Eyelid Doesn't Close All the Way After Upper Blepharoplasty, Is This Permanent? (photo)

Your eyelid incisions are in approximately the normal position, about 10 mm from the eyelash margin, and the skin of your upper eyelids do not appear to be overly thin.  The reason your eyelids don't close totally is due to micro scars that are connecting the dermis of your eyelid to the tendon of the muscle that elevates the eye (levator aponeurosis). 

The treatment is incredibly simple.  Put your index finger holding one eyelid down and then open and close the other eyelid.  Since the levator muscles work in unison, your other eyelid will attempt to open and close, stretching out the levator aponeurosis of the closed eye and breaking, or at least stretching, the micro scars preventing complete closure.  Then repeat with the other eye and the other index finger.

In my practice, I have patients begin this treatment on the 8th post operative day for 3 minutes, then again on the 9th post operative day for 3 minutes, and that usually cures the eyelid closure problem.  At 2 months after surgery, it make take a few more stretching exercises, but be careful not to overdo it.  To be safe, discuss this with your personal plastic surgeon, and don't forget, the incision was made at the right place and your surgeon did a great job.
 

       Massage and proper lubrication as well as followup at this point in your recovery is a reasonable course of action.

 

 

Kenneth Hughes, MD Los Angeles, CA

Usually two months is enough time for blinking issues to resolve. As long as there is ongoing improvement I think you have little to worry about.

Massaging is not a bad idea. It is still relatively early in the healing period and more improvement is possible in next 2-3 months. In the meantime, lubricate your eyes for better comfort and vision. If the problem does not resolve by then, discuss with your surgeon and/or see an oculoplastic surgeon.

This may involve damage to the muscle or nerve  surrounding the eyelid. This should be investigated since it has been 2 months now. I would see an ophthalmologist as you may suffer damage to your cornea if this does not resolve. There is always a chance it might continue to get better without treatment.

The eyelids look thin.  I think that the orbicularis oculi muscle on the tarsal platform was dennervated.  This means that the surgery caused a motor nerve injury that weakens the ability of the eyes to close.  When the surgery consent says that surgery can make your eyes dry, this is what they are talking about.  I recommend being assessed by a cornea specialist to determine how this weakness is affecting the heal of the corneal surfaces which will tend to dry out under these circumstances.  Some degree of motor nerve recovery can take place over the course of many months but it is generally not a complete recovery. The means that the measures that will be recommended by the cornea specialist are very helpful.

Although nerve injury is possible, it is extremely unlikely. Although it is difficult to assess based on the pictures, excessive skin does not appear to have been removed either. It may be due to scarring. It should resolve with massages and stretching as suggested by your surgeon. Your blurry vision is likely due to the lids not closing properly and the eye becoming dry and irritated as a consequence. Eye drops used during the day, and lubricated ointment at night may help but I suggest youyou’re your surgeon or generalist for them to examine and possibly recommend further work-up by an ophtalmologist. Best of luck!

At 2 months there is still a fair bit of healing left to go. It is likely that this will resolve over the next 3-4 months. Massaging can be good, but every 15 minutes probably isn't. You may be causing more irritation than you are helping by massaging so frequently. 5 minutes twice a day is probably enough. Be Patient, it will most likely turn out okay. Good luck.

Over the internet there is no way to examine you. Best to obtain a few in person second opinions..//

It does not appear to be an excessive removal of skin from your upper eyelids.  There could be some scarring of your levator muscles to the skin and simple stretching exercises usually take care of this problem.  It is unlikely that this is due to nerve damage.  Your blurred vision may be due to dryness of the corneas.  Use natural tears twice a day.