Droopy Eye After Mid Face Lift

mid face plastic surgery 15 days ago. right eye does not blink & lower eye lid has started to droop, eye also tearing. Dr has me tape at night and now in day, wants to schedule corrective surgery in 12 days. He told me 3 days ago to wait nerves may regenerate..now since I called him about lid drooping and eye tearing..wants to do surgery.Why so urgent now. why not wait for rejuvenation

Doctor Answers 19

No Rush for More Facelift Surgery or Midface Surgery

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There is no rush.  The best way is to treat conservatively for 3 to 6 months.  You will be fine.  There are many ways to protect your eyes....ointment....gel drops.....tears artificial......tapes.....patches at night plus ointment....humidified room....protective gloasses when outside........The whole trick is prevent dryness and you will clear up.  As the swelling gos you will come up and be fine.  Now there is a time to operate if you are way down or experiencing severe corneal symptoms.  Get an opthalomologist's opinion also.   I would wait based on information you have given.  Get another local opinion by a surgeon and an eye doctor.    Yhere is usually lots to gain by conservative treatment.  My Best.

Droopy eyelid after midface lift

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I assume that you did not have a blepharoplasty (surgery to the lower lid) which could also cause the lower lid to droop.  If all you had was a midface lift then the mostly likely cause was injury to the nerve going to the muscle that encircles the eye (orbicularis oculi).  This nerve can be damaged particularly during a deep plane lift as the nerve enters this muscle on its deep surface.  Hopefully the nerve was just stretched which has a better outcome than if the nerve was cut.  Nerves regenerate at a rate of about an inch per month so it may take a couple months before you will know for certain what the nerve status is.  In the meantime I agree with the other physicans' suggestions about applying a small strip of tape along the lower lid to support it and keep the lid in contact with the eye ball.  If the lids do not come together the eye is at risk of drying out so Lacrilube at bedtime can be helpful.  If you have an ophthalmologist they could help you with a moisture chamber to use at night.  Before considering any revision procedure I would get a second opinion from an oculoplastic surgeon.  Hopefully it will recover on its own and this will have been just a temporary inconvenience. 

Mark Loury, MD, FACS
Fort Collins Facial Plastic Surgeon

Droopy eye after midface lift

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Facial nerve branch injury after midface lift is not that uncommon.  Usually this will regenerate without long term issues.  Two weeks is still early and I would probably give it more time before reoperating.  The eye should be kept moist and taping should help.  I do not believe there is any downside to waiting a little longer as long as the eye properly protected.  Donald R. Nunn MD  Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Droopy eyelid following midface lift

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Hello and thank you for the question.

It is possible that in the process of the midface lift, a facial nerve motor branch injury was incurred, thus explaining the droopy lid. This is under the assumption that you did not undergo concomitant blepharoplasty as well, which can produce droopy eyelids in some cases.

Without examining you, it is difficult to make a determination as to why your surgeon wants to perform a re-operation in the short course.  A lack of lower eyelid support  as a consequence of the facial nerve injury can lead to a potential dry eye syndrome also know as keratoconjunctivitis sicca. This can put your cornea at risk for drying out, and thus requires a preventative interventional procedure whether surgical or non-surgical.  With all that being said, facial nerve injuries vary in their severity and nature. Often times, the injuries are only partial and regeneration is seen with time. In the interim, though, it is imperative that your eye remain well hydrated and protected from exposure.

I recommend you consult with your surgeon to discuss these issues further if you are having persistent concerns. 


Glenn Vallecillos, M.D., F.A.C.S.

Glenn Vallecillos, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Surgery in the short term after nerve injury

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I agree with the other posters - the likely issue is midface facial nerve branch injury, and this often improves spontaneously.


While it is difficult to know for sure, I think your surgeon's sudden concern and desire to operate may be due to the degree of tearing and eyelid droop. There is really nothing he can do operatively to repair tiny midface nerve branches, but he may be actually considering a temporary procedure to prevent your eye from remaining exposed, dry, and at risk for infection while your nerves regenerate. Ask him directly what this procedure is - trying to "fix" the issue, or trying to protect your eye while the nerve issue is being sorted out?

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

WIthout a personal consultation it is just speculation to discuss your situation.

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You will need to weigh your confidence in your current surgeon to know the right thing to do.

There is no substitute for an in depth personal consultation. Occasionally the lay description of what is going on and what is actual going on are not the same.

If you were 100% confident in your surgeon, you would not be casting about for opinions from strangers. I am going to advise you to listen to your feelings. Please do not blindly follow the recommendations of this surgeon or any surgeon if it does not make sense. Please do not "double down," on a second surgery unless you have a clear understanding of what is going on, and what surgery is planned, why is it necessary, what are the risks of the second surgery, what is the probability of success or failure?

Honestly, sometimes surgeons just panic in these situations. They have a fix-it mentality. He or she just wants to take care of the problem. However, this may not actually be the right time to fix the problem.

Lower eyelid surgery and midface surgery have significant risks associated with them. These risks may not be understood by your surgeon. The fact that your surgery has a complication does not mean that your surgeon did anything below the standard of care. However, what is done to address the problem can make a profound difference and should not be rushed.

Here is the big problem with lower eyelid surgery and midface surgery done through a skin incision under the lower eyelashes (infracillary incision): the anatomy described in some of the most important recent papers in the field are inaccurate. I know this may be hard to believe. I recently reviewed the entire literature on this subject and presented before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium.

It seems that some of the core papers describe anatomic hypotheses rather than proven anatomic fact. For example, it is clear that the soft tissue of the cheek is mobile (i.e. it slides when we smile). Analogously, the lower cheek is mobile over the lower half of the face. In this location, the nerves that supply the muscles of facial expression around the mouth travel in such a way that it is possible to safely dissect in this plane in the lateral half of the lower face, and this is a key aspect to the so-called deep plane facelift. Similarly, surgeons dissect under the skin and lower eyelid muscle to perform midface lifting. It is understandable that they would hope that this could be done without injuring the nerves that supply the eyelids. Not surprisingly, published papers appear to support this hypothesis which is the basis for a number of standard lower eyelid procedures.

Unfortunately, a hypothesis is a scientific guess. It does not make an established anatomic fact. There is also clear evidence in published papers suggesting that the nerves that supply the lower eyelid orbicularis oculi muscle travel in this so-called glide plane, which is actually just somewhat mobile fat and loose connective tissue between the cheek bone and the orbicularis oculi muscle. Complicating matters with regard to surgeon experience, it is clear that it is possible to do some degree of dissection in this plane without significantly altering the nerve supply to the orbicularis oculi muscle. We just not know how much is too much until after surgery. Additionally, when this dissection is carried out laterally into the crowsfeet area, it is also possible to do significant damage to the nerves that provide innervation to the orbicularis oculi muscle in the upper eyelid as well. This is significant because the elements of the orbicularis oculi muscle within about 5-8 mm of the lower eyelid margin are responsible for blinking the eye closed. WIthout this critical blink function, tears are not moved across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.

Returning to the situation you are describing, I am very concerned that in an attempt to remedy your situation, your surgeon will perform a very aggressive lateral canthal tightening procedure. This effectively shortens the eyelid. This is the most obvious remedy for this situation but uniformly this is a mistake and it substantially complicates future reconstructive efforts. First the globe is not a flat object but a round sphere. Pulled tight, the lower eyelid will seek to follow the shortest path around the fullness of the eye. So in some cases, much to the would-be eyelid reconstructive surgeon's surprise, the eyelid may actually take up a much lower ultimate position under the maximum curvature of the globe. With unusual efforts, such as drill hole canthoplasty (not recommended), it is possible to draw the eyelid straight like a tennis net. However, in this case, there is too much tension in the eyelid and it can actually result in increase cornea discomfort.

The answer in these situations to avoid further eyelid tightening. Rather, the best course is to allow the tissues to heal for now. Then in 6 months or more to comeback and address the situation. Generally what is done very much depends on the findings at the time. However, by preserving as much of the lower eyelid and not cutting out tissue as will occur with a canthoplasty performed at this time, there are many more options and increased likelihood of an improved outcome.

Measures now should be supportive including artificial tears, ointment at bedtime and possibly finger winking to stretch out the corner of the eyelid.

I strongly recommend that you put that proposed surgery on hold and seek several expert opinions. Do keep lines of communication open with your surgeon. Look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery. Be skeptical of solutions that must be done "urgently" or don't make sense. Please do not be in rush to fix this although the desire to do so is completely understandable. While very few of these mend themselves, with time it may improve so that less work may be needed than first thought. It is hard to be patient in these situations.

You may need to travel to find the appropriate experts. 

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Droopy Eye After Mid Face Lift

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There are many reasons to wait and let the nerves regenerate and very few reasons to take surgical action.  The main priority is to keep your eye from drying.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews


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I would take the doctor’s advice and do as they recommend.  They may have a suture around a nerve causing this problem or something else.  If they are not a Board Certified Plastic Surgeon, I would involve one at this point.  You want someone trained on complications, and one who has seen a few variations on the theme.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

Droopy tearing eye after Mid Facelift indicates nerve injury and surgical eyelid support is important

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During a Mid Facelift the motor branches of the Facial Nerve that go to the eyelids may be injured. If so the eyelid becomes weak and droops and if tearing occurs it means the eye is not adequately protected from dryness.

Usually these nerve injuries recover as there is a double innervation to the eyelid.

However the nerve takes time to heal and some action must be taken to protect the eye during this time.

If taping does not work effectively, the lower eyelid can be supported with a temporary suture technique called a Temporary Tarsorraphy, a simple one stitch procedure.

If tone does not return to the eyelid further reconstruction will be necessary but this is unusual.

Follow your doctors advice, don't delay, protect your eye.

Droopy eyelid after facelift

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At 15 days post Facelift surgery, you are still in the early post operative period.  The incision will be quite tight and your tissues and skin are still swollen.  It is not unusual for a lower eyelid to droop during this time.  With eyelid support (taping) and protection of the eye with saline eye drops and eye ointment, this situation may well improve over the next several weeks.  You may not require revisionary surgery on your eyelid.  However, your surgeon has examined you and I have not.  Discuss your situation with him and ask him if he feels that further surgery at this point is definitely necessary, or is it possible to wait for a while. 

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 63 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.