Problems Post-Blepharoplasty and CO2 Laser

Question

Two weeks ago, I had CO2 laser combined with a lower lid Blepharoplasty. Eyes are very dry, drooping, and stiff. Recovery has been much worse than I anticipated.  My eyes developed a few ugly scabs which, finally, seem to be flaking off.  But my eyes are still so sore from the tightness. One of my lids is drooping, red, very stiff and doesn't move naturally.
It's pretty bad, although I'm really more concerned about my upper lids.  They are so swollen! My surgeon didn't touch them so I can't understand why I would be swollen there.  I look in the mirror and think I have destroyed my eyes.  I read other people who were back to work in a week.  I wonder what on earth happened to me? Many thanks for any insight.

Richard J. Bruneteau, MD · Answer

Your history suggests that you've had a major surgical procedure on your eyelids with a complicated post-operative course. Since surgery, you've had dry eyes with stiff, swollen, droopy, lower eyelids. These findings suggest the development of an early ectropian. This condition occurs when scarring causes the lower eyelid to pull in a downward direction.This complication can occur with lower lid blepharoplasty when excess skin is removed or the underlying orbicularis muscle loses it's tone. CO2 lasers can also contribute to this problem by causing excessive skin tightening.Although your history is helpful, it's impossible to make a specific recommendation without pictures or a physical examination. It's probably reasonable to start lower eyelid massage at this point. If the ectropian is severe, secondary surgery may also be indicated.It's important to maintain close contact with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses this problem.

James R. Gordon, MD, FACS, FAAO · Answer

Your question is helpful for those considering lower blepharoplasty with skin resurfacing. This combination is an excellent choice for enhancing the appearance of lower eyelids, but can run the risk of making the skin too tight. Fortunately, 2 weeks is not nearly enough time to judge the results. Followup visit should be made for  2-3 weeks after the surgery. Artificial tears can be used to lubricate the eyes. Upper eyelid swelling is not unusual following lower eyelid surgery. Thank you for sharing the question.

Vincent N. Zubowicz, MD · Answer

What you are experiencing is not atypical after CO2 laser resurfacing.  After all, you have received a second degree burn of the skin.  It takes time to heal and 2 weeks may not be enough for you.

	I would be concerned about the lower lid position.  I would recommend that you discuss with your surgeon some repositioning therapy to keep this from becoming a problem that demands and operation for correction. 

	The redness and swelling will assuredly resolve, later than you would like, but still will.  In the mean time, protect the lower lid position.

D.J. Verret, MD · Answer

Recovery after eyelid surgery varies from patient to patient. While most lower eyelid surgery is healed within two weeks, some patients take longer for various reasons. I would definitely talk with your surgeon about what is happening as this may represent normal healing or can represent infection or some other complication.

William Portuese, MD · Answer

C02 laser is a thermal burn to the skin and takes months to recover. Your surgeon should have notified you of this extended healing time. As soon as the scab is healed (approximately two weeks) makeup can be applied. If your eyes are dry, the use of Lacri-Lube opthalmic ointment at night, and Natural Tears during the daytime will help. Patients who undergo blepharoplasty alone, have two weeks of swelling and bruising before returning to work or social activities without visual detectability. The laser extends this healing period longer, but one can use makeup over the lasered areas.

Scott E. Kasden, MD, FACS · Answer

Blepharoplasty is a fairly traumatic procedure for a small, delicate area.  On top of that, the CO2 laser is very very traumatic to the skin.  As you know by now, it will cause redness, swelling (including upper eye), drainage, scabbing, etc.
Either procedure alone may cause the lower lid to droop or lag so that it does not function properly.  As a result, the eye can dry, turn red, get ulcerations.
This does not mean that you ruined your eyes.  Steroid treatments (oral, iv) may help bring down the swelling.  If the skin is no longer oozing, I recommend that you ask your surgeon about using steri strips to suspend the lid into position until the muscles start to work and the swelling resolves.
It is also very important to protect the eye from dessication.  This may mean patching at night and ointments/eye drops at other times.  It is best to coordinate with the surgeon.

Francisco Canales, MD · Answer

The combination of  laser and lower lid blepharoplasty is not  uncommon one in our Santa Rosa plastic surgery practice.  The laser is usually what delays your postoperative healing.  However, your symptoms appear much more severe than the majority of patients I see.  It is not uncommon to have some stiffness of the lower lids and even some retraction so you see some white below the iris of the eye.
Keeping your eyes lubricated at all times is imperative to prevent dryness and potential corneal injury.  I would discuss with your surgeon a referral to an ophthalmolosgist who can examine the present state of your cornea and ensure that no other untoward process is delaying your healing. We work closely with one or two ophthalmologists and they are an invaluable source of help and knowledege for the rare patient that needs to see them. 
In addition, make sure that you have also discussed with your surgeon what the care of your lower lid skin should be at this stage.  The laser is akin to a burn so you need to moisturize it and keep it from any sun exposure right now. Eventually, your surgeon may recommend massage in an upward direction to soften that stiff lower lid. In general, the droop you refer to resolves with time and massage, but in rare cases an operation may be needed for correction.
Hang in there during this dificult time and communicate with your surgeon frequently since this is a time when conditions can still be modified in a positive direction with good postop care.  Good luck in your recovery.

Steven Wallach, MD · Answer

First, swelling in the upper eyelids is very common after ANY surgery around the eyes.  This should improve. The description of your lower lids concerns me. If they are very tight and you are seeing the conjunctiva and your eye are irritated then I suggest you quickly go back to your doctor to be checked out.  You don't want to get into a vicious cycle of dry eyes, possible ectropion and chemosis.
Steven Wallach, MD

Kenneth R. Francis, MD, FACS · Answer

CO2 laser resurfacing of the lower eyelid skin causes a burn. Burns take a few weeks to heal. Your peers that returned to work after a week probably didn't have the laser resurfacing done. Follow your surgeon's instructions and hang in there. They will get better. Good luck!

Robert M. Freund, MD · Answer

Some types of lower lid blepharoplasty will slow the drainage of blood and fluid from the upper eyelid, and this causes the lid to swell. As the swelling in the lower lid improves, so will the swelling in the upper lid.

Problems Post-Blepharoplasty and CO2 Laser

Answers (13)

More Eyelid Surgery Questions

WE SEND PRETTY
EMAILS

Answers (13)

More Eyelid Surgery Questions

How Much Does Eyelid Surgery Cost?

Lower Eyelid Drooping After Blepharoplasty

Swelling After Lower Blepharoplasty

Bloodshot Eyes After Blepharoplasty Surgery

Red, Dry Eyes After Blepharoplasty and CO2 Laser

Stitches Came off 2 Days After Blepharoplasty

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS