooping more than the other. One eye appears bigger than the other. And one eye lid is hanging lower than the other.

John J. Martin, Jr., MD · Answer

You want the lateral corner of the eye to be a little higher than the nasal side.  Yours seem to be lower.  YOu have some scleral show too but also some significant edema that may be pulling the lid lower.  As the edema resolves your lid may come up a bit.  However, the corner will still be low and you will probably want that elevated in the future.

Kenneth D. Steinsapir, MD · Answer

I am in the business of fixing eyelids after cosmetic eyelid surgery.  You definitely have a real problem with this surgery.  No amount of taping, massage, etc will allow the corners of these lids to be in a normal position.  At this point, there is no simple fix.  Do not compel your surgeon to take you back to the operating room to "tuck" the corners.  This will not fix the problem but it can make it worse and it does use up important resources that will be needed in the future to restore you appearance.  Rest assured that there are well developed methods for repairing this type of situation.  Will you need this type of reconstruction?  To be honest, it is hard to know this at this point.  What is certain is that you will need 4 to 6 month to heal before deciding if a correction is necessary.

Christopher I. Zoumalan, MD, FACS · Answer

It is still early to tell how you're going go heal but I would recommend you to followup regularly with your surgeon to make sure your progress is documented.  Eyelids can be quite swollen after surgery and it takes several months to assess how the lids will end up healing.  Your surgeon may recommend the use of artificial tears and even massaging the lids up during the healing phase. Good luck.

Darryl J. Blinski, MD · Answer

Re post after 8 weeks with a photo so we can compare your progress. I am slightly concerned with the position of the lateral lower lid junction...

Gary L. Ross, MBChB, FRCS · Answer

Its always difficult to comment on results without seeing the preop photos but you have a lot of swelling and bruising, scleral show and chemosis. You should consult with your PS. You really need some eyedrops / ointment and your PS may advise taping and massage over the coming weeks. The final result will take at least 3 months to become apparent. In terms of lid position and eye aperture its difficult to comment as it really depends on whether a cantopexy / canthoplasty / oribicularis hitch has been used. I would recommend letting everything settle for a few months but I would definitely give your PS a call.

Mia E. Skourtis, MD · Answer

It is common to have moderate swelling and bruising at one week after lower blepharoplasty surgery.  Your photo indicates that you have quite a bit more bruising on the left than on the right, and because of this, there is more swelling, and consequently, more traction on the left lower eyelid.  As your swelling and bruising resolve, you can expect that the position of your lower lid should improve.  Your plastic surgeon will likely prescribe some massaging exercises, or possibly even gentle taping of the lower lid, to help optimize the position of the lower lid during the healing process.

Amiya Prasad, MD - Account Suspended · Answer

I assume that an external approach to the lower eyelid was
done which meant making an incision underneath the eyelashes called a
transcutaneous blepharoplasty. Part of your surgery involved removal of some
skin. Once that is done, there is some loss of tone in a muscle called the
orbicularis oculi muscle. This muscle is like a hammock and it supports the
lower eyelid. Initially after this type of surgery, the muscle can have some
swelling and the nerves that go to that muscle can also be affected.

It’s hard for me to make a full assessment once the swelling,
fluid, bruising and the muscle heals because I don’t have any information about
your pre-operative appearance as well as the details of your pre-operative
consultation.

As an oculofacial cosmetic surgeon, patients come to us from
all over the world who has lower eyelid retraction, but this is after considerable
time since their initial surgery. Usually, the surface of the eye of
significant lower eyelid retraction is affected despite the use of lubrication
and other things. It is very important any issues with tearing and foreign body
sensation that you properly lubricate your eyes. Use artificial tear drops and
lubricating ointments to protect the eyes and allow them to heal.

If someone has significant lower eyelid retraction that they
did not want as part of their surgery, you have to understand that a lot of surgeons
expect that eyes have a certain rounding appearance. I practice in the Upper
East Side of Manhattan and in Garden City, Long Island and there is a certain
frequency of patients and surgeons who like that rounded look. I don’t cast any
judgment about that particular appearance if the patient and the doctor like it.
My personal aesthetic is more about the lower eyelid in a position at the
limbus, or the point where the iris and the sclera, the white part of the eye,
appear to meet. My personal aesthetic is more of an almond shape to the eyes.

One principle from an ophthalmic perspective is that eyelids
that look good function well. If the lower eyelids are in a good position, in
the long-term  they will protect the eye
well, have better distribution of tear film, and have proper drainage of the
tears into the tear duct. When the lower eyelids are down and displaced
laterally, the tears tend to pool at the outer aspect rather than going toward
the inner aspect.

In our practice, we deal with lower eyelid retraction by restoring
and reconstructing the anatomy when it's functionally and cosmetically
significant. At this point, it is important that you continue communicating
with your doctor. This is most likely something that needs to be observed , and
your surgeon may suggest to you to do some massaging to try to push the lower
eyelid up. If you need any ophthalmic care then maybe you can also have an
ophthalmologist work with you to take care of any external eye irritation
issues. In the short term, it is important to just wait this out until things
settle out and heal. I hope that was helpful, I wish you the best of luck, and
thank you for your question.

Brian Windle, MD (retired) · Answer

It appears, from this photograph that you very early in the postoperative period.  It is impossible for anyone to say what result you will get from your blepharoplasty or eyelid lift.  You may be very happy with the result ultimately but the swelling and bruising needs to settle.  This sill take at a minimum, 3 weeks and likely the final result will take about 6 months.  Make sure you check back with your surgeon on a regular basis.I hope that helps. Best regards.

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