Asian Eyelid Surgery - blink muscle damage or over excised skin? Incomplete closure. My surgeon won't respond. (Photo)

Question

I am 2 months post asian eyelid + epicanthoplasty. My eyes won't close completely at night and my blink is incomplete. Eyes are very dry and irritated. Can't wear contact lens :( My optometrist has prescribed Restasis, drops and ointments to protect my eyes. Closure has improved a little since last month, but still worrying. My surgeon keeps dismissing my concerns & says it will resolve. No doctors are willing to refer me to an Oculoplastic surgeon for 2nd opinion. Pls help. Photos for reference.

Karthik Ram, MRCS, DNB · Answer

hello, Thanks for your query. From the photos you have mild degree of lagopthalmos. Do not worry the eyelid skin tends to stretch over time and it will get corrected in a few months. Followup regularly with your operative surgeon.

Amiya Prasad, MD · Answer

Thank you for your question. You are describing you’re 2 months post op after undergoing Asian eyelid surgery and epicanthoplasty, and having difficulty with eye closure. dry eye, and irritation to the point you can’t wear your contact lenses. Your eye doctor prescribed Restasis and lubricating drops. You’re stating your doctor is not taking this very seriously, and is being dismissive. You are questioning whether or not you should be seen by an oculoplastic surgeon for further evaluation.
I can share with you a perspective as an oculoplastic surgeon for situations like yours in the absence of a physical exam. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Asian eyelid surgery is a very significant part of my practice. I also specialize in revision eyelid surgery, a wide range of both the non-incisional and incisional techniques, and epicanthoplasty, so I’m quite familiar with your type of procedure. 
There are certain issues important in a situation like yours that do deserve attention, and it looks like you are on the right path. It is generally well accepted in the oculoplastic community, surgeons specializing in eyelid surgery who also trained in eye surgery in ophthalmology, that eyelids that look good function well. There is also a perception in the general plastic surgery community to some degree that it is a norm to have difficulties in eye closure and dryness after surgery.
To give you some clarity as to how I advise my patients, or at least a perspective, I explain that any surgery around the eyes can temporarily cause some degree of dryness. This is more of a function of the possible reduction of baseline tear production from any procedure occurring around the eyes. For my contact lens patients, I often say make sure, particularly if you have a very high prescription where you really need to wear contact lenses, to wear them with a lot of lubricating drops and see if you can tolerate that. Also provide yourself with lubrication of the eyes with artificial tears. 
Since you are having a challenge with eye closure you also describe as improving since the previous month, this is particularly important, but not so much during the day. We would describe this as forced blinking where you’re awake and aware, and you blink your eyes to compensate for dryness. That is also important to also be aware of since your eyelid opening opens passively at night when you sleep. I often recommend when a patient comes in for a consultation or second opinion for difficulty of eyelid closure, the use of an ophthalmic lubricating gel at night to allow for proper lubrication, because when the eyelid is gapped, there will be evaporation of tears that would result in more irritation. 
I also recommend the typical dry eye management strategies, not only lubricating drops, but also to put a humidifier in their room when they’re sleeping to add some moisture to the ambient air for the management of the eye exposure. 
The question now is if there is a relative skin shortage, or if this is a manifestation of just short-term muscle or the nerves being affected that impact eye closure. It is difficult  to make that determination based on the photos you submitted. It is not unusual for someone to have these symptoms at this point, even if  there might be a slight skin shortage, or some degree of nerve dysfunction after this surgery. Over the course of several months, the area does get better, and function does improve. 
The key of this strategy whether you see an ophthalmologist or an oculoplastic surgeon is to protect the eye, vision, and the health of your eyes. I think your surgeon being submissive may just be a challenge in communication skills, and anticipating this would likely resolve without any additional surgical intervention. For now, I generally tell my patients who come for a second opinion like yourself to make sure your eyes are properly lubricated, even if you have to temporarily forgo wearing contact lenses. You need to allow about 6 months to a year to let the eyelids heal before considering any additional revision surgery. Again this is in the absence of a physical examination, but if you are able to manage your dry eye symptoms, be proactive, even if you don't have the symptoms, to continuously lubricate your eyes, I think you’ll be able to get through these next few months without needing intervention at this time. 
Follow-up with your surgeon, and  work with your eye doctor in managing the lubricating issue with the dry eye symptoms, eye closure and hopefully you can get through this without needing any additional surgery. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Asian Eyelid Surgery - blink muscle damage or over excised skin? Incomplete closure. My surgeon won't respond. (Photo)

Answers (2)

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Asian Eyelid Surgery - blink muscle damage or over excised skin? Incomplete closure. My surgeon won't respond. (Photo)

Answers (2)

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Everything you need to know about Double Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.