Corners of my eyes are hidden below upper lids after lower bleph creating an undesirable look? (Photos)

Question

8 days after lower bleph. Stitch in the outer corners of the eye (not sure of the correct term maybe canthopexy?) has caused the corners of my eyes to be hidden or tucked under my upper lids. It makes my upper lids look a bit pulled down and has created creases at the sides of both eyes. Can this be tweaked?

Daniel Ezra, MD, FRCS · Answer

Its very difficult to say based on the photo as the quality is not great. What is certain is that things will improve as the swelling settles. I do of course understand you anxiety and what I am not clear about is whether you have some webbing due to a poorly formed lateral canthus. This is quote a common problem that I see after lower lid blepharoplasty where the principles of canthal reformation have not been followed. Even in this scenario, it is a fairly straightforward thing to fix, so don't worry too much and I hope things settle down well for you.

Kenneth D. Steinsapir, MD · Answer

That you are seeing is a tug of war between the healing eyelid and the lateral canthal support stitch made by your plastic surgeon.  Without the support stitch, these eyelids would be sagging down.  Unfortunately the transcutaneous incision weakens the motor nerves that supply the orbicularis oculi muscle that keeps the eyelid margin against the eye.  That is why your surgeon did a lateral canthopexy.  This will soften as it heals.  The redness will eventually fade.  I do think that you may experience chronic dry eye do to the post surgical dysfunction in the lower eyelid.  This sometimes resolve sufficiently and in some cases reconstructive surgery can be necessary.  What you need know is supportive care in the form of dry eye management and tincture of time.

John J. Martin, Jr., MD · Answer

There is swelling in the outer corner of both the upper and lower lids.  This will sometimes cause the upper lid to hang down.  As the swelling resolves this should flatten out.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Due to your lower blepharoplasty and canthopexy you are having soft tissue swelling to the corners of your eyes that is resulting in this hooded appearance.  As your tissues continue to heal you should see steady improvement in appearance until this overhang no long occurs.  I know waiting is difficult but allow a few more weeks to pass to see visible improvement.

Mark Beaty, MD · Answer

At only 8 days following an eyelid surgery it is common to see this effect.  The purpose of the canthopexy is to provide additional support for the lower lid and usually a slight overcorrection is performed which will relax over a few weeks.  Combine this with expected post operative swelling and that explains the change in appearance you are seeing.  This will go away with a bit more time.

Roger Amar, MD · Answer

Generally immediately after a lower lid blepharoplasty there is a deep oedema which marks a temporary slight scleral show.Waiting is difficult for any patient, in your case, the receding of the swelling will give you good hope every day.

Byron A. Long, MD · Answer

You are very early in the healing process. Your surgeon hopefully used a dissolving suture during the canthopecy so this should lesson over about a month depending on the suture removal. Also you have some inflammation of the eyelid margin that could be helped with a steroid drop from your surgeon. Hang in there.

Karen Quigley, MD · Answer

When I do this surgery I use a deep suture to anchor a muscle flap to the bone at the level of the lateral canthus. This suture makes and indentation and causes the upper eyelid skin to look like it hangs over. This is a temporary phenomenon and will go away when the suture dissolves and the edema from doing this gets better. From what I see in your photos it looks like you will have quite a nice result.

Douglas McGeorge, FRCS(Plast) · Answer

You still have swelling of the eyelid tissues with stiffness of the scars, which creates this pulled look.  Both improve with time, reducing the appearance you are concerned about.  Proper assessment is best left until the scars have matured.

Corners of my eyes are hidden below upper lids after lower bleph creating an undesirable look? (Photos)

Answers (9)

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