Shortened upper lid and eye after lower bleph (photo)

Question

Hello, my lower bleph lead to something I was never told would be a risk. My upper lid is hooking down and around. My lashes are facing downwards and my lateral sight is shortened. My eye is rounder, shorter and looks distorted. Is this fixable? How and where? Any help is greatly appreciated

Kenneth D. Steinsapir, MD · Answer

There is no substitute for an in person, detailed consultation. What I am about to discuss here is based on a career of repairing these types of eyelids and your photographs. However, a photograph is not a detailed in person consultation. Based on your statement that you were advised that there was no risk of lower eyelid retraction, I assume you had a transconjunctival lower eyelid blepharoplasty. It is true that this approach is much less likely to cause lower eyelid retraction but the risk is not zero with this approach. I see that your surgeon had you tape which likely mitigated so of the retraction that might have result from this surgery. Things that cause this include excessive bruising or even cautery during surgery. The lateral canthus needs to be repositioned but that is only part of the what is needed for your reconstruction. In all likelihood, your lower eyelids needed to be supported to restore these eyes. Your upper eyelid position seems to have been affected but this may simply reflect the downward pull of the lateral canthus. Be highly skeptical of surgeons who simply recommend a "lateral canthoplasty," "lateral canthopexy, " or propose "putting a stitch in." These simple fixes will not get the job done and can use up what is needed to actually repair this injury. For the same reason, it is unlikely your current surgeon can fix this issue. Save yourself heart break by finding a specialist for this. It is worth traveling for this.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures. I'm sorry that you are having to deal with this. It appears that you have some internal scarring of your lower lid. This is termed ectropion. Depending on where you are in the healing process dictates what measure should be taken. Early in the healing process and tissue massage can be effective. Occasionally an injection of dilute steroid in addition to time and massage can also be effective. If this has been long-standing, then surgical correction is necessary. Typical requires suspending the lower lid in the right position. If the lower eyelid is shortened, and requires additional tissue in the form of a graft, then that can be accomplished either with tissue from the upper eyelid or inside the mouth, depending on where the shortage lies prior to surgery. It is best to address this with your operating surgeon if she is comfortable with this type of repair. If not then it's, more than reasonable to seek advice from an expert in revision blepharoplasty specifically ectropion repair. Best wishes!

Douglas McGeorge, FRCS(Plast) · Answer

Rounding is well recognised after blepharoplasty. The issue can be addressed with lifting and tightening the outer corner - a canthopexy. 
The issue may improve as the tissues soften but treatment is something that your surgeon should be able to arrange.

Shortened upper lid and eye after lower bleph (photo)

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