2 years after upper and lower blepharoplasty I have chemosis and drooping eye, what can I do?

Question

I had upper&lower bleph done 2 n half years ago. After the op I had chemosis in right eye, given drops. Eyes looked great for 1.5 years tiny minor chemosis when over tired or after party. Was put on steroid drops, did nothing to help. At Christmas (1.5 after initial op) my eye got very cross! Inflamed with fluid under conjunctiva. More steroid drops given. No better. It's been 8 months of pain and soreness. Now my eye droops. I'm doing higene, and lubricants daily. No alcohol, or going out

Kenneth D. Steinsapir, MD · Answer

I do not recommend returning to the same surgeon for this problem.  If they have not figured out that they created a big problem for you by now, they are likely to just tell you that you look M-A-R-V-E-L-O-U-S.  I think you have figured out that you are in trouble.  The lower blepharoplasty injures the motor nerves to the lower eyelid muscle that helps hold the lower eyelid against the eye.  This is not ectropion.  This is post lower eyelid surgery malposition from vertical and horizontal inadequacy.  There is inferior scleral show that is a bit worse on the right side.  Performing lateral canthoplasty (known in some circles as putting a stitch in) will not fix your issues and can make the problem worse.  Thightening the lower eyelid can actually pull the lower eyelid margin into a lower position on the eye surface.  That will make your problems much worse rather than better.  The fix is generally technical and specialized.  You need skin and soft tissue recruited into the lower eyelid.  Skin grafts are ugly.  For that reason, it is best to vertically lift the cheek.  To hold the cheek in place, I use a hand carved ePFTE rim implant that supports the weight of the cheek.  To control the lower eyelid shape, tissue from the roof of the mouth is used behind the eyelid.  Typically the two sides are repaired in separate operations separated in time by at least 1 week.  This repair will protect the eye from drying, make it comfortable and likely solve the problem with chemosis which is related to eye drying.  
The upper eyelid ptosis was also caused or worsened by your upper eyelid surgery.  Study my links below for more information.  This is fixable but requires more knowledge and skill than demonstrated by your original surgery.

Mehryar (Ray) Taban, MD, FACS · Answer

Discuss with your surgeon first. It appears you have lower eyelid retraction and ectropion with likely incomplete eye closure leading to dry eyes and chemosis. See an oculoplastic specialist for evaluation.

Adam Tattelbaum, MD · Answer

Sorry to hear you are re having any issues. From these photos you are having some pulling of the outer lower lids. This can expose the internal lining of the eye leading to swelling or chemosis. The lower eyelid has a tendon the inserts into the corner of the eye. In most cases this tendon can be tightened and or elevated. You will need to discuss with your PS to see if that is right for you.Best wishes.

Arthur Dean Jabs, MD, PhD, FACS · Answer

It appears that your eyelids are not in the right position. This can happen due to age and relaxation of the structures that attach the lid to the bone. It can also happen after surgery due to scar formation and shrinking of the soft tissues. 
It appears you need a canthoplasty (a procedure to move the attachment of the lid up and cover more of the eyeball. If the lower lid is not mobile you may also need release of the scar and possibly a graft to act as a spacer.
Talk to your surgeon don't be afraid to seek a second opinion
Best of Luck
Dr. J

Damon B. Chandler, MD · Answer

Sorry to hear about your current issues. It seems from your photographs that you have Ptosis of the upper eyelids (drooping due to muscle weakness) and retraction and laxity of the lower eyelids. Both of these issues would require surgical correction to fix. Have you discussed this with your initial surgeon??
Ptosis surgery and correction of lower eyelid laxity are very technical and require great precision to have a natural, beautiful outcome.  Few surgeons are masters at these conditions -- especially in cases like yours where there has been a prior surgery. Even in the best hands this surgery can be quite tough to achieve perfect symmetry, but I believe you can be improved for sure. After discussing with your surgeon I would make sure to have an in-person consultation with a board-certified, fellowship-trained Oculofacial Plastic Surgeon with extensive experience in ptosis repair and revisional eyelid surgery.  You must avoid any doctors that do ptosis or eyelid surgery part time, they cannot help you, and could make you far worse. I very routinely see patients from great distances to correct this sort of problem after the initial surgery did not turn out as expected. If you are interested, you could let me know and my coordinator could discuss things with you. Best regards.
Damon B. Chandler, MD
Harvard-Penn Trained Oculofacial Plastic Surgeon

2 years after upper and lower blepharoplasty I have chemosis and drooping eye, what can I do?

Answers (7)

Answer: Drooping eyes post op

Answer: Drooping eyes post op

Answer: Chemosis and Drooping Eyelids After Blepharoplasty

Answer: Chemosis and Drooping Eyelids After Blepharoplasty

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2 years after upper and lower blepharoplasty I have chemosis and drooping eye, what can I do?

Answers (7)

Answer: Drooping eyes post op

Answer: Drooping eyes post op

Answer: Chemosis and Drooping Eyelids After Blepharoplasty

Answer: Chemosis and Drooping Eyelids After Blepharoplasty

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Recommended reading

Everything you need to know about Eyelid Surgery

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