Ectropion or lower lid retraction after blepharoplasty? (photos)

Thank you for your question. You submitted some photos and state you had lower eyelid surgery, which resulted in your lower left eyelid not sitting flat against your eye. You want to know whether this is ectropion or retraction, as well as what you can expect before moving forward.To give you a little more about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. Cosmetic oculofacial plastic surgery is a major part of my focus, and along with that, revision of cosmetic eyelid surgery. Patients who come to us from all over the world for revision eyelid surgery often exhibit problems similar to yours — eyelid retraction — so I can certainly give you some guidance on this issue.After reviewing your photos, it is clear that the margin of the eyelid is positioned slightly away from the eyeball, which is technically referred to as ectropion. When it comes to ectropion, there are many degrees of severity, and fortunately this is considered very minimal ectropion. With regard to determining eyelid retraction, I think it is important to just compare the two eyes and your eyelid position before surgery.Ectropion can occur when a doctor performs lower eyelid surgery from the outside of the eye via the transcutaneous approach. During a transcutaneous lower eyelid surgical procedure, an incision is made beneath the eyelashes, the fat pockets are addressed, excess skin is trimmed, and then stitches or sutures are placed in order to close the eyelid. Such a procedure can cause either a slight or significant shortage of skin, and can cause dysfunction in a muscle called the orbicularis oculi. This means that the muscle that helps keep the eyelid positioned properly against the eyeball can experience a combination of swelling and neuropraxia - a temporary reduction of the muscle tone from the nerve fibers that go into the muscle. Oftentimes, people with more severe ectropion require immediate operation.In your case I think you still have some time. In my practice, when people come to me with these types of concerns, I first advise them to use lubricating drops to keep the eyes moist, as it is very important to maintain the health and function of the eye. I would also recommend a massage, however this is something that you will need to discuss first with your doctor. The purpose of the massage is to bring the eye into the proper position, release scar formation, and to allow the eyelid to gently be pushed into the proper position. With the help of lubricating drops and gentle massaging, mild ectropion like yours usually gets better.Ultimately, as long as you are happy with the position and appearance of your eyelids, then there is really no need to go into the semantics of what defines ectropion or retraction. I think looking at the bigger picture — deciding if you like how the other eye looks and considering how you can go about making the left eye look more like the right eye — is more beneficial. Considering that it’s only been two weeks, there is a good chance that your eyelid will move back into the proper position and that you will get a more symmetric outcome.I recommend that you talk to your doctor, discuss other options such as lubrication and massage, and move forward from there. With this very slight amount of ectropion, I think the odds are in your favor. In fact, I’ve seen cases much more serious than this, and even in those situations, the eyelid did eventually move back into the proper position.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Hi cringe,Thanks for your question and good photos. You have the slightest bit of ectropion more so on the left than the right side. It is hard to tell for sure unless you have your preoperative pictures. It is perfectly normal to have this especially after only two week after surgery. I would recommend massage but please check with your surgeon before. Your tissue is also likely swollen and the scar maturation process takes at least 6 weeks before the scar can tolerate normal pulling. I do not see lower eyelid retraction. So far I would say that your result is as expected. This issue should correct itself and you should see gradual improvement. I would take a picture weekly to see the changes that you will likely not see daily.Good Luck,Carlos Mata MD, MBA, FACS

You have slight lower eyelid ectropion after lower blepharoplasty. It is early in the healing period and likely to improve by itself. Do squinting exercises.  If the problem persists after 3 months, see an oculoplastic specialist.