Follow-up after Blepharoplasty and Micro Fractional CO2 Laser Resurfacing
It’s important to work closely with your doctor to prevent the lower eyelids from pulling downwards. The CO2 laser is effective in reducing wrinkles (I routinely use a MixtoSX Microfractional CO2 laser in my practice) however the heat from the laser can cause the skin to contract significantly. It’s difficult to provide a complete diagnosis without an examination,
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.
CO2 and Lower eye lid surgery
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
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.
Early Post-Operative Ectropian
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.
Possible ectropion following lower Bleph/CO2
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.
Recovery After Eyelid Surgery
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.
CO2 laser takes longer to heal
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.
Patience and continued care are your best option
Without knowing exactly what surgery was performed it is hard to say what the best course of actionis. We are assuming that uyou have used a board certified plastic surgeon. The tightness is from the laser and the lid drooping is fromtension on the lid which should resolve . It is really too early to tell what will happen. The combination of surgery and laser treatment is a longer healing period. All the best.
Keep eyes lubricated and see an ophthalmologist
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.