Ectropion after blepharoplasty. (photo)

I had an upper and lower blepharoplasty in March 2014. I immediately developed an ectropion on my left lower lid. I have since had two revisions (the first with the original surgeon, the second with his partner). Both failed. Do I have any hope of getting this corrected (attached pic was taken today)? I want to go back to the surgeon but I have become disheartened based on the previous revision failures and I am afraid of making it worse.

Doctor Answers 7

You need expert care for this. Stop letting your original surgeons whittle on your eyelids.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You should not let these surgeons attempt to repair this eyelid with a skin graft.  That is not state of the art repair for this type of lower eyelid malposition.  Please down load my free ebook on eyelid surgery cited below and study the sections of reconstruction lower eyelids after blepharoplasty.  The goal here is a correction that not only fixed the lower eyelid malposition but also achieves the original cosmetic goals of improving your appearance.  I assure you a skin graft will disfigure you as much as this lower eyelid does. Standard lateral canthal tightening surgery will only make your situation worse.  For the past 20 years I have developed and perfected a definitive approach to correcting eyelids like yours.  The reconstruction is achieve by vertically lifting the cheek onto a hand carved orbital rim implant that is used as a felting material to support the weight of the cheek.  This removes the weight of the cheek from the lower eyelid, which is a significant factor in the eyelid malposition.  The lifted cheek also recruits needed skin and soft tissue for the lower eyelid.  The shape of the lower eyelid is controlled using a graft of hard palate from the rook of the mouth.  I am sorry that this type of work is not available close to where you live.  I have patients who fly in from all over the world to Los Angeles for this type of correction.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

There is hope in restoring your lower eyelid, but you will need an oculofacial/oculoplastic revision eyelid specialist

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question. You’ve submitted single photo and describe a situation where you underwent upper and lower eyelid surgery in 2014. You had immediately developed ectropion, or the eyelid turning away from the eye. You underwent two revision surgeries: one by the original surgeon and one by the surgeon’s partner. You still have ectropion and ask if it can be corrected.

I can certainly give you a lot of guidance on this question, a little background: I’m a Board-certified cosmetic surgeon, and a Fellowship-trained oculofacial, plastic and reconstructive surgeon. I’ve been in practice in Manhattan Long Island for over 20 years, and revision eyelid surgery is one of the major areas of my practice for which people come to me from around the world. One of the most common problems I deal with is a problem exactly like yours. I’ll give you a little framework for the basis of your situation, at and what can be done for someone like yourself.

To understand lower eyelid surgery and lower eyelid position, we always have to go back to some basic anatomical facts. The lower eyelid can be deceptively complex. The lower eyelids in many ways is like a suspension bridge, so there are critical elements that keep the suspension bridge up: the tendons attached to the muscle, the balance of the skin in the front and back, the tissue between the skin called the conjunctiva, and the back of the eyelid that is the part of the support system, so the support is like pillars.

Very often when lower eyelid blepharoplasty is performed from the outside, when fat is removed, this system of support is compromised. In addition, when skin is removed in the effort to reduce and improve wrinkles, then there is actually a skin shortage. In your situation, without the benefit of a physical examination, I can reasonably conclude that there’s opportunity to restore the anatomy and position of the lower eyelid.

It’s critically important that lower eyelid position be restored because it’s not just about the aesthetics, but also about the health of the eyes. Proper eye function requires the continuous lubrication of the surface of the eye with tears. When the eyelid is everted away, the natural distribution of tears is compromised.

There are options to help you improve your outcome. I think what you need to do, and with due respect to the doctors who tried to help improve your appearance, you may want to consider getting an additional opinion by a oculofacial plastic surgeon who does a lot of revisional surgery. Many years ago in my practice, I made this decision to focus on a lot of cosmetic oculofacial and facial aging issues. It is almost specialty within oculoplastic surgery in the way I work. We have to address not only the medical issue of getting the eyelid in place, but also the cosmetic issue of optimizing a result so they look very good, and so there is often a combination of technologies applied, whether lasers, platelet-rich plasma, or regenerative medicine. I think it’s important for you to be really comfortable with a doctor who is going to help you with this procedure, who is a revision specialist, but understand there is hope that something can be done. It’s not going be a short journey, but it will likely lead to a better outcome than what you’ve dealt with the last couple of years. I hope that was helpful, I wish you the best of luck. Thank you for question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Ectropion repair

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Repair of ectropion is a very challenging procedure.  You need a proper diagnosis, to figure out if you have scar tissue buildup that is pulling everything down or too much removal of skin that is pulling it down.  There is always a possibility of a very relaxed lower eyelid that needs to be tightened on the side call canthopexy.  An oculoplastic surgeon or a facial plastic surgeon who has experience with ectropion repair should be able to help you.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Ectropion after lower blepharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
From the looks of your photo, you likely have scarring pulling down the eyelid, which really means you are short on skin in this area. If previous attempts at fixing it only involved tightening the eyelid, they were destined to fail.  See an oculoplastic surgeon in your area. You may require a skin graft to lengthen the eyelid and allow it to return to a normal position.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Ectropion after blepharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is definitely hope of correction! An Oculoplastic surgeon who is experienced with eyelid malpositions after blepharoplasty would be the type of surgeon to help you. Corrective surgery would be accompanied by some swelling and bruising, but you should have an immediate improvement in the position of the eyelid against the eye. If there is a deficit of skin, the skin may be re-arranged to fill in the vertical deficit. Best wishes for resolution of your ectropion problem.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Ectropion of lower eyelid

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is hard to tell based on your one photo. I would recommend you see a board certified opthal-plastic surgeon for a second opinion or a plastic surgeon with extensive experience with eyelid surgery. At the time of examination, a plan can be recommended.

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

Ectropian following blepharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Tough problem obviously. Might be worth a trip to see a seasoned oculoplastic surgeon like Dr Glen Jelks.  He is in Manhattan.  Best wishes

Craig Harrison, MD, PA
Tyler Plastic Surgeon

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.