Is This a Permanent Disfigurement with the Lower Eyelid? (photo)

Had lower eyelid surgery 3 weeks ago. No stitches. Did through the inside. I noticed that only my left eye is having an irritation with the contact lens due to edge of the lens rubbing against the lower eyelid. I also notice that my left eye is bigger than my right eye a bit more than usual after the surgery. Went back to surgeon & he said nothing seems wrong. He never mentioned about taping or massaging. I had such nice eyes & now I am so scared & sad esp. with not being able to wear contacts

Doctor Answers 6

Eye change after blepharoplasty

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Thank you for your question about the change in your left eye after blepharoplasty.

  • Your photos show that before blepharoplasty your left lower lid had 1 mm of 'scleral show', ie white below the pupil Now it has two mm. The left lid margin looks swollen. See your surgeon now - if scar is forming inside the eye, it needs treatment. If s/he can't treat this, see a Board Certified Plastic Surgeon or Opthalmologist
  • Also there is 1 mm more elevation of the upper lid. No blepharoplasthy was done here. You need an endocrinologist to assess you for thyroid disease. Hope this helps. Best wishes.


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Lower eyelid retraction and scleral show status post transconjunctival blepharoplasty is often treatable with timely massage, appropriate support tape, useful cool packs and possibly dilute steroid injections (when indicated and when performed correctly for the right reason).  Please return to your surgeon ASAP!

Your lower eyelid is pulled down from normal position by scar tissue.

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It appears that your lower lid position is below the "normal" position of the opposite lower eyelid because of scar tissue (perhaps from minute amounts of bleeding/bruising) on that side. This should be managed aggressively to prevent the lid from staying in this incorrect location.

I would suggest that you return immediately to your surgeon, who should be showing you upward stretching exercises, or even using topical anesthetic and skin hooks to pull and stretch out the abnormal scarring. If this is allowed to persist, surgical revision may be necessary.

I must confess I'm a bit surprised you underwent surgery in the first place, as I cannot see excessive skin laxity, wrinkling, or fat pad protrusion in your pre-operative photographs. What were you trying to change with your "nice eyes?"

You may need to seek consultation with another ABPS-certified plastic surgeon if your own surgeon continues to say nothing is wrong. Best wishes! Dr. Tholen

I Recommend a Second Opinion With an Oculoplatic Surgeon.

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What impresses me is that in addition to a slight lower eyelid retraction, your after picture suggests also upper eyelid retraction. You indicate that you only had lower eyelid surgery. So something is up. Occasionally we see patients who just happen to develop thyroid eye disease at the time of eyelid surgery. The surgery does not cause the thyroid eye disease. The relationship is coincidental but very confusing. Thyroid testing is not routinely performed for preoperative clearance. An oculoplastic surgeon has the necessary training, skill, and experience to assess you and determine if in fact you have evidence of upper eyelid retraction. The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their web site that will help you find a highly qualified surgeon in your area.

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

Retraction and lower eyelid lift

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Hi! It appears that you have some mild retraction of your left lower eyelid. This is not as common with the "inside" approach as it is with the "outside" approach. The good news is that you are still in a stage of healing when you can positively impact this condition. My recommendation is to see your surgeon and ask him to do a careful exam to see if he/she can feel any tethering or scar tissue on that side. Upward massage, lid taping, and supportive measures for the next 2-3 weeks can make a big difference! Best of luck!  

Jess Prischmann, MD
Minneapolis Facial Plastic Surgeon

Is This a Permanent Disfigurement with the Lower Eyelid?

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I would recommend that you return to your plastic surgeons office. Your issue could be temporary and due to some swelling but I will usually start patients with some vertically oriented massage to help reposition the lower eyelid and eyedrops to prevent drying of the eye. It would be unusual to have long-standing lower eyelid malposition after a transconjunctivalunctival approach but it is possible and massage should help reduce the risk. However, before taking this advice, please consult with your plastic surgeon for their recommendations. I hope this information is helpful.

Stephen Weber MD, FACS

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.