Ectropion after blepharoplasty. (photo)
Doctor Answers 7
You need expert care for this. Stop letting your original surgeons whittle on your eyelids.
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.
There is hope in restoring your lower eyelid, but you will need an oculofacial/oculoplastic revision eyelid specialist
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.
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