I Have Scar Tissue That Has Formed Under my Eyes After Eye Bag Surgery. It Has Caused my Eyelid to Sag? (photo)

My question is wherever I should get a injection of cortisone into the scar tissue to loosen it up like suggested by a plastic surgeon I visited. Is it safe?

Doctor Answers 2

Revison surgery is needed right away to protect your eye. You have a combination of ectropion and lower eyelid retraction

As a specialist in oculofacial plastic surgery for over 20 years, I have to say that a photo like yours indicates this should be addressed sooner rather than later.

The photo shows the left lower eyelid pulled down very significantly. It’s clear that you have a condition called ectropion, which is the lower eyelid turned from the eye. I can also assess from your photo that you have lower eyelid retraction which means that eyelid is pulled down. With the absence of a physical exam, based on your photos you have a combination of lower eyelid retraction and ectropion.

Ectropion and lower eyelid retraction is not unusual and can happen. However, in your case, it is important that we protect your eye.  With your eyelids pulled down so much, there is a risk of irritation and infection. Your doctor is right that a cortisone injection will stop the scar tissue formation that caused the tension and pulling. But I would like to add that you have a relative shortage of skin which adds to the tension of the outer corner of the eyelid. This area is called the lateral canthal tendon and you might need a revisional eyelid surgery to protect this area.

Patients with these types of issues can be managed with topical lubrication even if their eyelid is retracted or they have ectropion. Cortisone injections and other conservative therapies such as a massage can also be done. However, an advanced procedure is necessary to protect the eye.  I hope that was helpful, I wish you the best of luck, and thank you for question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

I wish that injecting the eyelid with steroid would fix the lower eyelid.

I think it may be worth a try.  The questions is when was surgery?  You are not bruised so I assume you are at least 10 to 14 days out from surgery.  You left lower eyelid surgery has permanently or temporarily damaged the nerves supply the small muscle in the lower eyelid that helps hold the lower eyelid against the globe.  This condition is formally known as ectropion.  However, do to the fact that you developed ectropion as a result of lower eyelid surgery you situation will be complicated by a contracting scar in the lower eyelid.  Taping the lower eyelid up at the side and also performing lid massage can help keep the lower eyelid from healing in a worse than necessary position.  If the motor nerve function returns, then over time the eyelid will resume a more normal position.  If the motor nerve function does not recover in 6 months, then you will need some time of reconstructive procedure to make this better.  Because the lower eyelid malposition can contribute to a dry eye, you might also benefit from seeing your general ophthalmologist.  

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

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