I had a transcutaneous lower bleph 4 years ago which caused about 1mm of sclera show and hollowed round eye appearance? (Photos)

Why are my lower lids perfect first thing in the morning? After awhile they drop back down a bit, and I have more of a trough under my eyes. What does this suggest about the best treatment options for me? I do not think I can do any major surgery at this point.

Doctor Answers 10

Eyelid ectropion-retraction after lower blepharoplasty

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You do have lower eyelid ectropion/retraction, which unfortunately can happen after transcutaneous lower blepharoplasty. You should be candidate for lower eyelid ectropion/retraction surgery. See an oculoplastic surgeon. See link below too.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

There is no simple fix for this.

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Having a "tuck" to tighten the lower eyelid will not fix the inferior scleral show.  It generally actually worsens the situation.  That is why more complex repairs are necessary.  We are fighting gravity, scar tissue, and missing tissue.  The repair is both functional and cosmetic.  My free ebook cited below has much more information regarding these procedures.

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

Filler first for retracted eyelid after Blepharoplasty

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Lower lid complaints begin because of inadequate cheek bone serving as the leading edge in this area. If inadequate or reduced due to age the fat pads and skin appear dominant. This is why fillers over the cheek and lower lid bone have replaced a lot of eyelid surgery. Most traditional surgeons remove the fat creating MORE loose skin, that is removed, leading to what you don't like.

Before further surgery most of us have been able to raise the eyelid significantly just using fillers over the cheek and under the eye. Each time a surgeon operates on your eyelid the muscles become weaker that hold the lid up. You may eventually seek a SOOF lift with canthopexy but try filler first.

good luck,

Smythe Rich, MD
Facial Plastic Surgeon

J. Smythe Rich, MD
Columbia Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews


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A canthopexy where the lateral corner of your eyelid is lifted up slightly can help correct the scleral show and roundness.  This can be done as an office procedure under local anesthesia.  Best wishes, Dr. T

How do I correct this scleral show and ectropion from a lower lid blepharoplasty?

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You are correct with your assessment, but the solution is not a simple one. You say you cannot undergo surgery at this time. I would suggest trying a filler in the tear trough and hollow of the lower lid. this may give you some support and mild to moderate relief. Also a minor surgery you could have is a canthoplasty, which  will help, but not be completely corrective.

The problem is in your case appears to be lack of tissue If this continues to bother you, and if you start getting dry eyes, you will need to have tissue grafted into the area from your upper eyelids. In the meantime, try Sustain gel drops for dry eyes.

Thank you for your question.

Droopy eyes?

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You are correct. You have lower lid scleral show without ectropion. This can be corrected,  but only with a surgical procedure called a canthoplasty. This requires release of the lateral (outside) canthus and suturing of the lower lid to a higher spot on the bone. This should correct the deformity but will require you to go to sleep with the surgery. The good news is that this will likely help the tear trough as well. Thanks for your question, good luck. 

Erez Sternberg, MD
Jacksonville Plastic Surgeon
4.9 out of 5 stars 33 reviews

Rounded eyes after lower blepharoplasty

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In the mornings, you probably have a bit of natural swelling from lying down at night - that natural puffiness in the mornings fills in and lifts the lid a bit. Fillers injected into that area would give a little lift. The surgical answer would be a lateral canthoplasty to elevate the lateral lid contour. This type of revision could be done in an office setting with minimal down time. Either way, be sure to have an Oculoplastic surgeon perform the filler injection or surgery. There are risks of fillers in the periocular area and you need to have someone who is very familiar with the anatomy and potential risks in that location.

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

Lower lid hollowing

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I would try some HA filler into the hollow in the lids.  THis will help fill in the hollow and will usually add some support to the lid so it may actually lift up a bit. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Eyelid Malposition

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Lateral rounding and scleral show can be seen after lower eyelid blepharoplasty.  The correction is a relatively simple procedure that can be performed under local anesthesia.  The procedure takes about twenty minutes per eye and results are permanent.  Recovery is short with minimal bruising and swelling. 
Best of luck.
Dr. Garcia

J. Phillip Garcia, MD, FACS
Jacksonville Facial Plastic Surgeon
4.8 out of 5 stars 45 reviews

I had a transcutaneous lower bleph 4 years ago which caused about 1mm of sclera show and hollowed round eye appearance? (Photos)

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Best results are with a surgical canthoplasty/pexy and nano fat grafting. But you can try HA fillers to tear troughs like Restylane Silk or Belotero- Balance 

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.